Changing the cost of care for chronic myeloid leukemia: the availability of generic imatinib in the USA and the EU

PubMed Central

Padula, William V.; Larson, Richard A.

2015-01-01

Imatinib is an oral tyrosine kinase inhibitor and considered to be the most successful targeted anti-cancer agent yet developed given its substantial efficacy in treating chronic myeloid leukemia (CML) and other malignant diseases. In the USA and the European Union (EU), Novartis’ composition of matter patent on imatinib will expire in 2016. The potential impact on health system spending levels for CML after generic imatinib becomes available is the subject of significant interest among stakeholders. The extent of the potential savings largely depends on whether and to what extent prices decline and use stays the same or even increases. These are also empirical questions since the likely spending implications following generic imatinib’s availability are predicated on multiple factors: physicians’ willingness to prescribe generic imatinib, molecule characteristics, and health system priorities. This article discusses each of these issues in turn. We then review their implications for the development of country-specific cost-effectiveness models to predict the implications for cost and quality of care from generic imatinib. PMID:25814091

Smokers' rights to health care.

PubMed Central

Persaud, R

1995-01-01

The question whether rights to health care should be altered by smoking behaviour involves wideranging implications for all who indulge in hazardous behaviours, and involves complex economic utilitarian arguments. This paper examines current debate in the UK and suggest the major significance of the controversy has been ignored. That this discussion exists at all implies increasing division over the scope and purpose of a nationalised health service, bestowing health rights on all. When individuals bear the cost of their own health care, they appear to take responsibility for health implications of personal behaviour, but when the state bears the cost, moral obligations of the community and its doctors to care for those who do not value health are called into question. The debate has far-reaching implications as ethical problems of smokers' rights to health care are common to situations where health as a value comes into conflict with other values, such as pleasure or wealth. PMID:8558542

Reduced length of stay in hospital for burn patients following a change in practice guidelines: financial implications.

PubMed

Jansen, Leigh A; Hynes, Sally L; Macadam, Sheina A; Papp, Anthony

2012-01-01

The objective of this study was to analyze the financial implications of the implementation of new institutional practice guidelines including greater outpatient care and earlier operative intervention in a provincial burn center. A retrospective review was performed including all patients admitted to the Burn Unit with burns up to 20% TBSA between August 2005 and July 2009, including 2 years before and after the new guidelines were introduced. Daily costs for the burn unit were used to calculate this portion of cost. Length of stay (LOS) was based on actual data and representative clinical scenarios. Two hundred sixty-four patients were included. Mean LOS decreased from 10.3 to 3.9 (P < .01) and 21.0 to 13.3 (P > .05) for nonoperative burns 0 to 10% and 10 to 20% TBSA, respectively. Mean LOS for operative burns decreased from 16.6 to 12.9 and 32.3 to 29.8 days for 0 to 10% and 10 to 20% TBSA, respectively (P > .05). Burn patient management requires significant financial resources, and LOS has a large impact on cost. Given per diem rates of Can$1,663, scenario analysis shows potential cost savings of Can$19,956 per patient for operative and nonoperative burns <20% TBSA. With an average of 66 such patients treated each year, potential annual cost savings are Can$1.3 million. If outcomes are not compromised, earlier operative management and greater outpatient care can translate into significant cost savings. A prospective analysis capturing all costs and patient quality of life is required for further assessment.

Implications of the method of capital cost payment on the weighted average cost of capital.

PubMed Central

Boles, K E

1986-01-01

The author develops a theoretical and mathematical model, based on published financial management literature, to describe the cost of capital structure for health care delivery entities. This model is then used to generate the implications of changing the capital cost reimbursement mechanism from a cost basis to a prospective basis. The implications are that the cost of capital is increased substantially, the use of debt must be restricted, interest rates for borrowed funds will increase, and, initially, firms utilizing debt efficiently under cost-basis reimbursement will be restricted to the generation of funds from equity only under a prospective system. PMID:3525468

Integrated Instrumentation and Sensor Systems Enabling Condition-Based Maintenance of Aerospace Equipment

DTIC Science & Technology

2012-01-01

systems . For some specific sensor requirements in the domains considered here, for example, assessing system behavior and component state in gas turbine ...Cost Objectives. In general , the implication of the suitability and life cycle cost [LCC] driven objectives for integrated instrumentation/sensor system ...section should be considered. In general , the systems engineering approach provided clear benefits in defining user significant IISS system requirements and

C5 palsy after posterior cervical decompression and fusion: cost and quality-of-life implications.

PubMed

Miller, Jacob A; Lubelski, Daniel; Alvin, Matthew D; Benzel, Edward C; Mroz, Thomas E

2014-12-01

C5 palsy is a debilitating postoperative complication of cervical decompression surgery. Although the prognosis is typically good, patients may be unable to perform basic activities of daily living, resulting in a decreased quality of life. No studies have investigated the quality-of-life and financial implications. The aim of the study was to determine the impact on quality-of-life and costs of C5 palsy after posterior cervical decompression and fusion (PCDF). A 2:1 matched retrospective cohort study was conducted at a single tertiary-care institution between 2007 and 2012. Individuals who had undergone PCDF were included. Self-reported: Euroqol-5 Dimensions quality-of-life survey. Physiologic: postoperative change in deltoid and biceps strength via manual muscle testing. Functional: cost of interventions and missed workdays postoperatively. Individuals with postoperative C5 palsy were matched to controls based on age, gender, body mass index, and diagnosis. Demographic, operative, postoperative, quality-of-life, and cost data were collected for both the C5 palsy and control groups, with 1-year follow-up. We reviewed 245 patients who underwent PCDF and 17 were identified (6.9%) with C5 palsy and matched to 34 controls. No significant differences in demographic or operative characteristics were observed between groups. The C5 palsy group had a significantly reduced capacity for self-care in the immediate postoperative (2.0±0.71 vs. 1.2±0.4, p<.001) and long-term (1.6±0.6 vs. 1.2±0.4, p=.004) periods and a significantly reduced capacity for completion of usual activities (2.4±0.7 vs. 1.9±0.6, p=.014) compared with controls. Furthermore, the C5 group had a significantly greater cost of physical/occupational therapy, an increase of $2,078 ($4,386±$2,801 vs. $2,307±$1,907, p=.013). There were no significant differences between groups in the cost of hospital stay, surgery, or other direct or indirect costs. Overall, there was a significantly greater cost ($1,918) for the C5 palsy group compared with the control group ($7,584±$3,992 vs. $5,666±$2,359, respectively, p=.038). This study represents the first quantification of the impact of C5 palsy on patients' quality of life and the associated costs for care. We found that C5 palsy adds a significant burden on patients' quality of life and presents a financial burden to the health-care system. Copyright © 2014 Elsevier Inc. All rights reserved.

Quality and Growth Implications of Incremental Costing Models for Distance Education Units

ERIC Educational Resources Information Center

Crawford, C. B.; Gould, Lawrence V.; King, Dennis; Parker, Carl

2010-01-01

The purpose of this article is to explore quality and growth implications emergent from various incremental costing models applied to distance education units. Prior research relative to costing models and three competing costing models useful in the current distance education environment are discussed. Specifically, the simple costing model, unit…

Cost implications of self-management education intervention programmes in arthritis.

PubMed

Brady, Teresa J

2012-10-01

The purpose of this review is to examine cost implications, including cost-effectiveness analyses, cost-savings calculated from health-care utilisation and intervention delivery costs of arthritis-related self-management education (SME) interventions. Literature searches, covering 1980-March 2012, using arthritis, self-management and cost-related terms, identified 487 articles; abstracts were reviewed to identify those with cost information. Three formal cost-effectiveness analyses emerged; results were equivocal but analyses done from the societal perspective, including out-of-pocket and other indirect costs, were more promising. Eight studies of individual, group and telephone-delivered SME calculated cost-savings based on health-care utilisation changes. These studies had variable results but the costs-savings extrapolation methods are questionable. Meta-analyses of health-care utilisation changes in two specific SME interventions demonstrated only one significant result at 6 months, which did not persist at 12 months. Eleven studies reported intervention delivery costs ranging from $35 to $740 per participant; the variability is likely due to costing methods and differences in delivery mode. Economic analysis in arthritis-related SME is in its infancy; more robust economic evaluations are required to reach sound conclusions. The most common form of analysis used changes in health-care utilisation as a proxy for cost-savings; the results are less than compelling. However, other value metrics, including the value of SME as part of health systems' self-management support efforts, to population health (from improved self-efficacy, psychological well-being and physical activity), and to igniting patient activation, are all important to consider. Published by Elsevier Ltd.

The Implications of Lowering the Cost to Access Space on Airpower

DTIC Science & Technology

2017-06-01

1 The Implications of Lowering the Cost to Access Space on Airpower Major Gabe Arrington School of Advanced Air and Space Studies...2017 DISTRIBUTION A: Approved for public release: distribution unlimited 2 Disclaimer Opinions, conclusions, and recommendations...implications that lowering the cost to access space will have on Airpower. The research conducted used predominantly qualitative research techniques to

National Cost Implications of a Potentional Perchlorate Regulation

EPA Pesticide Factsheets

In this study, a screening level cost assessment was conducted to evaluate the national cost implications of five potential regulatory levels for perchlorate in drinking water 4, 6, 12, 18, and 24 ?g/L.

Railroad cost conditions : implications for policy

DOT National Transportation Integrated Search

2000-05-10

This report, which is posted on the FRA homepage, includes a simplified framework for examining the welfare implications of railroad mergers and competition. It examines the cost implications of mergers and competition over existing rail lines by tes...

The incidence of the healthcare costs of smoking.

PubMed

Cowan, Benjamin; Schwab, Benjamin

2011-09-01

Smokers earn less than non-smokers, but much is still unknown about the source(s) of the smoker's wage gap. We build on the work of Bhattacharya and Bundorf (2009), who provide evidence that obese workers receive lower wages on account of their higher expected healthcare costs. Similarly, we find that smokers who hold employer-sponsored health insurance (ESI) receive significantly lower wages than their non-smoking peers, while smokers who are not insured through their employer endure no such wage penalty. Our results have two implications: first, the incidence of smokers' elevated medical costs appears to be borne by smokers themselves in the form of lower wages. Second, differences in healthcare costs between smokers and non-smokers are a significant source of the smoker's wage gap. Copyright © 2011 Elsevier B.V. All rights reserved.

Psychiatric service utilization and cost for persons with schizophrenia in a Medicaid managed care program.

PubMed

Rothbard, Aileen B; Kuno, Eri; Hadley, Trevor R; Dogin, Judith

2004-01-01

A pre-post study design was used to look at changes in behavioral health care services and costs for Medicaid-eligible individuals with schizophrenia in a managed care (MC) carve-out compared to a fee-for-service (FFS) program in Pennsylvania between 1995 and 1998. Statistically significant reductions of 59% were found in hospital expenditures in the MC program compared to 18.3% in the FFS program. The decline in hospital costs was due to dramatic fee reductions in the MC site. No significant differences in overall ambulatory utilization were found in either program; however, ambulatory expenditures rose 57% in the MC program versus a decline of 11% in fee for service. The ambulatory cost increase resulted from a cost shift between county block grant funds, and Medicaid funds, with no additional revenues provided to outpatient providers. Study implications are that cost reductions from MC are mainly due to reducing utilization and payments to hospitals, similar to the findings for private sector programs.

Self-castration by a transsexual woman: financial and psychological costs: a case report.

PubMed

St Peter, Matthew; Trinidad, Anton; Irwig, Michael S

2012-04-01

The out-of-pocket cost for an elective orchiectomy, which is often not covered by health insurance, is a significant barrier to male-to-female transsexuals ready to proceed with their physical transition. This and other barriers (lack of access to a surgeon willing to perform the operation, waiting times, and underlying psychological and psychiatric conditions) lead a subset of transsexual women to attempt self-castration. Little information has been published on the financial costs and implications of self-castration to both patients and health care systems. We compare the financial and psychological costs of elective surgical orchiectomy vs. self-castration in the case of a transsexual woman in her 40s. We interviewed the patient and her providers and obtained financial information from local reimbursement and billing specialists. After experiencing minor hemorrhage following the self-castration, our patient presented to the emergency department and underwent a bilateral inguinal exploration, ligation and removal of bilateral spermatic cords, and complicated scrotal exploration, debridement, and closure. She was admitted to the psychiatric service for a hospital stay of three days. The total bill was U.S. $14,923, which would compare with U.S. $4,000 for an elective outpatient orchiectomy in the patient's geographical area. From a financial standpoint, an elective orchiectomy could have cost the health care system significantly less than a hospital admission with its associated additional costs. From a patient safety standpoint, elective orchiectomy is preferable to self-castration which carries significant risks such as hemorrhage, disfigurement, infection, urinary fistulae, and nerve damage. Healthcare providers of transsexual women should carefully explore patient attitudes toward self-castration and work toward improving access to elective orchiectomy to reduce the number of self-castrations and costs to the overall health care system. Further research on the financial implications of self-castration from different health care systems and from a series of patients is needed. © 2012 International Society for Sexual Medicine.

Impact of actuarial assumptions on pension costs: A simulation analysis

NASA Astrophysics Data System (ADS)

Yusof, Shaira; Ibrahim, Rose Irnawaty

2013-04-01

This study investigates the sensitivity of pension costs to changes in the underlying assumptions of a hypothetical pension plan in order to gain a perspective on the relative importance of the various actuarial assumptions via a simulation analysis. Simulation analyses are used to examine the impact of actuarial assumptions on pension costs. There are two actuarial assumptions will be considered in this study which are mortality rates and interest rates. To calculate pension costs, Accrued Benefit Cost Method, constant amount (CA) modification, constant percentage of salary (CS) modification are used in the study. The mortality assumptions and the implied mortality experience of the plan can potentially have a significant impact on pension costs. While for interest rate assumptions, it is inversely related to the pension costs. Results of the study have important implications for analyst of pension costs.

Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications.

PubMed

Rice-Townsend, Samuel; Hall, Matthew; Barnes, Jeff N; Baxter, Jessica K; Rangel, Shawn J

2012-06-01

The purpose of this study was to characterize epidemiologic trends and cost implications of hospital readmission after treatment of pediatric appendicitis. We conducted a 5-year retrospective cohort analysis of 30-day readmission rates for 52,054 patients admitted with appendicitis at 38 children's hospitals participating in the Pediatric Health Information System database. Patients were categorized as "uncomplicated" (postoperative length of stay [LOS] ≤ 2 days) or "complicated" (LOS ≥ 3 days and ≥ 4 consecutive days of antibiotics) and analyzed for demographic data, treatment received during the index admission, readmission rates, and excess LOS and hospital-related costs attributable to readmission encounters. The aggregate 30-day readmission rate was 8.7%, and this varied significantly by disease severity and management approach (uncomplicated appendectomy, 5.6%; complicated appendectomy, 12.8%; drainage, 22.6%; antibiotics only, 24.6%; P < .0001). The median hospital cost per case attributable to readmission was $3401 (reflecting a 44% relative increase in cumulative treatment-related cost), and this varied significantly by disease severity and management approach (uncomplicated appendectomy, $1946 [31% relative increase]; complicated appendectomy, $6524 [53% increase]; drainage, $6827 [48% increase]; antibiotics only, $5835 [58% increase]; P < .0001). In freestanding children's hospitals, readmission after treatment of pediatric appendicitis is a relatively common and costly occurrence. Collaborative efforts are needed to characterize patient, treatment, and hospital-related risk factors as a basis for developing preventative strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

Economic and financial outcomes in transplantation: whose dime is it anyway?

PubMed

Axelrod, David A

2013-04-01

Organ transplant is a resource-intensive service that has been subjected to increasing scrutiny in this era of cost containment. A detailed understanding of the economic (societal) and financial (transplant provider) implications of organ quality, recipient characteristics, and allocation policy is vital for the transplant professionals. Prior studies of kidney transplant economics demonstrate significant cost savings achieved by eliminating the need for long-term dialysis. However, transplant providers are experiencing higher financial costs because of changes in recipient characteristics and broader use of marginal organs. Liver transplantation economics are also more challenging because of the severity of illness-based organ allocation. Furthermore, the use of more allografts recovered from donors after cardiac death has been demonstrated to increase costs with minimal benefits. Finally, successful long-term mechanical support devices have fundamentally changed the economic implications of advanced heart failure care. Although care for end-stage organ failure through transplant is one of the landmark accomplishments of 20th century medicine, maintaining or expanding access to transplant care is threatened by the high cost of care. Novel strategies are vital to reduce the financial burden faced by the centers that transplant high-risk patients and utilize lower quality organs.

A review of cost measures for the economic impact of domestic violence.

PubMed

Chan, Ko Ling; Cho, Esther Yin-Nei

2010-07-01

Although economic analyses of domestic violence typically guide decisions concerning resource allocation, allowing policy makers to make better informed decisions on how to prioritize and allocate scarce resources, the methods adopted to calculate domestic violence costs have varied widely from study to study. In particular, only a few studies have reviewed the cost measures of the economic impact of domestic violence. This article reviews and compares these measures by covering approaches to categorizing costs, the cost components, and ways to estimate them and recommends an integrated framework that brings the various approaches together. Some issues still need to be addressed when further developing measures such as including omitted but significant measures and expanding the time horizons of others. The implications for future study of domestic violence costs are discussed.

Does co-morbid depression impact diabetes related costs? Evidence from a cross-sectional survey in a low-income country.

PubMed

Chereches, Răzvan M; Litan, Cristian M; Zlati, Alina M; Bloom, Joan R

2012-09-01

The economic implications of co-morbid depression in patients with chronic medical disorders have been studied mainly in high-income countries. However, the applicability of such findings in developing countries cannot be assumed. In the present study we estimate diabetes related costs and explore the link between depression and diabetes related costs in Romania. In this former communist country, the general perception of practitioners and policy-makers is that psychological issues are far less important than medical concerns for patients with diabetes, a perception that may lead to the misallocation of already scarce resources. Data related to costs of diabetes care and to co-morbid depression were collected from a sample of 1,171 diabetes patients at the Nutrition and Diabetes Center in Cluj-Napoca, Romania, using the Diabetes Costs Questionnaire (DCQ) and the Patient Health Questionnaire 9 (PHQ9). The gathered data were subjected to a bivariate analysis of the depression-cost relationship, as well as a regression analysis in order to isolate the effect of depression on diabetes related costs from the effect of covariates. Direct and indirect diabetes related costs equally contributed to the total costs. The repartition of the cost burden between the public system and private agents is nearly equal as well. The bivariate analysis of the depression-cost relationship reveals statistically significant larger diabetes related costs for patients with major depression than for patients with minor depression, and the latter have larger diabetes related costs than patients free of depression symptoms. When the pure effect of depression on diabetes related costs was isolated by means of regression techniques, the provisional diagnosis of major depression was found to significantly increase diabetes related costs. The equal distribution of diabetes related costs between direct and indirect measures, as well as the cost burden equally split between the public system and private agents can be explained by the costs of medication and the costs associated with time lost by the non-compensated caregivers. Consistent with Romanian cultural traditions, most of the patients rely on their relatives in an informal diabetes caregiving market for assistance. Alongside depression, the multivariate analysis revealed that factors such as Hungarian ethnicity, income, and number of years since diagnosis also significantly contribute to diabetes related costs. Findings that depression increases diabetes related costs bear potential implications for health policies and health care provision (i.e., the effect of depression on costs can be minimized by adequate recognition and treatment). As such, screening and treatment of co-occurring depression in diabetes patients should become part of the diabetes treatment protocol, not only in Romania but in other Central and Eastern European countries as well.

Drug prescribing in rural health facilities in China: implications for service quality and cost.

PubMed

Zhan, S K; Tang, S L; Guo, Y D; Bloom, G

1998-01-01

Overuse of drugs in rural areas of China has led to a growing concern regarding service quality and cost. The study found evidence of high levels of drug use in some rural health facilities in comparison with a number of other developing countries. Such a result was significantly associated with the government policy of financing health care, regulation and monitoring of health services, and users' attitudes and behaviour. It underlines the need for measures to be taken in China to improve drug use in order to allow its population access to effective care at reasonable cost.

Spacecraft Complexity Subfactors and Implications on Future Cost Growth

NASA Technical Reports Server (NTRS)

Leising, Charles J.; Wessen, Randii; Ellyin, Ray; Rosenberg, Leigh; Leising, Adam

2013-01-01

During the last ten years the Jet Propulsion Laboratory has used a set of cost-risk subfactors to independently estimate the magnitude of development risks that may not be covered in the high level cost models employed during early concept development. Within the last several years the Laboratory has also developed a scale of Concept Maturity Levels with associated criteria to quantitatively assess a concept's maturity. This latter effort has been helpful in determining whether a concept is mature enough for accurate costing but it does not provide any quantitative estimate of cost risk. Unfortunately today's missions are significantly more complex than when the original cost-risk subfactors were first formulated. Risks associated with complex missions are not being adequately evaluated and future cost growth is being underestimated. The risk subfactor process needed to be updated.

The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: a comparative study of direct costs.

PubMed

Duncan, Christopher M; Hall Long, Kirsten; Warner, David O; Hebl, James R

2009-01-01

Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing lower extremity joint replacement surgery. An economic cost comparison was performed on Mayo Clinic patients (n = 100) undergoing traditional total knee or total hip arthroplasty using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional anesthetic (non-TJRA) techniques. Matching criteria included age, sex, surgeon, type of procedure, and American Society of Anesthesiologists (ASA) physical status (PS) classification. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups, and a subgroup analysis was performed based on ASA PS classification. The estimated mean direct hospital costs were significantly reduced among TJRA patients when compared with controls (cost difference, 1999 dollars; 95% confidence interval, 584-3231 dollars; P = 0.0004). A significant reduction in hospital-based (Medicare Part A) costs accounted for the majority of the total cost savings. Use of a comprehensive, multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement surgery provides a significant reduction in the estimated total direct medical costs. The reduction in mean cost is primarily associated with lower hospital-based (Medicare Part A) costs, with the greatest overall cost difference appearing among patients with significant comorbidities (ASA PS III-IV patients).

Endovascular abdominal aortic aneurysm repair (EVAR) procedures: counterbalancing the benefits with the costs.

PubMed

Paraskevas, Kosmas I; Bessias, Nikolaos; Giannoukas, Athanasios D; Mikhailidis, Dimitri P

2010-05-01

Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is associated with lower 30-day mortality rates compared with open repair. Despite that, there are no significant differences in mortality rates between the two procedures at 2 years. On the other hand, EVAR is associated with considerably higher costs compared with open repair. The lack of significant long-term differences between the two procedures together with the substantially higher cost of EVAR may question the appropriateness of EVAR as an alternative to open surgical repair in patients fit for surgery. With several thousands of AAA procedures performed worldwide, the employment of EVAR for the management of all AAAs irrespective of the patient's surgical risk may hold implications for several national health economies. The lower perioperative mortality and morbidity rates associated with EVAR should thus be counterbalanced against the considerable costs of these procedures.

Climate change is projected to have severe impacts on the frequency and intensity of peak electricity demand across the United States.

PubMed

Auffhammer, Maximilian; Baylis, Patrick; Hausman, Catherine H

2017-02-21

It has been suggested that climate change impacts on the electric sector will account for the majority of global economic damages by the end of the current century and beyond [Rose S, et al. (2014) Understanding the Social Cost of Carbon: A Technical Assessment ]. The empirical literature has shown significant increases in climate-driven impacts on overall consumption, yet has not focused on the cost implications of the increased intensity and frequency of extreme events driving peak demand, which is the highest load observed in a period. We use comprehensive, high-frequency data at the level of load balancing authorities to parameterize the relationship between average or peak electricity demand and temperature for a major economy. Using statistical models, we analyze multiyear data from 166 load balancing authorities in the United States. We couple the estimated temperature response functions for total daily consumption and daily peak load with 18 downscaled global climate models (GCMs) to simulate climate change-driven impacts on both outcomes. We show moderate and heterogeneous changes in consumption, with an average increase of 2.8% by end of century. The results of our peak load simulations, however, suggest significant increases in the intensity and frequency of peak events throughout the United States, assuming today's technology and electricity market fundamentals. As the electricity grid is built to endure maximum load, our findings have significant implications for the construction of costly peak generating capacity, suggesting additional peak capacity costs of up to 180 billion dollars by the end of the century under business-as-usual.

Measuring Costs to Community-Based Agencies for Implementation of an Evidence-Based Practice.

PubMed

Lang, Jason M; Connell, Christian M

2017-01-01

Healthcare reform has led to an increase in dissemination of evidence-based practices. Cost is frequently cited as a significant yet rarely studied barrier to dissemination of evidence-based practices and the associated improvements in quality of care. This study describes an approach to measuring the incremental, unreimbursed costs in staff time and direct costs to community-based clinics implementing an evidence-based practice through participating in a learning collaborative. Initial implementation costs exceeding those for providing "treatment as usual" were collected for ten clinics implementing trauma-focused cognitive behavioral therapy through participation in 10-month learning collaboratives. Incremental implementation costs of these ten community-based clinic teams averaged the equivalent of US$89,575 (US$ 2012). The most costly activities were training, supervision, preparation time, and implementation team meetings. Recommendations are made for further research on implementation costs, dissemination of evidence-based practices, and implications for researchers and policy makers.

Sepsis, parenteral vaccination and skin disinfection.

PubMed

Cook, Ian F

2016-10-02

ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like 'clean' surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost.

Sepsis, parenteral vaccination and skin disinfection

PubMed Central

Cook, Ian F.

2016-01-01

ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like ‘clean’ surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost. PMID:27295449

Financial Implications of Residency Programs for Sponsoring Organizations.

ERIC Educational Resources Information Center

Heiberger, Michael H.

1997-01-01

Explores cost implications of residency programs within the Veterans Administration health care system, particularly the costs and benefits of residencies in family medicine, osteopathic medicine, and general dentistry, because they resemble optometric residencies most closely. Costs of an existing vision therapy residency are examined, and…

Out-of-hours primary care. Implications of organisation on costs

PubMed Central

van Uden, Caro JT; Ament, Andre JHA; Voss, Gemma BWE; Wesseling, Geertjan; Winkens, Ron AG; van Schayck, Onno CP; Crebolder, Harry FJM

2006-01-01

Background To perform out-of-hours primary care, Dutch general practitioners (GPs) have organised themselves in large-scale GP cooperatives. Roughly, two models of out-of-hours care can be distinguished; GP cooperatives working separate from the hospital emergency department (ED) and GP cooperatives integrated with the hospital ED. Research has shown differences in care utilisation between these two models; a significant shift in the integrated model from utilisation of ED care to primary care. These differences may have implications on costs, however, until now this has not been investigated. This study was performed to provide insight in costs of these two different models of out-of-hours care. Methods Annual reports of two GP cooperatives (one separate from and one integrated with a hospital emergency department) in 2003 were analysed on costs and use of out-of-hours care. Costs were calculated per capita. Comparisons were made between the two cooperatives. In addition, a comparison was made between the costs of the hospital ED of the integrated model before and after the set up of the GP cooperative were analysed. Results Costs per capita of the GP cooperative in the integrated model were slightly higher than in the separate model (ε 11.47 and ε 10.54 respectively). Differences were mainly caused by personnel and other costs, including transportation, interest, cleaning, computers and overhead. Despite a significant reduction in patients utilising ED care as a result of the introduction of the GP cooperative integrated within the ED, the costs of the ED remained the same. Conclusion The study results show that the costs of primary care appear to be more dependent on the size of the population the cooperative covers than on the way the GP cooperative is organised, i.e. separated versus integrated. In addition, despite the substantial reduction of patients, locating the GP cooperative at the same site as the ED was found to have little effect on costs of the ED. Sharing more facilities and personnel between the ED and the GP cooperative may improve cost-efficiency. PMID:16674814

Out-of-hours primary care. Implications of organisation on costs.

PubMed

van Uden, Caro J T; Ament, Andre J H A; Voss, Gemma B W E; Wesseling, Geertjan; Winkens, Ron A G; van Schayck, Onno C P; Crebolder, Harry F J M

2006-05-04

To perform out-of-hours primary care, Dutch general practitioners (GPs) have organised themselves in large-scale GP cooperatives. Roughly, two models of out-of-hours care can be distinguished; GP cooperatives working separate from the hospital emergency department (ED) and GP cooperatives integrated with the hospital ED. Research has shown differences in care utilisation between these two models; a significant shift in the integrated model from utilisation of ED care to primary care. These differences may have implications on costs, however, until now this has not been investigated. This study was performed to provide insight in costs of these two different models of out-of-hours care. Annual reports of two GP cooperatives (one separate from and one integrated with a hospital emergency department) in 2003 were analysed on costs and use of out-of-hours care. Costs were calculated per capita. Comparisons were made between the two cooperatives. In addition, a comparison was made between the costs of the hospital ED of the integrated model before and after the set up of the GP cooperative were analysed. Costs per capita of the GP cooperative in the integrated model were slightly higher than in the separate model (epsilon 11.47 and epsilon 10.54 respectively). Differences were mainly caused by personnel and other costs, including transportation, interest, cleaning, computers and overhead. Despite a significant reduction in patients utilising ED care as a result of the introduction of the GP cooperative integrated within the ED, the costs of the ED remained the same. The study results show that the costs of primary care appear to be more dependent on the size of the population the cooperative covers than on the way the GP cooperative is organised, i.e. separated versus integrated. In addition, despite the substantial reduction of patients, locating the GP cooperative at the same site as the ED was found to have little effect on costs of the ED. Sharing more facilities and personnel between the ED and the GP cooperative may improve cost-efficiency.

Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization.

PubMed

Brauer, David G; Hawkins, William G; Strasberg, Steven M; Brunt, L Michael; Jaques, David P; Mercurio, Nicholas R; Hall, Bruce L; Fields, Ryan C

2015-12-01

Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost-benefit associations will be necessary to justify expenditures in the era of bundled payment structures. All laparoscopic cholecystectomies (LCCKs) performed within a single health system over a 1-year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes. From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs. Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall cost, the opportunity exists for improved resource utilization with no obvious risk for a reduction in the quality of care. © 2015 International Hepato-Pancreato-Biliary Association.

Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization

PubMed Central

Brauer, David G; Hawkins, William G; Strasberg, Steven M; Brunt, L Michael; Jaques, David P; Mercurio, Nicholas R; Hall, Bruce L; Fields, Ryan C

2015-01-01

Background Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost-benefit associations will be necessary to justify expenditures in the era of bundled payment structures. Methods All laparoscopic cholecystectomies (LCCKs) performed within a single health system over a 1-year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes. Results From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs. Conclusions Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall cost, the opportunity exists for improved resource utilization with no obvious risk for a reduction in the quality of care. PMID:26345351

Administrative costs for advance payment of health coverage tax credits: an initial analysis.

PubMed

Dorn, Stan

2007-03-01

Health Coverage Tax Credits (HCTCs), created under the Trade Act of 2002, pay 65 percent of health insurance premiums for certain workers displaced by international trade and early retirees. These credits can be paid directly to insurers when monthly premiums are due, in advance of annual tax return filing. While HCTC administrative costs have fallen significantly since program start-ups, they still comprise approximately 34 percent of total spending. Changes to the HCTC program could lower administrative costs, but the size of the resulting savings is unknown. These findings have important implications for any future tax credit plan intended to cover the uninsured.

An investigation into the personal financial costs associated with stuttering.

PubMed

Blumgart, Elaine; Tran, Yvonne; Craig, Ashley

2010-09-01

Stuttering has been found to deteriorate quality of life in psychological, emotional and social functioning domains. It is reasonable to assume then that stuttering would also be associated with economic consequences that may also challenge quality of life. Remarkably, the personal financial costs associated with stuttering in adults has rarely if ever been explored or investigated in the fluency disorders field. This study involved an assessment of the personal costs of stuttering and an investigation into determinants that may influence spending. Two hundred adults who stutter participated in this study. Findings indicated that the average total cost was around $5,500 (median cost $4,165) in 2007/08 Australian dollars over a 5-year period. Major financial items included costs of direct and indirect treatments for stuttering, self-help, stuttering related conferences, and technology. Financial costs were not significantly influenced by the sex of the person, annual income, or by how severe the person stuttered. However, those individuals younger than 60 years old spent significantly more on treatment related costs, while those with elevated levels of social anxiety spent significantly less than those with lower levels of social anxiety. Quality of life implications associated with stuttering are discussed. The reader will be able to: (a) describe the method for assessing the direct financial costs of stuttering over a 5-year period; (b) describe the financial personal cost of stuttering for adults who stutter; (c) describe the relationship between factors like sex, age, severity of stuttering and financial costs; and (d) describe the relationship between social anxiety and the financial cost of stuttering.

Cost Implications of an Interim Storage Facility in the Waste Management System

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

Jarrell, Joshua J.; Joseph, III, Robert Anthony; Howard, Rob L

2016-09-01

This report provides an evaluation of the cost implications of incorporating a consolidated interim storage facility (ISF) into the waste management system (WMS). Specifically, the impacts of the timing of opening an ISF relative to opening a repository were analyzed to understand the potential effects on total system costs.

What are the Implications for Policy Makers? A Systematic Review of the Cost-Effectiveness of Screening and Brief Interventions for Alcohol Misuse in Primary Care

PubMed Central

Angus, Colin; Latimer, Nicholas; Preston, Louise; Li, Jessica; Purshouse, Robin

2014-01-01

Introduction: The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; however, evidence on their cost-effectiveness is limited. A small number of previous reviews have concluded that SBI programs are likely to be cost-effective but these results are equivocal and important questions around the cost-effectiveness implications of key policy decisions such as staffing choices for delivery of SBIs and the intervention duration remain unanswered. Methods: Studies reporting both the costs and a measure of health outcomes of programs combining SBIs in primary care were identified by searching MEDLINE, EMBASE, Econlit, the Cochrane Library Database (including NHS EED), CINAHL, PsycINFO, Assia and the Social Science Citation Index, and Science Citation Index via Web of Knowledge. Included studies have been stratified both by delivery staff and intervention duration and assessed for quality using the Drummond checklist for economic evaluations. Results: The search yielded a total of 23 papers reporting the results of 22 distinct studies. There was significant heterogeneity in methods and outcome measures between studies; however, almost all studies reported SBI programs to be cost-effective. There was no clear evidence that either the duration of the intervention or the delivery staff used had a substantial impact on this result. Conclusion: This review provides strong evidence that SBI programs in primary care are a cost-effective option for tackling alcohol misuse. PMID:25225487

Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

PubMed

Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

2017-06-01

This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective ® Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases indicated a financial benefit for shifting from inpatient to outpatient MIS.

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

PubMed

Lopes, G de L

2013-09-01

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

Climate change is projected to have severe impacts on the frequency and intensity of peak electricity demand across the United States

PubMed Central

Auffhammer, Maximilian; Baylis, Patrick; Hausman, Catherine H.

2017-01-01

It has been suggested that climate change impacts on the electric sector will account for the majority of global economic damages by the end of the current century and beyond [Rose S, et al. (2014) Understanding the Social Cost of Carbon: A Technical Assessment]. The empirical literature has shown significant increases in climate-driven impacts on overall consumption, yet has not focused on the cost implications of the increased intensity and frequency of extreme events driving peak demand, which is the highest load observed in a period. We use comprehensive, high-frequency data at the level of load balancing authorities to parameterize the relationship between average or peak electricity demand and temperature for a major economy. Using statistical models, we analyze multiyear data from 166 load balancing authorities in the United States. We couple the estimated temperature response functions for total daily consumption and daily peak load with 18 downscaled global climate models (GCMs) to simulate climate change-driven impacts on both outcomes. We show moderate and heterogeneous changes in consumption, with an average increase of 2.8% by end of century. The results of our peak load simulations, however, suggest significant increases in the intensity and frequency of peak events throughout the United States, assuming today’s technology and electricity market fundamentals. As the electricity grid is built to endure maximum load, our findings have significant implications for the construction of costly peak generating capacity, suggesting additional peak capacity costs of up to 180 billion dollars by the end of the century under business-as-usual. PMID:28167756

Long-term implications of sustained wind power growth in the United States: Potential benefits and secondary impacts

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

Wiser, Ryan; Bolinger, Mark; Heath, Garvin

We model scenarios of the U.S. electric sector in which wind generation reaches 10% of end-use electricity demand in 2020, 20% in 2030, and 35% in 2050. As shown in a companion paper, achieving these penetration levels would have significant implications for the wind industry and the broader electric sector. Compared to a baseline that assumes no new wind deployment, under the primary scenario modeled, achieving these penetrations imposes an incremental cost to electricity consumers of less than 1% through 2030. These cost implications, however, should be balanced against the variety of environmental and social implications of such a scenario.more » Relative to a baseline that assumes no new wind deployment, our analysis shows that the high-penetration wind scenario yields potential greenhouse-gas benefits of $85-$1,230 billion in present-value terms, with a central estimate of $400 billion. Air-pollution-related health benefits are estimated at $52-$272 billion, while annual electric-sector water withdrawals and consumption are lower by 15% and 23% in 2050, respectively. We also find that a high-wind-energy future would have implications for the diversity and risk of energy supply, local economic development, and land use and related local impacts on communities and ecosystems; however, these additional impacts may not greatly affect aggregate social welfare owing to their nature, in part, as resource transfers.« less

The roles of vibration analysis and infrared thermography in monitoring air-handling equipment

NASA Astrophysics Data System (ADS)

Wurzbach, Richard N.

2003-04-01

Industrial and commercial building equipment maintenance has not historically been targeted for implementation of PdM programs. The focus instead has been on manufacturing, aerospace and energy industries where production interruption has significant cost implications. As cost-effectiveness becomes more pervasive in corporate culture, even office space and labor activities housed in large facilities are being scrutinized for cost-cutting measures. When the maintenance costs for these facilities are reviewed, PdM can be considered for improving the reliability of the building temperature regulation, and reduction of maintenance repair costs. An optimized program to direct maintenance resources toward a cost effective and pro-active management of the facility can result in reduced operating budgets, and greater occupant satisfaction. A large majority of the significant rotating machinery in a large building environment are belt-driven air handling units. These machines are often poorly designed or utilized within the facility. As a result, the maintenance staff typically find themselves scrambling to replace belts and bearings, going from one failure to another. Instead of the reactive-mode maintenance, some progressive and critical institutions are adopting predictive and proactive technologies of infrared thermography and vibration analysis. Together, these technologies can be used to identify design and installation problems, that when corrected, significantly reduce maintenance and increase reliability. For critical building use, such as laboratories, research facilities, and other high value non-industrial settings, the cost-benefits of more reliable machinery can contribute significantly to the operational success.

Review of the Evidence for Oral Health Promotion Effectiveness

ERIC Educational Resources Information Center

Satur, Julie G.; Gussy, Mark G.; Morgan, Michael V.; Calache, Hanny; Wright, Clive

2010-01-01

Dental caries, periodontal diseases, tooth loss and oral cancers have significant burden of disease effects, quality of life and cost implications for the Australian community. Oral health promotion is a key approach to addressing these conditions endorsed as part of the National Oral Health Plan. Understanding the evidence for effectiveness of…

Injury Prevalence among Children and Adolescents with Mental Retardation

ERIC Educational Resources Information Center

Slayter, Elspeth M.; Garnick, Deborah W.; Kubisiak, Joanna M.; Bishop, Christine E.; Gilden, Daniel M.; Hakim, Rosemarie B.

2006-01-01

Childhood injuries lead to increased morbidity and result in significant costs to public insurance programs. People with mental retardation, most of whom are covered by Medicaid, are at high risk for injury, which has implications for community inclusion, a central policy goal. Medicaid data from inpatient, outpatient, and long-term care settings…

Can market-based policies accomplish the optimal floodplain management? A gap between static and dynamic models.

PubMed

Mori, Koichiro

2009-02-01

The purpose of this short article is to set static and dynamic models for optimal floodplain management and to compare policy implications from the models. River floodplains are important multiple resources in that they provide various ecosystem services. It is fundamentally significant to consider environmental externalities that accrue from ecosystem services of natural floodplains. There is an interesting gap between static and dynamic models about policy implications for floodplain management, although they are based on the same assumptions. Essentially, we can derive the same optimal conditions, which imply that the marginal benefits must equal the sum of the marginal costs and the social external costs related to ecosystem services. Thus, we have to internalise the external costs by market-based policies. In this respect, market-based policies seem to be effective in a static model. However, they are not sufficient in the context of a dynamic model because the optimal steady state turns out to be unstable. Based on a dynamic model, we need more coercive regulation policies.

Cost Implications of Uncertainty in CO{sub 2} Storage Resource Estimates: A Review

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

Anderson, Steven T., E-mail: sanderson@usgs.gov

Carbon capture from stationary sources and geologic storage of carbon dioxide (CO{sub 2}) is an important option to include in strategies to mitigate greenhouse gas emissions. However, the potential costs of commercial-scale CO{sub 2} storage are not well constrained, stemming from the inherent uncertainty in storage resource estimates coupled with a lack of detailed estimates of the infrastructure needed to access those resources. Storage resource estimates are highly dependent on storage efficiency values or storage coefficients, which are calculated based on ranges of uncertain geological and physical reservoir parameters. If dynamic factors (such as variability in storage efficiencies, pressure interference,more » and acceptable injection rates over time), reservoir pressure limitations, boundaries on migration of CO{sub 2}, consideration of closed or semi-closed saline reservoir systems, and other possible constraints on the technically accessible CO{sub 2} storage resource (TASR) are accounted for, it is likely that only a fraction of the TASR could be available without incurring significant additional costs. Although storage resource estimates typically assume that any issues with pressure buildup due to CO{sub 2} injection will be mitigated by reservoir pressure management, estimates of the costs of CO{sub 2} storage generally do not include the costs of active pressure management. Production of saline waters (brines) could be essential to increasing the dynamic storage capacity of most reservoirs, but including the costs of this critical method of reservoir pressure management could increase current estimates of the costs of CO{sub 2} storage by two times, or more. Even without considering the implications for reservoir pressure management, geologic uncertainty can significantly impact CO{sub 2} storage capacities and costs, and contribute to uncertainty in carbon capture and storage (CCS) systems. Given the current state of available information and the scarcity of (data from) long-term commercial-scale CO{sub 2} storage projects, decision makers may experience considerable difficulty in ascertaining the realistic potential, the likely costs, and the most beneficial pattern of deployment of CCS as an option to reduce CO{sub 2} concentrations in the atmosphere.« less

Cost implications of uncertainty in CO2 storage resource estimates: A review

USGS Publications Warehouse

Anderson, Steven T.

2017-01-01

Carbon capture from stationary sources and geologic storage of carbon dioxide (CO2) is an important option to include in strategies to mitigate greenhouse gas emissions. However, the potential costs of commercial-scale CO2 storage are not well constrained, stemming from the inherent uncertainty in storage resource estimates coupled with a lack of detailed estimates of the infrastructure needed to access those resources. Storage resource estimates are highly dependent on storage efficiency values or storage coefficients, which are calculated based on ranges of uncertain geological and physical reservoir parameters. If dynamic factors (such as variability in storage efficiencies, pressure interference, and acceptable injection rates over time), reservoir pressure limitations, boundaries on migration of CO2, consideration of closed or semi-closed saline reservoir systems, and other possible constraints on the technically accessible CO2 storage resource (TASR) are accounted for, it is likely that only a fraction of the TASR could be available without incurring significant additional costs. Although storage resource estimates typically assume that any issues with pressure buildup due to CO2 injection will be mitigated by reservoir pressure management, estimates of the costs of CO2 storage generally do not include the costs of active pressure management. Production of saline waters (brines) could be essential to increasing the dynamic storage capacity of most reservoirs, but including the costs of this critical method of reservoir pressure management could increase current estimates of the costs of CO2 storage by two times, or more. Even without considering the implications for reservoir pressure management, geologic uncertainty can significantly impact CO2 storage capacities and costs, and contribute to uncertainty in carbon capture and storage (CCS) systems. Given the current state of available information and the scarcity of (data from) long-term commercial-scale CO2 storage projects, decision makers may experience considerable difficulty in ascertaining the realistic potential, the likely costs, and the most beneficial pattern of deployment of CCS as an option to reduce CO2 concentrations in the atmosphere.

Advanced Engineering Environments: Implications for Aerospace Manufacturing

NASA Technical Reports Server (NTRS)

Thomas, D.

2001-01-01

There are significant challenges facing today's aerospace industry. Global competition, more complex products, geographically-distributed design teams, demands for lower cost, higher reliability and safer vehicles, and the need to incorporate the latest technologies quicker all face the developer of aerospace systems. New information technologies offer promising opportunities to develop advanced engineering environments (AEEs) to meet these challenges. Significant advances in the state-of-the-art of aerospace engineering practice are envisioned in the areas of engineering design and analytical tools, cost and risk tools, collaborative engineering, and high-fidelity simulations early in the development cycle. These advances will enable modeling and simulation of manufacturing methods, which will in turn allow manufacturing considerations to be included much earlier in the system development cycle. Significant cost savings, increased quality, and decreased manufacturing cycle time are expected to result. This paper will give an overview of the NASA's Intelligent Synthesis Environment, the agency initiative to develop an AEE, with a focus on the anticipated benefits in aerospace manufacturing.

Markets for hospital services in Zambia.

PubMed

Nakamba, Pamela; Hanson, Kara; McPake, Barbara

2002-01-01

Hospital reforms involving the introduction of measures to increase competition in hospital markets are being implemented in a range of low and middle-income countries. However, little is understood about the operation of hospital markets outside the USA and the UK. This paper assesses the degree of competition for hospital services in two hospital markets in Zambia (Copperbelt and Midlands), and the implications for prices, quality and efficiency. We found substantial differences among different hospital types in prices, costs and quality, suggesting that the hospital service market is a segmented market. The two markets differ significantly in their degree of competition, with the high cost inpatient services market in Copperbelt relatively more competitive than that in the Midlands market. The implications of these differences are discussed in terms of the potential for competition to improve hospital performance, the impact of market structure on equity of access, and how the government should address the problem of the mine hospitals.

Utility of additional tissue sections in dermatopathology: diagnostic, clinical and financial implications.

PubMed

Stuart, Lauren N; Rodriguez, Adrianna S; Gardner, Jerad M; Foster, Toby E; MacKelfresh, Jamie; Parker, Douglas C; Chen, Suephy C; Stoff, Benjamin K

2014-02-01

As histopathologic assessment is subject to sampling error, some institutions 'preorder' deeper sections on some or all cases (hereafter referred to as prospective deeper sections), while others order additional sections only when needed (hereafter referred to as retrospective deeper sections). We investigated how often additional sections changed a diagnosis and/or clinical management. Given the recent decrease in reimbursement for CPT-code 88305, we also considered the financial implications of ordering additional sections. Cases (n = 204) were assigned a preliminary diagnosis, based on review of the initial slide, and a final diagnosis, after reviewing additional sections. Cases with discordant diagnoses were assessed by two dermatologists, who indicated whether the change in diagnosis altered clinical management. Expenses were estimated for three scenarios: (a) no additional sections, (b) prospective deeper sections and (c) retrospective deeper sections. Diagnoses were modified in 9% of cases, which changed clinical management in 56% of these cases. Lesions obtained by punch-biopsy and inflammatory lesions were disproportionately overrepresented amongst cases with changed diagnoses (p < 0.001, p = 0.12, respectively). The cost of prospective deeper sections and retrospective deeper sections represented a 56% and 115% increase over base costs, respectively. Labor costs, particularly the cost of dermatopathologist evaluation, were the most significant cost-drivers. While additional sections improve diagnostic accuracy, they delay turn-around-time and increase expenditures. In our practice, prospective deeper sections are cost effective, however, this may vary by institution. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Electricity demand and storage dispatch modeling for buildings and implications for the smartgrid

NASA Astrophysics Data System (ADS)

Zheng, Menglian; Meinrenken, Christoph

2013-04-01

As an enabler for demand response (DR), electricity storage in buildings has the potential to lower costs and carbon footprint of grid electricity while simultaneously mitigating grid strain and increasing its flexibility to integrate renewables (central or distributed). We present a stochastic model to simulate minute-by-minute electricity demand of buildings and analyze the resulting electricity costs under actual, currently available DR-enabling tariffs in New York State, namely a peak/offpeak tariff charging by consumed energy (monthly total kWh) and a time of use tariff charging by power demand (monthly peak kW). We then introduce a variety of electrical storage options (from flow batteries to flywheels) and determine how DR via temporary storage may increase the overall net present value (NPV) for consumers (comparing the reduced cost of electricity to capital and maintenance costs of the storage). We find that, under the total-energy tariff, only medium-term storage options such as batteries offer positive NPV, and only at the low end of storage costs (optimistic scenario). Under the peak-demand tariff, however, even short-term storage such as flywheels and superconducting magnetic energy offer positive NPV. Therefore, these offer significant economic incentive to enable DR without affecting the consumption habits of buildings' residents. We discuss implications for smartgrid communication and our future work on real-time price tariffs.

Learning in Developing Countries: Implications for Workforce Training and Development in Africa

ERIC Educational Resources Information Center

Arthur-Mensah, Nana; Shuck, Brad

2014-01-01

The implementation of e-learning as a strategy has risen exponentially over the last 20 years as more adults use this medium to enhance their skills and acquire knowledge. The utilization of technology offers significant advantages to both learners and organizations in terms of cost, time and rich learning content. E-learning has been widely…

Confidence in Airline Performance in Difficult Market Conditions: An Analysis of JetBlue's Financial Market Results

NASA Technical Reports Server (NTRS)

Flouris, Triant; Walker, Thomas

2005-01-01

This paper examines the stock market s reaction to JetBlue s Initial Public Offering (1PO) and subsequent price movements of the stock. In particular, w e examine whether the euphoria surrounding JetBlue s IPO carried over to other firms in the sector by testing whether the shares of JetBlue s competitors showed a significant price reaction to JetBlue s IPO. JetBlue's IPO took place just a few months following September 11, 2001. These events resulted in dramatic changes in the airline industry and had significant implications on the economic gains of airlines. We examine JetBlue s accounting and stock performance and compare it to the relative performance of Southwest Airlines (SWA), a representative of the loa-cost carrier group. In addition, we compare both JetBlue's and SWA's financial condition and the relative performance of their stock to two mainline U S. carriers, Continental and Northwest. representatives of the conventional-cost carrier group. We analyze whether there are any performance differences among the low-cost carriers and between low-cost carriers and conventional-cost carriers. In particular, we examine whether low-cost carriers were able to sustain the economic impacts of 9/11 better than the conventional-cost carriers.

Incorporating considerations of cost-effectiveness, affordability, and resource implications in guideline development: article 6 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Hill, Suzanne R; Olson, Leslie G; Falck-Ytter, Yngve; Cruz, Alvaro A; Atkins, David; Baumann, Michael; Jaeschke, Roman; Woitalla, Thomas; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that health care recommendations are based on the best available research evidence. This is the sixth of a series of 14 articles prepared to advise guideline developers for respiratory and other diseases on how to achieve this goal. In this article, we focused on integrating cost and resource information in guideline development and formulating recommendations focusing on four key questions. We addressed the following specific questions. (1) When is it important to incorporate costs, and/or resource implications, and/or cost-effectiveness, and/or affordability considerations in guidelines? (2) Which costs and which resource use should be considered in guidelines? (3)What sources of evidence should be used to estimate costs, resource use, and cost-effectiveness? (4) How can cost-effectiveness, resource implications, and affordability be taken into account explicitly? Our work was based on a prior review on this topic and our conclusions are based on available evidence, consideration of what guideline developers are doing, and workshop discussions. Many authorities suggest that there is a need to include explicit consideration of costs, resource use, and affordability during guideline development. Where drug use is at issue, "explicit consideration" may need to involve only noting whether the price (easily determined and usually the main component of "acquisition cost") of a drug is high or low. Complex interventions such as rehabilitation services are to a greater degree setting- and system-dependent. Resources used, and the costs of those resources, will vary among systems, and formal identification by a guideline group of the resource requirements of a complex intervention is essential. A clinical guideline usually contains multiple recommendations, and in some cases there are hundreds. Defining costs and resource use for all of them-especially for multiple settings-is unlikely to be feasible. At present, disaggregated resource utilization accompanied by some cost information seems to be the most promising approach. The method for assigning values to costs, including external or indirect cost (such as time off work), can have a significant impact on the outcome of any economic evaluation. The perspective that the guideline assumes should be made explicit. Standards for evidence for clinical data are usually good-quality trials reporting a relevant endpoint that should be summarized in a systematic review. Like others, we are therefore proposing that the ideal sources of evidence for cost and resource utilization data for guideline development are systematic reviews of randomized controlled trials that report resource utilization, with direct comparisons between the interventions of interest.

The role of capital costs in decarbonizing the electricity sector

NASA Astrophysics Data System (ADS)

Hirth, Lion; Steckel, Jan Christoph

2016-11-01

Low-carbon electricity generation, i.e. renewable energy, nuclear power and carbon capture and storage, is more capital intensive than electricity generation through carbon emitting fossil fuel power stations. High capital costs, expressed as high weighted average cost of capital (WACC), thus tend to encourage the use of fossil fuels. To achieve the same degree of decarbonization, countries with high capital costs therefore need to impose a higher price on carbon emissions than countries with low capital costs. This is particularly relevant for developing and emerging economies, where capital costs tend to be higher than in rich countries. In this paper we quantitatively evaluate how high capital costs impact the transformation of the energy system under climate policy, applying a numerical techno-economic model of the power system. We find that high capital costs can significantly reduce the effectiveness of carbon prices: if carbon emissions are priced at USD 50 per ton and the WACC is 3%, the cost-optimal electricity mix comprises 40% renewable energy. At the same carbon price and a WACC of 15%, the cost-optimal mix comprises almost no renewable energy. At 15% WACC, there is no significant emission mitigation with carbon pricing up to USD 50 per ton, but at 3% WACC and the same carbon price, emissions are reduced by almost half. These results have implications for climate policy; carbon pricing might need to be combined with policies to reduce capital costs of low-carbon options in order to decarbonize power systems.

Implications of employer coverage of contraception: Cost-effectiveness analysis of contraception coverage under an employer mandate.

PubMed

Canestaro, W; Vodicka, E; Downing, D; Trussell, J

2017-01-01

Mandatory employer-based insurance coverage of contraception in the US has been a controversial component of the Affordable Care Act (ACA). Prior research has examined the cost-effectiveness of contraception in general; however, no studies have developed a formal decision model in the context of the new ACA provisions. As such, this study aims to estimate the relative cost-effectiveness of insurance coverage of contraception under employer-sponsored insurance coverage taking into consideration newer regulations allowing for religious exemptions. A decision model was developed from the employer perspective to simulate pregnancy costs and outcomes associated with insurance coverage. Method-specific estimates of contraception failure rates, outcomes and costs were derived from the literature. Uptake by marital status and age was drawn from a nationally representative database. Providing no contraception coverage resulted in 33 more unintended pregnancies per 1000 women (95% confidence range: 22.4; 44.0). This subsequently significantly increased the number of unintended births and terminations. Total costs were higher among uninsured women owing to higher costs of pregnancy outcomes. The effect of no insurance was greatest on unmarried women 20-29 years old. Denying female employees' full coverage of contraceptives increases total costs from the employer perspective, as well as the total number of terminations. Insurance coverage was found to be significantly associated with women's choice of contraceptive method in a large nationally representative sample. Using a decision model to extrapolate to pregnancy outcomes, we found a large and statistically significant difference in unintended pregnancy and terminations. Denying women contraception coverage may have significant consequences for pregnancy outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Financial implications of ventral hernia repair: a hospital cost analysis.

PubMed

Reynolds, Drew; Davenport, Daniel L; Korosec, Ryan L; Roth, J Scott

2013-01-01

Complicated ventral hernias are often referred to tertiary care centers. Hospital costs associated with these repairs include direct costs (mesh materials, supplies, and nonsurgeon labor costs) and indirect costs (facility fees, equipment depreciation, and unallocated labor). Operative supplies represent a significant component of direct costs, especially in an era of proprietary synthetic meshes and biologic grafts. We aim to evaluate the cost-effectiveness of complex abdominal wall hernia repair at a tertiary care referral facility. Cost data on all consecutive open ventral hernia repairs (CPT codes 49560, 49561, 49565, and 49566) performed between 1 July 2008 and 31 May 2011 were analyzed. Cases were analyzed based upon hospital status (inpatient vs. outpatient) and whether the hernia repair was a primary or secondary procedure. We examined median net revenue, direct costs, contribution margin, indirect costs, and net profit/loss. Among primary hernia repairs, cost data were further analyzed based upon mesh utilization (no mesh, synthetic, or biologic). Four-hundred and fifteen patients underwent ventral hernia repair (353 inpatients and 62 outpatients); 173 inpatients underwent ventral hernia repair as the primary procedure; 180 inpatients underwent hernia repair as a secondary procedure. Median net revenue ($17,310 vs. 10,360, p < 0.001) and net losses (3,430 vs. 1,700, p < 0.025) were significantly greater for those who underwent hernia repair as a secondary procedure. Among inpatients undergoing ventral hernia repair as the primary procedure, 46 were repaired without mesh; 79 were repaired with synthetic mesh and 48 with biologic mesh. Median direct costs for cases performed without mesh were $5,432; median direct costs for those using synthetic and biologic mesh were $7,590 and 16,970, respectively (p < .01). Median net losses for repairs without mesh were $500. Median net profit of $60 was observed for synthetic mesh-based repairs. The median contribution margin for cases utilizing biologic mesh was -$4,560, and the median net financial loss was $8,370. Outpatient ventral hernia repairs, with and without synthetic mesh, resulted in median net losses of $1,560 and 230, respectively. Ventral hernia repair is associated with overall financial losses. Inpatient synthetic mesh repairs are essentially budget neutral. Outpatient and inpatient repairs without mesh result in net financial losses. Inpatient biologic mesh repairs result in a negative contribution margin and striking net financial losses. Cost-effective strategies for managing ventral hernias in a tertiary care environment need to be developed in light of the financial implications of this patient population.

How Much Do Hospitals Cost Shift? A Review of the Evidence

PubMed Central

Frakt, Austin B

2011-01-01

Context: Hospital cost shifting—charging private payers more in response to shortfalls in public payments—has long been part of the debate over health care policy. Despite the abundance of theoretical and empirical literature on the subject, it has not been critically reviewed and interpreted since Morrisey did so nearly fifteen years ago. Much has changed since then, in both empirical technique and the health care landscape. This article examines the theoretical and empirical literature on cost shifting since 1996, synthesizes the predominant findings, suggests their implications for the future of health care costs, and puts them in the current policy context. Methods: The relevant literature was identified by database search. Papers describing policies were considered first, since policy shapes the health care market in which cost shifting may or may not occur. Theoretical works were examined second, as theory provides hypotheses and structure for empirical work. The empirical literature was analyzed last in the context of the policy environment and in light of theoretical implications for appropriate econometric specification. Findings: Most of the analyses and commentary based on descriptive, industrywide hospital payment-to-cost margins by payer provide a false impression that cost shifting is a large and pervasive phenomenon. More careful theoretical and empirical examinations suggest that cost shifting can and has occurred, but usually at a relatively low rate. Margin changes also are strongly influenced by the evolution of hospital and health plan market structures and changes in underlying costs. Conclusions: Policymakers should view with a degree of skepticism most hospital and insurance industry claims of inevitable, large-scale cost shifting. Although some cost shifting may result from changes in public payment policy, it is just one of many possible effects. Moreover, changes in the balance of market power between hospitals and health care plans also significantly affect private prices. Since they may increase hospitals’ market power, provisions of the new health reform law that may encourage greater provider integration and consolidation should be implemented with caution. PMID:21418314

Is family-friendly policy (FFP) working in the private sector of South Korea?

PubMed

Kang, Young-Hee

2013-01-01

Using the Korean Labor and Income Panel Study (KLIPS), I investigated the impact of family-friendly policies (FFPs) on job satisfaction and organizational commitment in the private sector of South Korea. Paid leave, childcare leave, and support for housing are positively related to both job satisfaction and organizational commitment. Sick leave is positively related to organizational commitment. However, subsidized family event cost is a marginally significant predictor of job satisfaction and organizational commitment. In addition, the relationships between subsidized childcare cost and employee attitudes were not supported. Implications and suggestions for future research are discussed.

Disease management improves ESRD outcomes.

PubMed

Sands, J J

2006-02-01

Renal disease management organizations have reported achieving significant decreases in mortality and hospitalization in conjunction with cost savings, improved patient satisfaction and quality of life. Disease management organizations strive to fill existing gaps in care delivery through the standardized use of risk assessment, predictive modeling, evidence based guidelines and process and outcomes measurement. Patient self-management education and the provision of individual nurse care managers are also key program components. As we more fully measure clinical outcomes and total health-care costs including payments from all insurance and government entities, pharmacy costs and out-of-pocket expenditures, the full implications of disease management can be better defined. The results of this analysis will have a profound influence on United States healthcare policy. At present, current data suggests that the promise of disease management, improved care at reduced cost, can and is being realized in ESRD.

Long-Term Effect of Participation in an Early Exercise and Education Program on Clinical Outcomes and Cost Implications, in Patients with TIA and Minor, Non-Disabling Stroke.

PubMed

Faulkner, James; Stoner, Lee; Lanford, Jeremy; Jolliffe, Evan; Mitchelmore, Andrew; Lambrick, Danielle

2017-06-01

Participation in exercise and education programs following transient ischemic attack (TIA) or minor stroke may decrease cardiovascular disease risk. The purpose of this study was to assess the long-term effect (3.5 years) of an exercise and education program administered soon after TIA or minor stroke diagnosis on clinical outcome measures (stroke classification and number, patient deaths, hospital/emergency department admission) and cost implications obtained from standard hospital records. Hospital records were screened for 60 adults (male, n = 31; 71 ± 10 years), diagnosed with TIA or non-disabling stroke, who had previously been randomised and completed either an 8-week exercise and education program, or usual care control. Follow-up clinical outcomes and cost implications were obtained 3.5 ± 0.3 years post-exercise. Participants randomised to the exercise and education program had significantly fewer recurrent stroke/TIAs (n = 3 vs. n = 13, Cohen's d = 0.79) than the control group (P ≤ 0.003). Similar finding were reported for patient deaths (n = 0 vs. n = 4, d = 0.53), and hospital admissions (n = 48 vs. n = 102, d = 0.54), although these findings were only approaching statistical significance. The relative risk (mean; 95%CI) of death, stroke/TIAs and hospital admissions were 0.11 (0.01 to 1.98), 0.23 (0.07 to 0.72) and 0.79 (0.57 to 1.09), respectively. Hospital admission costs were significantly lower for the exercise group ($9041 ± 15,080 NZD [~$6000 ± 10,000 USD]) than the control group ($21,750 ± 22,973 NZD [~$14,000 ± 15,000 USD]) during the follow-up period (P < 0.05, d = 0.69). The present study demonstrates the long-term patient benefit and economic importance of providing secondary prevention, exercise and education programs for patients with TIA and minor stroke. URL: http://www.anzctr.org.au/ ; Trial Registration Number: ACTRN12611000630910.

Career stages in wildland firefighting: Implications for voice in risky situations

Treesearch

Alexis Lewis; Troy E. Hall; Anne Black

2011-01-01

Avoidance of injury and death on the fireline may depend on firefighters voicing their concerns, but often this does not occur. Reasons for employee reticence identified in the literature include a perception of various personal costs or a belief that raising concerns is futile. Additionally, the social context may play a significant role. In a qualitative study using...

Liquid Crystalline Polymers

DTIC Science & Technology

1990-02-28

include energy costs, time required for cooling, large volume changes, and degradation. For many high -temperature LCPs, the latter may be the most...LCPs)- high local (microscopic) orientational order, which is retained in the solid state-has significant implications in a range of DOD applications...that yield and maintain specific mer sequences. * Continue efforts to measure mer sequence distribution, e.g., by multinuclei NMR. 0 Develop high

Intentions to Quit Work among Care Staff Working in the Aged Care Sector

ERIC Educational Resources Information Center

Karantzas, Gery C.; Mellor, David; McCabe, Marita P.; Davison, Tanya E.; Beaton, Paul; Mrkic, Dejan

2012-01-01

Purpose of the Study: The aged care industry experiences high rates of staff turnover. Staff turnover has significant implications for the quality of care provided to care recipients and the financial costs to care agencies. In this study, we applied a model of intention to quit to identify the contextual and personal factors that shape aged care…

Impact of side-effects of atypical antipsychotics on non-compliance, relapse and cost.

PubMed

Mortimer, A; Williams, P; Meddis, D

2003-01-01

Atypical antipsychotics generally have milder side-effects than conventional antipsychotics, but also differ among themselves in this respect. This study aimed to compare the impact of different side-effect profiles of individual atypical antipsychotics on non-compliance, relapse and cost in schizophrenia. A state-transition model was built using literature data supplemented by expert opinion. The model found that quetiapine and ziprasidone were similar in estimated non-compliance and relapse rates. Olanzapine and risperidone had higher estimated non-compliance and relapse rates, and incremental, 1-year, per-patient direct costs, using US-based cost data, of approximately $530 (95% confidence interval [CI] approximately $275, $800), and approximately $485 (95% CI approximately $235, $800), respectively, compared with quetiapine. Incremental costs attributable to different side-effect profiles were highly significant. This study shows that differing side-effect profiles of the newer antipsychotic agents are likely to lead to different compliance rates, and consequent variation in relapse rates. The cost implications of these heterogenous clinical outcomes are substantial.

Health economics in the United States: cost implications.

PubMed

Whitelaw, G N

1993-01-01

World health care costs are increasing uncontrollably and will continue to grow even if draconian controls are implemented immediately. In the United States, the health care objectives are to control the escalating costs of health care and increase access to quality care. To achieve these goals, new administrative controls will be put in place to respond to the cost pressures. New policies to accommodate these new controls will be made by the state and federal governments and by various private third parties. The policies will contain incentives and disincentives for private and institutional providers and beneficiaries. As a result, providers are responding with various cost-control techniques and payors are attempting to reduce costs. In addition, new decision makers in hospitals, insurance companies, and government will be evaluating new technologies by new standards. In order to gain or maintain significant market penetration for a product, drug and device manufacturers will have to develop a multifaceted strategy to present their products in the most favorable economic light.

Economic utilization of general aviation airport runways

NASA Technical Reports Server (NTRS)

Piper, R. R.

1971-01-01

The urban general aviation airport economics is studied in detail. The demand for airport services is discussed, and the different types of users are identified. The direct cost characteristics of the airport are summarized; costs to the airport owner are largely fixed, and, except at certain large airports, weight is not a significant factor in airport costs. The efficient use of an existing airport facility is explored, with the focus on the social cost of runway congestion as traffic density at the airport build up and queues form. The tradeoff between aircraft operating costs and airport costs is analyzed in terms of runway length. The transition from theory to practice is treated, and the policy of charging prices only on aircraft storage and fuel is felt likely to continue. Implications of the study from the standpoint of public policy include pricing that spreads traffic peaks to improve runway utilization, and pricing that discriminates against aircraft requiring long runways and causes owners to adopt V/STOL equipment.

Ethical Issues of Predictive Genetic Testing for Diabetes

PubMed Central

Haga, Susanne B.

2009-01-01

With the rising number of individuals affected with diabetes and the significant health care costs of treatment, the emphasis on prevention is key to controlling the health burden of this disease. Several genetic and genomic studies have identified genetic variants associated with increased risk to diabetes. As a result, commercial testing is available to predict an individual's genetic risk. Although the clinical benefits of testing have not yet been demonstrated, it is worth considering some of the ethical implications of testing for this common chronic disease. In this article, I discuss several issues that should be considered during the translation of predictive testing for diabetes, including familial implications, improvement of risk communication, implications for behavioral change and health outcomes, the Genetic Information Nondiscrimination Act, direct-to-consumer testing, and appropriate age of testing. PMID:20144329

A perverse quality incentive in surgery: implications of reimbursing surgeons less for doing laparoscopic surgery.

PubMed

Fader, Amanda N; Xu, Tim; Dunkin, Brian J; Makary, Martin A

2016-11-01

Surgery is one of the highest priced services in health care, and complications from surgery can be serious and costly. Recently, advances in surgical techniques have allowed surgeons to perform many common operations using minimally invasive methods that result in fewer complications. Despite this, the rates of open surgery remain high across multiple surgical disciplines. This is an expert commentary and review of the contemporary literature regarding minimally invasive surgery practices nationwide, the benefits of less invasive approaches, and how minimally invasive compared with open procedures are differentially reimbursed in the United States. We explore the incentive of the current surgeon reimbursement fee schedule and its potential implications. A surgeon's preference to perform minimally invasive compared with open surgery remains highly variable in the U.S., even after adjustment for patient comorbidities and surgical complexity. Nationwide administrative claims data across several surgical disciplines demonstrates that minimally invasive surgery utilization in place of open surgery is associated with reduced adverse events and cost savings. Reducing surgical complications by increasing adoption of minimally invasive operations has significant cost implications for health care. However, current U.S. payment structures may perversely incentivize open surgery and financially reward physicians who do not necessarily embrace newer or best minimally invasive surgery practices. Utilization of minimally invasive surgery varies considerably in the U.S., representing one of the greatest disparities in health care. Existing physician payment models must translate the growing body of research in surgical care into physician-level rewards for quality, including choice of operation. Promoting safe surgery should be an important component of a strong, value-based healthcare system. Resolving the potentially perverse incentives in paying for surgical approaches may help address disparities in surgical care, reduce the prevalent problem of variation, and help contain health care costs.

Benchmarking the cost efficiency of community care in Australian child and adolescent mental health services: implications for future benchmarking.

PubMed

Furber, Gareth; Brann, Peter; Skene, Clive; Allison, Stephen

2011-06-01

The purpose of this study was to benchmark the cost efficiency of community care across six child and adolescent mental health services (CAMHS) drawn from different Australian states. Organizational, contact and outcome data from the National Mental Health Benchmarking Project (NMHBP) data-sets were used to calculate cost per "treatment hour" and cost per episode for the six participating organizations. We also explored the relationship between intake severity as measured by the Health of the Nations Outcome Scales for Children and Adolescents (HoNOSCA) and cost per episode. The average cost per treatment hour was $223, with cost differences across the six services ranging from a mean of $156 to $273 per treatment hour. The average cost per episode was $3349 (median $1577) and there were significant differences in the CAMHS organizational medians ranging from $388 to $7076 per episode. HoNOSCA scores explained at best 6% of the cost variance per episode. These large cost differences indicate that community CAMHS have the potential to make substantial gains in cost efficiency through collaborative benchmarking. Benchmarking forums need considerable financial and business expertise for detailed comparison of business models for service provision.

Distribution system costs associated with the deployment of photovoltaic systems

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

Horowitz, Kelsey A. W.; Palmintier, Bryan; Mather, Barry

The broadening of our energy system to include increasing amounts of wind and solar has led to significant debate about the total costs and benefits associated with different types of generators - with potentially far-reaching policy implications. This has included debate about the cost associated with integrating these generators onto the electric grid. For photovoltaics (PV), this encompasses costs incurred on both the bulk power and distribution systems, as well as the value provided to them. These costs and benefits, in particular those associated with integrating PV onto the distribution system, are not well understood. We seek to advance themore » state of understanding of 'grid integration costs' for the distribution system by reviewing prior literature and outlining a transparent, bottom-up approach that can be used to calculate these costs. We provide a clear delineation of costs to integrate PV in to the distribution system within the larger context of total costs and benefits associated with PV generators. We emphasize that these costs are situationally dependent, and that a single 'cost of integration' cannot be obtained. We additionally emphasize that benefits must be considered when evaluating the competitiveness of the technology in a given situation.« less

Financial Implications of Intravenous Anesthetic Drug Wastage in Operation Room

PubMed Central

Kaniyil, Suvarna; Krishnadas, A.; Parathody, Arun Kumar; Ramadas, K. T.

2017-01-01

Background and Objectives: Anesthetic drugs and material wastage are common in operation rooms (ORs). In this era of escalating health-care expenditure, cost reduction strategies are highly relevant. The aim of this study was to assess the amount of daily intravenous anesthetic drug wastage from major ORs and to estimate its financial burden. Any preventive measures to minimize drug wastage are also looked for. Methods: It was a prospective study conducted at the major ORs of a tertiary care hospital after getting the Institutional Research Committee approval. The total amount of all drugs wasted at the end of a surgical day from each major OR was audited for five nonconsecutive weeks. Drug wasted includes the drugs leftover in the syringes unutilized and opened vials/ampoules. The total cost of the wasted drugs and average daily loss were estimated. Results: The drugs wasted in large quantities included propofol, thiopentone sodium, vecuronium, mephentermine, lignocaine, midazolam, atropine, succinylcholine, and atracurium in that order. The total cost of the wasted drugs during the study period was Rs. 59,631.49, and the average daily loss was Rs. 1987.67. The average daily cost of wasted drug was maximum for vecuronium (Rs. 699.93) followed by propofol (Rs. 662.26). Interpretation and Conclusions: Financial implications of anesthetic drug wastage can be significant. Propofol and vecuronium contributed maximum to the financial burden. Suggestions for preventive measures to minimize the wastage include education of staff and residents about the cost of drugs, emphasizing on the judicial use of costly drugs. PMID:28663611

Tradable credits system design and cost savings for a national low carbon fuel standard for road transport

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

Rubin, Jonathan; Leiby, Paul N.

2012-06-11

This research examines the economic implications of different designs for a national low carbon fuel standard (NLCFS) for the road transportation sector. A NLCFS based on the average Carbon Intensity (CI) of all fuels sold in the gasoline and diesel markets will generate an incentive for fuel suppliers to reduce the measured CI of their petroleum fuels. The economic impacts of a NLCFS are fundamentally determined by: the availability of low carbon fuels; the compliance path; the reference level CI of the fuel baseline; and the degree of flexibility in the credit system. To quantitatively examine the implications of amore » NLCFS, we created the Transportation Regulation and Credit Trading (TRACT) Model. With TRACT, we model a NLCFS credit trading system among profit maximizing fuel suppliers for light- and heavy-duty vehicle fuel use for the United States from 2012 - 2030. Given the wide range of cost and availability of biofuels, we find that credit trading across gasoline and diesel fuel markets combined with credit banking can significantly reduce compliance costs and stabilize credit prices. We make policy recommendations on how to combine a NLCFS with other existing regulations for transportation fuels.« less

Equivalence and interchangeability of narrow therapeutic index drugs in organ transplantation

PubMed Central

Johnston, Atholl

2013-01-01

The calcineurin inhibitors (CNIs), ciclosporin and tacrolimus, are the mainstay of immunosuppression in solid organ transplantation. Generic formulations of these drugs are now available. With increasing pressure on healthcare budgets and the consequent need to match health expectations to available resources, substitution with a generic product appears an attractive option to reduce costs. Approval of generic products differs from innovator drugs, and narrow therapeutic index drugs (NTIs; including CNIs) bring their own particular considerations. With NTIs, small variations in drug exposure could result in reduced immunosuppression or drug toxicity with potentially adverse effects on patient outcomes. NTIs are subject to stricter regulatory approval versus many other generic drugs. However, different generic formulations may still not necessarily be therapeutically equivalent in individuals, raising the possibility of significant differences in exposure between products. Although regional recommendations vary, many guidelines emphasise the need for NTI drug substitution to be initiated by the transplant physician, thus ensuring careful therapeutic monitoring and reduced negative patient impact. The need for therapeutic monitoring during generic substitution has important implications for the overall costs of generic treatment as these costs have to be factored in to the potential savings made from using generic formulations. The reduced acquisition costs of generic products may not necessarily translate into lower overall healthcare costs. This article examines the issue of equivalence and interchangeability of NTI drugs used in organ transplantation, the implications of the approval process for generic drugs on treatment efficacy and safety, and the effective management of substitutions between products. PMID:24089632

Overcoming Cost Implications of Mutational Analysis in Patients with Gastrointestinal Stromal Tumors: A Pragmatic Approach.

PubMed

Schöffski, Patrick; Wozniak, Agnieszka; Schöffski, Oliver; van Eycken, Liesbet; Debiec-Rychter, Maria

2016-01-01

Genetic analysis of tissue derived from patients with advanced gastrointestinal stromal tumors (GISTs) is not uniformly applied on a national and international level, even though mutational data can provide clinically relevant prognostic and predictive information, especially in patients qualifying for treatment with expensive targeted agents. The current article describes the rationale for genetic testing of GIST tissue, looks at financial implications associated with such analysis and speculates on potential cost savings introduced by routine mutational testing and tailored use of tyrosine kinase inhibitors based on genotyping. This work is based on a hypothetical analysis of epidemiological data, drug costs, reimbursement criteria and market research figures. The cost burden for routine genotyping of important genes in GISTs, especially in patients at high risk for relapse after primary surgery and in advanced, inoperable metastatic disease, is relatively low. The early identification of GISTs with primary resistance mutations should be the basis for personalized GIST treatment and reimbursement of drugs. As illustrated by Belgian figures, the exclusive use of a drug such as imatinib in patients who are likely to benefit from the agent based on genetic information can lead to significant cost savings, which outweigh the costs for testing. Mutational analysis of GIST should be considered early in all patients at risk for relapse after curative surgery and in the case of advanced, inoperable, metastatic disease. The costs for the actual genotyping should not be used as an argument against profiling of the tumor. The adjuvant and palliative systemic treatment of GISTs should be personalized based on the genotype and other known prognostic and predictive factors. Reimbursement criteria for essential agents such as imatinib should be adapted accordingly. © 2016 S. Karger GmbH, Freiburg.

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

PubMed

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

2014-02-01

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

Time to clinical response: an outcome of antibiotic therapy of febrile neutropenia with implications for quality and cost of care.

PubMed

Elting, L S; Rubenstein, E B; Rolston, K; Cantor, S B; Martin, C G; Kurtin, D; Rodriguez, S; Lam, T; Kanesan, K; Bodey, G

2000-11-01

To determine whether antibiotic regimens with similar rates of response differ significantly in the speed of response and to estimate the impact of this difference on the cost of febrile neutropenia. The time point of clinical response was defined by comparing the sensitivity, specificity, and predictive values of alternative objective and subjective definitions. Data from 488 episodes of febrile neutropenia, treated with either of two commonly used antibiotics (coded A or B) during six clinical trials, were pooled to compare the median time to clinical response, days of antibiotic therapy and hospitalization, and estimated costs. Response rates were similar; however, the median time to clinical response was significantly shorter with A-based regimens (5 days) compared with B-based regimens (7 days; P =.003). After 72 hours of therapy, 33% of patients who received A but only 18% of those who received B had responded (P =.01). These differences resulted in fewer days of antibiotic therapy and hospitalization with A-based regimens (7 and 9 days) compared with B-based regimens (9 and 12 days, respectively; P <.04) and in significantly lower estimated median costs ($8,491 v $11,133 per episode; P =.03). Early discharge at the time of clinical response should reduce the median cost from $10,752 to $8,162 (P <.001). Despite virtually identical rates of response, time to clinical response and estimated cost of care varied significantly among regimens. An early discharge strategy based on our definition of the time point of clinical response may further reduce the cost of treating non-low-risk patients with febrile neutropenia.

Targeting the probability versus cost of feared outcomes in public speaking anxiety.

PubMed

Nelson, Elizabeth A; Deacon, Brett J; Lickel, James J; Sy, Jennifer T

2010-04-01

Cognitive-behavioral theory suggests that social phobia is maintained, in part, by overestimates of the probability and cost of negative social events. Indeed, empirically supported cognitive-behavioral treatments directly target these cognitive biases through the use of in vivo exposure or behavioral experiments. While cognitive-behavioral theories and treatment protocols emphasize the importance of targeting probability and cost biases in the reduction of social anxiety, few studies have examined specific techniques for reducing probability and cost bias, and thus the relative efficacy of exposure to the probability versus cost of negative social events is unknown. In the present study, 37 undergraduates with high public speaking anxiety were randomly assigned to a single-session intervention designed to reduce either the perceived probability or the perceived cost of negative outcomes associated with public speaking. Compared to participants in the probability treatment condition, those in the cost treatment condition demonstrated significantly greater improvement on measures of public speaking anxiety and cost estimates for negative social events. The superior efficacy of the cost treatment condition was mediated by greater treatment-related changes in social cost estimates. The clinical implications of these findings are discussed. Published by Elsevier Ltd.

Cost implications of organizing nursing home workforce in teams.

PubMed

Mukamel, Dana B; Cai, Shubing; Temkin-Greener, Helena

2009-08-01

To estimate the costs associated with formal and self-managed daily practice teams in nursing homes. Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers. A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors. Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports. Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians. Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs.

Neural Basis of Empathy and Its Dysfunction in Autism Spectrum Disorders (ASD)

DTIC Science & Technology

2012-08-01

donation behavior in rhesus monkeys when there is no perceived cost to self. These findings potentially implicate shared neural mechanisms and validate the...egalitarian and monogamous ones, like prairie voles and humans, when there is no perceived cost to self. These findings potentially implicate shared neural...maximally self-regarding in this context in the absence of OT. Thus, OT robustly enhanced prosocial choices when there was no potential cost to self, but

Comparing definitions of outpatient surgery: Implications for quality measurement.

PubMed

Mull, Hillary J; Rivard, Peter E; Legler, Aaron; Pizer, Steven D; Hawn, Mary T; Itani, Kamal M F; Rosen, Amy K

2017-08-01

Adverse event (AE) rates in outpatient surgery are inconsistently reported, partly because of the lack of a standard definition of outpatient surgery. We compared the types and rates of surgical procedures defined by two national healthcare agencies: Health Care Cost Institute (HCCI) and the Healthcare Cost and Utilization Project (HCUP) and considered implications for quality measurement. We used HCCI and HCUP definitions to identify FY2012-14 VA outpatient surgeries. There were six times as many HCCI surgeries as HCUP (6,575,830 versus 1,086,640). Ninety-nine percent of HCUP-defined surgeries were also identified by HCCI. More HCUP surgeries had higher average Medicare Relative Value Units then HCCI surgeries [5.3 (SD = 4.4) versus 1.6 (SD = 2.3) RVUs]. Rates and types of procedures vary widely between definitions. Quality measurement using HCCI versus HCUP may produce significantly lower AE rates because many of the surgeries included reflect low complexity and potentially low risk of AEs. Published by Elsevier Inc.

The Potential of Phased Arrays for Planetary Exploration

NASA Astrophysics Data System (ADS)

Pogorzelski, Ronald J.

2000-01-01

Phased array antennas provide a set of operational capabilities which are very attractive for certain mission applications and not very attractive for others. Such antennas are by no means a panacea for telecommunications. In this paper the features of phased arrays are reviewed and their implications for space missions are considered in terms of benefits and costs. The primary capability provided by a phased array is electronic beam agility. The beam direction may be controlled at electronic speeds (vs. mechanical actuation) permitting time division multiplexing of multiple "users." Moreover, the beam direction can be varied over a full hemisphere (for a planar array). On the other hand, such antennas are typically much more complicated than the more commonly used reflectors and horns and this implies higher cost. In some applications, this increased cost must be accepted if the mission is to be carried out at all. The SIR-C radar is an example of such a case albeit not for deep space. Assuming for the sake of argument that the complexity and cost of a phased array can be significantly reduced, where can such antennas be of value in the future of planetary exploration? Potential applications to be discussed are planetary rovers, landers, and orbiters including both the areosynchronous and low orbit varieties. In addition, consideration is given to links from deep space to earth. As may be fairly obvious, the deep space link to earth would not benefit from the wide angle steering capability provided by a phase array whereas a rover could gain advantage from the capability to steer a beam anywhere in the sky. In the rover case, however, physical size of the aperture becomes a significant factor which, of course, has implications regarding the choice of frequency band. Recent research work concerning phased arrays has suggested that future phased arrays might be made less complex and, therefore, less costly. Successful realization of such phased arrays would enable many of the planetary missions discussed in this paper and significantly broaden the telecommunications capabilities available to the mission designers of the future.

Air pollution, public health, and inflation

PubMed Central

Ostro, Bart David

1980-01-01

Since the passage of the environmental legislation in the early 1970's, critics have attacked these laws as being unnecessary and for contributing significantly to the problem of inflation in the United States. This paper is an attempt to put the inflationary costs of air pollution into perspective by considering them in light of the cost, especially to public health, of not proceeding with pollution control. There is now a great deal of evidence that the concentration of certain pollutants in the air can contribute significantly to the incidence of respiratory and cardiovascular diseases and to certain forms of cancer. On the basis of the results of a recent study of the impacts of pollution control on inflation, the annual reduction in purchasing power of the average family is calculated to be $31 per family. To determine the average costs of air pollution on human health, research by Lave and Seskin is utilized. First, the implications of air pollution for mortality and morbidity rates are determined. Then, the reduction in direct health costs and indirect costs (lost productivity of workers) as a result of pollution abatement is estimated. These annual health costs from pollution total approximately $250 per family. The results suggest that the inflationary costs of air pollution control are more than offset by the damages to public health from unabated air pollution. PMID:6771129

The Potential Cost Implications of Averting Severe Hypoglycemic Events Requiring Hospitalization in High-Risk Adults With Type 1 Diabetes Using Real-Time Continuous Glucose Monitoring

PubMed Central

Bronstone, Amy; Graham, Claudia

2016-01-01

Background: Severe hypoglycemia remains a major barrier to optimal diabetes management and places a high burden on the US health care system due to the high costs of hypoglycemia-related emergency visits and hospitalizations. Patients with type 1 diabetes (T1DM) who have hypoglycemia unawareness are at a particularly high risk for severe hypoglycemia, the incidence of which may be reduced by the use of real-time continuous glucose monitoring (RT-CGM). Methods: We performed a cost calculation using values of key parameters derived from various published sources to examine the potential cost implications of standalone RT-CGM as a tool for reducing rates of severe hypoglycemia requiring hospitalization in adult patients with T1DM who have hypoglycemia unawareness. Results: In a hypothetical commercial health plan with 10 million members aged 18-64 years, 9.3% (930 000) are expected to have diagnosed diabetes, with approximately 5% (46 500) having T1DM, of whom approximately 20% (9300) have hypoglycemia unawareness. RT-CGM was estimated to reduce the cost of annual hypoglycemia-related hospitalizations in this select population by $54 369 000, yielding an estimated net cost savings of $8 799 000 to $12 519 000 and a savings of $946 to $1346 per patient. Conclusion: This article presents a cost calculation based on available data from multiple sources showing that RT-CGM has the potential to reduce short-term health care costs by averting severe hypoglycemic events requiring hospitalization in a select high-risk population. Prospective, randomized studies that are adequately powered and specifically enroll patients at high risk for severe hypoglycemia are needed to confirm that RT-CGM significantly reduces the incidence of these costly events. PMID:26880392

Disease management improves end-stage renal disease outcomes.

PubMed

Sands, Jeffrey J

2006-01-01

Renal disease management organizations have reported achieving significant decreases in mortality and hospitalization in conjunction with cost savings, improved patient satisfaction and quality of life. Disease management organizations strive to fill existing gaps in care delivery through the standardized use of risk assessment, predictive modeling, evidence-based guidelines, and process and outcomes measurement. Patient self-management education and the provision of individual nurse care managers are also key program components. As we more fully measure clinical outcomes and total healthcare costs, including payments from all insurance and government entities, pharmacy costs and out of pocket expenditures, the full implications of disease management can be better defined. The results of this analysis will have a profound influence on United States healthcare policy. At present current data suggest that the promise of disease management, improved care at reduced cost, can and is being realized in end-stage renal disease. Copyright 2006 S. Karger AG, Basel.

Nitrogen in the Baltic Sea--policy implications of stock effects.

PubMed

Hart, Rob; Brady, Mark

2002-09-01

We develop an optimal control model for cost-effective management of pollution, including two state variables, pollution stock and ecosystem quality. We apply it to Baltic Sea pollution by nitrogen leachates from agriculture. We present a sophisticated, non-linear model of leaching abatement costs, and a simple model of nitrogen stocks. We find that significant abatement is achievable at reasonable cost, despite the countervailing effects of existing agricultural policies such as price supports. Successful abatement should lead to lower nitrogen stocks in the sea in 5 years or less. However, the rate of ecosystem recovery is less certain. The results are highly dependent on the rate of self-cleaning of the Baltic Sea, and less so on the discount rate. Choice of target has a radical effect on the abatement path chosen. Cost-effectiveness demands such a choice, and should therefore be used with care when stock effects are present.

Insecticide Resistance and Malaria Vector Control: The Importance of Fitness Cost Mechanisms in Determining Economically Optimal Control Trajectories

PubMed Central

Brown, Zachary S.; Dickinson, Katherine L.; Kramer, Randall A.

2014-01-01

The evolutionary dynamics of insecticide resistance in harmful arthropods has economic implications, not only for the control of agricultural pests (as has been well studied), but also for the control of disease vectors, such as malaria-transmitting Anopheles mosquitoes. Previous economic work on insecticide resistance illustrates the policy relevance of knowing whether insecticide resistance mutations involve fitness costs. Using a theoretical model, this article investigates economically optimal strategies for controlling malaria-transmitting mosquitoes when there is the potential for mosquitoes to evolve resistance to insecticides. Consistent with previous literature, we find that fitness costs are a key element in the computation of economically optimal resistance management strategies. Additionally, our models indicate that different biological mechanisms underlying these fitness costs (e.g., increased adult mortality and/or decreased fecundity) can significantly alter economically optimal resistance management strategies. PMID:23448053

The effect of dietary nicotine on the allocation of assimilated food to energy metabolism and growth in fourth-instar larvae of the southern armyworm, Spodoptera eridania (Lepidoptera: Noctuidae).

PubMed

Cresswell, James E; Merritt, Stewart Z; Martin, Michael M

1992-03-01

Dietary nicotine (0.5%), which is a substrate of the PSMO (polysubstrate monooxygenase) detoxification system in the southern armyworm Spodoptera eridania, has significant negative effects on the weight of food ingested, weight gained, relative growth rate (RGR), and efficiency of conversion of digested food (ECD) by fourthinstar S. eridania larvae on a nutrient-rich artificial diet. It has a significant positive effect on the weight of food respired by the larvae. Thus, the detoxification of nicotine by the PSMO system exacts a fitness cost and imposes a metabolic cost on S. eridania larvae. In contrast, dietary α-(+)-pinene, an inducer of the PSMO system, neither exacts a fitness cost nor imposes a metabolic cost on the larvae. We believe this to be the first study to demonstrate unequivocally that the negative effect of a dietary toxin on net growth efficiency (ECD) in an insect herbivore is due to an increase in the allocation of assimilated food to energy metabolism and not to a decrease in the amount of food assimilated. This study, therefore, supports the hypothesis that detoxification can impose a significant metabolic load on an insect herbivore. Implications of a corroboration of the metabolic load hypothesis are discussed.

One-Year Health Care Costs Associated with Delirium in the Elderly

PubMed Central

Leslie, Douglas L.; Marcantonio, Edward R.; Zhang, Ying; Leo-Summers, Linda; Inouye, Sharon K.

2015-01-01

Background While delirium has been increasingly recognized as a serious and potentially preventable source of morbidity and mortality for hospitalized older persons, its long-term implications are not well understood. The objective of this study is to determine the total 1-year health care costs associated with delirium. Methods Hospitalized patients aged 70 years and older who participated in a previous controlled clinical trial of a delirium prevention intervention at an academic medical center between 1995 and 1998 were followed for 1 year after discharge. Total inflation-adjusted healthcare costs were computed using data from Medicare administrative files, hospital billing records, and the Connecticut Long-Term Care Registry. Regression models were used to determine costs associated with delirium after adjusting for patient sociodemographic and clinical characteristics. Results During the index hospitalization, 109 (13%) patients developed delirium while 732 did not. Patients with delirium had significantly higher unadjusted healthcare costs than non-delirious patients and survived fewer days. After adjusting for pertinent demographic and clinical characteristics, average costs per day survived among patients with delirium were over two and a half times the costs among patients without delirium. Total cost estimates attributable to delirium ranged from $16,303 to $64,421 per patient, implying that the national burden of delirium on the health care system ranges from $38 billion to $152 billion each year. Conclusions The economic impact of delirium is substantial, rivaling the health care costs of falls and diabetes. These results highlight the need for increased efforts to mitigate this clinically significant and costly disorder. PMID:18195192

Consumer-directed health care: implications for health care organizations and managers.

PubMed

Guo, Kristina L

2010-01-01

This article uses a pyramid model to illustrate the key components of consumer-directed health care. Consumer-directed health care is considered the essential strategy needed to lower health care costs and is valuable for making significant strides in health care reform. Consumer-directed health care presents new challenges and opportunities for all health care stakeholders and their managers. The viability of the health system depends on the success of managers to respond rapidly and with precision to changes in the system; thus, new and modified roles of managers are necessary to successfully sustain consumerism efforts to control costs while maintaining access and quality.

Medicare privatization and the erosion of retirement security.

PubMed

Polivka, Larry; Kwak, Jung

2008-01-01

This paper describes initiatives to privatize the Medicare program over the last 10 years and the implications of these initiatives for the future of retirement security. Our analysis focuses on the privatization provisions of the Medicare Modernization Act, which is largely designed to benefit the corporate health care sector without containing costs or significantly reducing the threat of rising health care costs to the economic security of current and future retirees. In fact, as designed, the Medicare Modernization Act is likely to increase the threat to retirement security in the years ahead. We conclude with a series of policy alternatives to the neoliberal agenda for the privatization of Medicare.

Financial well-being of young children with disabilities and their families.

PubMed

Parish, Susan L; Cloud, Jennifer M

2006-07-01

Young children with disabilities are significantly more likely to live in poverty than their peers without disabilities. Exposure to poverty creates additional risk of adverse outcomes for these vulnerable children. In this article, the following key circumstances contributing to this increased risk of impoverishment are analyzed: elevated costs of raising children with disabilities, low levels of public income transfer benefits, difficulty balancing parental employment and caregiving responsibilities, unavailable or high-cost child care, and inadequate leave time to permit parents to meet their children's episodic care needs. The implications of these issues for social work practice and advocacy needs are discussed.

Benefit design innovations: implications for consumer-directed health care.

PubMed

Tu, Ha T; Ginsburg, Paul B

2007-02-01

Current health insurance benefit designs that simply rely on higher, one-size-fits-all patient cost sharing have limited potential to curb rapidly rising costs, but innovations in benefit design can potentially make cost sharing a more effective tool, according to a new study by the Center for Studying Health System Change (HSC). Innovative benefit designs include incentives to encourage healthy behaviors; incentives that vary by service type, patient condition or enrollee income; and incentives to use efficient providers. But most applications of these innovative designs are not widespread, suggesting that any significant cost impact is many years off. Moreover, regulations governing high-deductible, consumer-directed health plans eligible for health savings accounts (HSAs) preclude some promising benefit design innovations and dilute the incentives in others. A movement away from a one-size-fits-all HSA benefit structure toward a more flexible design might broaden the appeal of HSA plans and enable them to incorporate features that promote cost-effective care.

The Cost of a Healthier Diet for Young Children with Type 1 Diabetes Mellitus

PubMed Central

Patton, Susana R.; Goggin, Kathy; Clements, Mark A.

2015-01-01

Objective The study used a market-basket approach to examine the availability and cost of a standard food shopping list (R-TFP) versus a healthier food shopping list (H-TFP) in the grocery stores used by a sample of 23 families of young children with type 1 diabetes mellitus (T1DM). Methods Frequency counts were used to measure availability. The average cost of the R-TFP and the H-TFP was compared using a paired t-test. Results Small or independent markets had the highest percent of missing foods (14%), followed by chain supermarkets (3%), and big box stores (2%). There was a significant difference in the average cost for the R-TFP versus the H-TFP ($324.71 and $380.07, respectively p<0.001). Conclusions and Implications Families may encounter problems finding healthier foods and/or incur greater costs for healthier foods. Nutrition education programs for T1DM need to teach problem solving to help families overcome these barriers. PMID:26164132

Cost Accounting for Decision Makers.

ERIC Educational Resources Information Center

Kaneklides, Ann L.

1985-01-01

Underscores the importance of informed decision making through accurate anticipation of cost incurrence in light of changing economic and environmental conditions. Explains the concepts of cost accounting, full allocation of costs, the selection of an allocation base, the allocation of indirect costs, depreciation, and implications for community…

Preventive and social cost implications of Ebola Virus Disease (EVD) outbreak on selected organizations in Lagos state, Nigeria

PubMed Central

Olugasa, Babasola Oluseyi; Oshinowo, Oluwafunmilola Yemisi; Odigie, Eugene Amienwanlen

2015-01-01

Introduction As Ebola virus disease (EVD) continues to pose public health challenge in West Africa, with attending fears and socio-economic implications in the current epidemic challenges. It is compelling to estimate the social and preventive costs of EVD containment in a Nigerian city. Hence, this study was to determine the social and preventive cost implications of EVD among selected public institutions in Lagos, Nigeria, from July to December, 2014. Methods Questionnaires and key-informants interview were administered to respondents and administrators of selected hospitals, hotels and schools in Eti-Osa Local Government Area of Lagos State. Knowledge of disease transmission, mortality and protocols for prevention, including cost of specific preventive measures adopted against EVD were elicited from respondents. Descriptive statistics and categorical analysis were used to summarize and estimate social and preventive costs incurred by respective institutions. Results An estimated five million, nineteen thousand, three hundred and seventy-nine Naira and eighty kobo (N5,019,379.80) only was observed as direct and social cost implication of EVD prevention. This amount translated into a conservative estimate of one billion, twenty-seven million, ninety-four thousand, seven hundred and fifty-six Naira (N1,027,094,756.10) for a total of four thousand schools, two hundred and fifty-three hospitals and one thousand, four hundred and fifty one hotels in Lagos during the period (July 20-November 20, 2014). Conclusion The high cost of prevention of EVD within the short time-frame indicated high importance attached to a preventive policy against highly pathogenic zoonotic disease in Nigeria. PMID:26740848

Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery: A Cost Analysis.

PubMed

Eichler, Klaus; Urner, Martin; Twerenbold, Claudia; Kern, Sabine; Brügger, Urs; Spahn, Donat R; Beck-Schimmer, Beatrice; Ganter, Michael T

2017-03-01

Pharmacologic pre- and postconditioning with sevoflurane compared with total IV anesthesia in patients undergoing liver surgery reduced complication rates as shown in 2 recent randomized controlled trials. However, the potential health economic consequences of these different anesthesia regimens have not yet been assessed. An expostcost analysis of these 2 trials in 129 patients treated between 2006 and 2010 was performed. We analyzed direct medical costs for in-hospital stay and compared pharmacologic pre- and postconditioning with sevoflurane (intervention) with total IV anesthesia (control) from the perspective of a Swiss university hospital. Year 2015 costs, converted to US dollars, were derived from hospital cost accounting data and compared with a multivariable regression analysis adjusting for relevant covariables. Costs with negative prefix indicate savings and costs with positive prefix represent higher spending in our analysis. Treatment-related costs per patient showed a nonsignificant change by -12,697 US dollars (95% confidence interval [CI], 10,956 to -36,352; P = .29) with preconditioning and by -6139 US dollars (95% CI, 6723 to -19,000; P = .35) with postconditioning compared with the control group. Results were robust in our sensitivity analysis. For both procedures (control and intervention) together, major complications led to a significant increase in costs by 86,018 US dollars (95% CI, 13,839-158,198; P = .02) per patient compared with patients with no major complications. In this cost analysis, reduced in-hospital costs by pharmacologic conditioning with sevoflurane in patients undergoing liver surgery are suggested. This possible difference in costs compared with total IV anesthesia is the result of reduced complication rates with pharmacologic conditioning, because major complications have significant cost implications.

Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value?

PubMed

Rizzo, J A; Bogardus , S T; Leo-Summers, L; Williams, C S; Acampora, D; Inouye, S K

2001-07-01

Delirium, or acute confusional state, is a common and serious occurrence among hospitalized older persons. Current estimates suggest that delirium complicates hospital stays for more than 2.3 million older persons each year, involving more than 17.5 million hospital days and accounting for more than $4 billion (1994 dollars) of Medicare expenditures. A 40% reduction was recently reported in the risk for delirium among hospitalized older persons receiving a multicomponent targeted risk factor intervention (MTI) strategy to prevent delirium, compared with subjects receiving usual hospital care.1 Before recommending that this preventive strategy be implemented in clinical practice, however, the cost implications must be thoroughly examined as well. The present analysis performs net cost evaluations of the MTI for the prevention of delirium among hospitalized patients. Hospital charge and cost-to-charge ratio data are linked to a database of 852 subjects, who were treated with MTI or usual care. Multivariable regression methods were used to help isolate the impact of MTI on hospital costs. These results were then combined with our earlier work on the impact of the MTI on delirium prevention to assess the cost effectiveness of this intervention. The MTI significantly reduced nonintervention costs among subjects at intermediate risk for developing delirium, but not among subjects at high risk. When MTI intervention costs were included, MTI had no significant effect on overall health care costs in the intermediate risk cohort, but raised overall costs in the high risk group. Because the MTI prevented delirium in the intermediate risk group without raising costs, the conclusion reached is that it is a cost effective treatment option for patients at intermediate risk for developing delirium. In contrast, the results suggest that the MTI is not cost effective for subjects at high risk.

Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery: A Cost Analysis

PubMed Central

Urner, Martin; Twerenbold, Claudia; Kern, Sabine; Brügger, Urs; Spahn, Donat R.; Beck-Schimmer, Beatrice; Ganter, Michael T.

2017-01-01

BACKGROUND: Pharmacologic pre- and postconditioning with sevoflurane compared with total IV anesthesia in patients undergoing liver surgery reduced complication rates as shown in 2 recent randomized controlled trials. However, the potential health economic consequences of these different anesthesia regimens have not yet been assessed. METHODS: An expostcost analysis of these 2 trials in 129 patients treated between 2006 and 2010 was performed. We analyzed direct medical costs for in-hospital stay and compared pharmacologic pre- and postconditioning with sevoflurane (intervention) with total IV anesthesia (control) from the perspective of a Swiss university hospital. Year 2015 costs, converted to US dollars, were derived from hospital cost accounting data and compared with a multivariable regression analysis adjusting for relevant covariables. Costs with negative prefix indicate savings and costs with positive prefix represent higher spending in our analysis. RESULTS: Treatment-related costs per patient showed a nonsignificant change by −12,697 US dollars (95% confidence interval [CI], 10,956 to −36,352; P = .29) with preconditioning and by −6139 US dollars (95% CI, 6723 to −19,000; P = .35) with postconditioning compared with the control group. Results were robust in our sensitivity analysis. For both procedures (control and intervention) together, major complications led to a significant increase in costs by 86,018 US dollars (95% CI, 13,839-158,198; P = .02) per patient compared with patients with no major complications. CONCLUSIONS: In this cost analysis, reduced in-hospital costs by pharmacologic conditioning with sevoflurane in patients undergoing liver surgery are suggested. This possible difference in costs compared with total IV anesthesia is the result of reduced complication rates with pharmacologic conditioning, because major complications have significant cost implications. PMID:28067701

Increased maternal BMI is associated with an increased risk of minor complications during pregnancy with consequent cost implications.

PubMed

Denison, F C; Norrie, G; Graham, B; Lynch, J; Harper, N; Reynolds, R M

2009-10-01

To investigate the effect of maternal body mass index (BMI) on minor complications, associated additional medication use during pregnancy and the consequent cost implications. Retrospective analysis of case notes. Labour wards, tertiary referral hospital, Royal Infirmary Edinburgh, UK. Population Six hundred and fifty-one women with a singleton pregnancy over four separate time periods in 2007 and 2008. Descriptive statistics, univariate and multivariate logistic regression analysis and cost analysis using standard techniques and inflation indices. Minor complications, use of medications during pregnancy and consequent incremental costs from the perspective of the National Health Service (NHS). 42.4% of women were overweight or obese (BMI > or = 25 kg/m(2)). Higher BMI during the first trimester (BMI > or = 30 kg/m(2) compared with BMI < 25 kg/m(2)) was associated with an increased risk of minor complications including symphysis pubis dysfunction (OR 3.97; 95% CI 2.19-7.18), heartburn (OR 2.65; 95% CI 1.42-4.94) and chest infection (OR 8.71; 95% 2.20-34.44) and with drugs used to treat these complications including Gaviscon (OR 3.52; 95% CI 1.78-6.96). The mean incremental (additional) NHS costs per woman for treating minor complications increased with maternal BMI were 15.45 pounds/woman, 17.64 pounds/woman and 48.66 pounds/woman for BMI < 25 kg/m(2), BMI > or = 25 to <30 kg/m(2) and BMI > or = 30 kg/m(2) respectively. Increased maternal BMI is associated with increased risk of developing minor complications during pregnancy; use of medications associated with treating these conditions and has significant NHS costs.

Health economic implications of complications associated with pancreaticoduodenectomy at a University Hospital: a retrospective cohort cost study.

PubMed

Wang, Jason; Ma, Ronald; Eleftheriou, Paul; Churilov, Leonid; Debono, David; Robbins, Ray; Nikfarjam, Mehrdad; Christophi, Chris; Weinberg, Laurence

2018-05-01

A cost analyses of complications following pancreaticoduodenectomy (PD) was performed in a high volume hepato-biliary-pancreatic service. We hypothesised that costs are increased with both severity and number of complications; we investigated the relationship between complications and specific cost centres. 100 patients from 2011 to 2016 were included. Data relating to their perioperative course were collected. Complications were documented by the Clavien-Dindo classification and costs were inflated and converted to 2017 USD. Mean hospital costs in complicated patients more than doubled those of uncomplicated patients ($28 330 vs. $57 150, p < 0.0001). Total hospital costs significantly increased with both severity and number of complications. This cost increase was influenced by medical consult, pathology, pharmacy, radiology, ward, intensive care, and allied health costs, but not operating theatre or anaesthesia costs. Postoperative pancreatic fistula, postoperative haemorrhage, delayed gastric emptying and infection were associated with cost differentials of $65 438, $74 079, $35 620 and $46 316 respectively over uncomplicated patients. The development of complications following PD is common, costly and associated with increased length of stay. Costs increased with greater complication severity, and specific complications. The in-depth breakdown of hospital costs suggests specific targets for cost containment. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Protein-energy wasting significantly increases healthcare utilization and costs among patients with chronic kidney disease: a propensity-score matched cohort study.

PubMed

Chao, Chia-Ter; Tang, Chao-Hsiun; Cheng, Rhoda Wen-Yi; Wang, Michael Yao-Hsien; Hung, Kuan-Yu

2017-09-01

Disease-related malnutrition is highly prevalent, and has prognostic implications for patients with chronic kidney disease (CKD); however, few studies have investigated the impact of malnutrition, or protein-energy wasting (PEW), on healthcare utilization and medical expenditure among CKD patients. Using claim data from the National Health Insurance in Taiwan, this study identified patients with CKD between 2009-2013 and categorized them into those with mild, moderate, or severe CKD. Cases with PEW after CKD was diagnosed were propensity-score matched with controls in a 1:4 ratio. Healthcare resource utilization metrics were compared, including outpatient and emergency department visits, frequency and duration of hospitalization, and the cumulative costs associated with different CKD severity. From among 347,501 CKD patients, eligible cohorts of 66,872 with mild CKD (49.2%), 27,122 with moderate CKD (19.9%), and 42,013 with severe CKD (30.9%) were selected. Malnourished CKD patients had significantly higher rates of hospitalization (p < .001 for all severities) and re-admission (p = .015 for mild CKD, p = .002 for severe CKD) than non-malnourished controls. Cumulative medical costs for outpatient and emergency visits, and hospitalization, were significantly higher among all malnourished CKD patients than non-malnourished ones (p < .001); total medical costs were also higher among malnourished patients with mild (62.9%), moderate (59.6%), or severe (43.6%) CKD compared to non-malnourished patients (p < .001). In a nationally-representative cohort, CKD patients with PEW had significantly more healthcare resource utilization and higher aggregate medical costs than those without, across the spectrum of CKD: preventing PEW in CKD patients should receive high priority if we would like to reduce medical costs.

School Lunch Waste among Middle School Students: Implications for Nutrients Consumed and Food Waste Costs

PubMed Central

Cohen, Juliana F.W.; Richardson, Scott; Austin, S. Bryn; Economos, Christina D.; Rimm, Eric B.

2013-01-01

Background The National School Lunch Program has been guided by modest nutrient standards, and the palatability of meals, which drives consumption, receives inadequate attention. School food waste can have important nutritional and cost implications for policy makers, students, and their families. Purpose Nutrient losses and economic costs associated with school meal waste were examined. The study also assessed if school foods served were valid proxies for foods consumed by students. Methods Plate waste measurements were collected from middle school students in Boston attending two Chef Initiative schools (n=1609) and two control schools (n=1440) during a two-year pilot study (2007-2009) where a professional chef trained cafeteria staff to make healthier school meals. The costs associated with food waste were calculated and the percent of foods consumed was compared with a gold standard of 85% consumption. Analyses were conducted in 2010-2011. Results Overall, students consumed less than the required/recommended levels of nutrients. An estimated $432,349 of food (26.1% of the total food budget) was discarded by middle school students annually at lunch in Boston middle schools. For most meal components, significantly less than 85% was consumed. Conclusions There is substantial food waste among middle school students in Boston. Overall, students' nutrient consumption levels were below school meal standards and foods served were not valid proxies for foods consumed. The costs associated with discarded foods are high; if translated nationally for school lunches, roughly $1,238,846,400 annually is wasted. Students would benefit if additional focus was given to the quality and palatability of school meals. PMID:23332326

Long term healthcare costs of infants who survived neonatal necrotizing enterocolitis: a retrospective longitudinal study among infants enrolled in Texas Medicaid

PubMed Central

2013-01-01

Background Infants who survive advanced necrotizing enterocolitis (NEC) at the time of birth are at increased risk of having poor long term physiological and neurodevelopmental growth. The economic implications of the long term morbidity in these children have not been studied to date. This paper compares the long term healthcare costs beyond the initial hospitalization period incurred by medical and surgical NEC survivors with that of matched controls without a diagnosis of NEC during birth hospitalization. Methods The longitudinal healthcare utilization claim files of infants born between January 2002 and December 2003 and enrolled in the Texas Medicaid fee-for-service program were used for this research. Propensity scoring was used to match infants diagnosed with NEC during birth hospitalization to infants without a diagnosis of NEC on the basis of gender, race, prematurity, extremely low birth weight status and presence of any major birth defects. The Medicaid paid all-inclusive healthcare costs for the period from 6 months to 3 years of age among children in the medical NEC, surgical NEC and matched control groups were evaluated descriptively, and in a generalized linear regression framework in order to model the impact of NEC over time and by birth weight. Results Two hundred fifty NEC survivors (73 with surgical NEC) and 2,909 matched controls were available for follow-up. Medical NEC infants incurred significantly higher healthcare costs than matched controls between 6–12 months of age (mean incremental cost = US$ 5,112 per infant). No significant difference in healthcare costs between medical NEC infants and matched controls was seen after 12 months. Surgical NEC survivors incurred healthcare costs that were consistently higher than that of matched controls through 36 months of age. The mean incremental healthcare costs of surgical NEC infants compared to matched controls between 6–12, 12–24 and 24–36 months of age were US$ 18,274, 14,067 (p < 0.01) and 8,501 (p = 0.06) per infant per six month period, respectively. These incremental costs were found to vary between sub-groups of infants born with birth weight < 1,000g versus ≥ 1,000g (p < 0.05). Conclusions The all-inclusive healthcare costs of surgical NEC survivors continued to be substantially higher than that of matched controls through the early childhood development period. These results can have important treatment and policy implications. Further research in this topic is needed. PMID:23962093

Implications of early and guideline adherent physical therapy for low back pain on utilization and costs.

PubMed

Childs, John D; Fritz, Julie M; Wu, Samuel S; Flynn, Timothy W; Wainner, Robert S; Robertson, Eric K; Kim, Forest S; George, Steven Z

2015-04-09

Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS). Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models. 753,450 eligible patients with a primary care visit for LBP between 18-60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs. The potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.

A cost-effective approach to the development of printed materials: a randomized controlled trial of three strategies.

PubMed

Paul, C L; Redman, S; Sanson-Fisher, R W

2004-12-01

Printed materials have been a primary mode of communication in public health education. Three major approaches to the development of these materials--the application of characteristics identified in the literature, behavioral strategies and marketing strategies--have major implications for both the effectiveness and cost of materials. However, little attention has been directed towards the cost-effectiveness of such approaches. In the present study, three pamphlets were developed using successive addition of each approach: first literature characteristics only ('C' pamphlet), then behavioral strategies ('C + B' pamphlet) and then marketing strategies ('C + B + M' pamphlet). Each pamphlet encouraged women to join a Pap Test Reminder Service (PTRS). Each pamphlet was mailed to a randomly selected sample of 2700 women aged 50-69 years. Registrations with the PTRS were monitored and 420 women in each pamphlet group were surveyed by telephone. It was reported that the 'C + B' and 'C + B + M' pamphlets were significantly more effective than the 'C' pamphlet. The 'C + B' pamphlet was the most cost-effective of the three pamphlets. There were no significant differences between any of the pamphlet groups on acceptability, knowledge or attitudes. It was suggested that the inclusion of behavioral strategies is likely to be a cost-effective approach to the development of printed health education materials.

The metabolic cost of changing walking speeds is significant, implies lower optimal speeds for shorter distances, and increases daily energy estimates.

PubMed

Seethapathi, Nidhi; Srinivasan, Manoj

2015-09-01

Humans do not generally walk at constant speed, except perhaps on a treadmill. Normal walking involves starting, stopping and changing speeds, in addition to roughly steady locomotion. Here, we measure the metabolic energy cost of walking when changing speed. Subjects (healthy adults) walked with oscillating speeds on a constant-speed treadmill, alternating between walking slower and faster than the treadmill belt, moving back and forth in the laboratory frame. The metabolic rate for oscillating-speed walking was significantly higher than that for constant-speed walking (6-20% cost increase for ±0.13-0.27 m s(-1) speed fluctuations). The metabolic rate increase was correlated with two models: a model based on kinetic energy fluctuations and an inverted pendulum walking model, optimized for oscillating-speed constraints. The cost of changing speeds may have behavioural implications: we predicted that the energy-optimal walking speed is lower for shorter distances. We measured preferred human walking speeds for different walking distances and found people preferred lower walking speeds for shorter distances as predicted. Further, analysing published daily walking-bout distributions, we estimate that the cost of changing speeds is 4-8% of daily walking energy budget. © 2015 The Author(s).

The metabolic cost of changing walking speeds is significant, implies lower optimal speeds for shorter distances, and increases daily energy estimates

PubMed Central

Seethapathi, Nidhi; Srinivasan, Manoj

2015-01-01

Humans do not generally walk at constant speed, except perhaps on a treadmill. Normal walking involves starting, stopping and changing speeds, in addition to roughly steady locomotion. Here, we measure the metabolic energy cost of walking when changing speed. Subjects (healthy adults) walked with oscillating speeds on a constant-speed treadmill, alternating between walking slower and faster than the treadmill belt, moving back and forth in the laboratory frame. The metabolic rate for oscillating-speed walking was significantly higher than that for constant-speed walking (6–20% cost increase for ±0.13–0.27 m s−1 speed fluctuations). The metabolic rate increase was correlated with two models: a model based on kinetic energy fluctuations and an inverted pendulum walking model, optimized for oscillating-speed constraints. The cost of changing speeds may have behavioural implications: we predicted that the energy-optimal walking speed is lower for shorter distances. We measured preferred human walking speeds for different walking distances and found people preferred lower walking speeds for shorter distances as predicted. Further, analysing published daily walking-bout distributions, we estimate that the cost of changing speeds is 4–8% of daily walking energy budget. PMID:26382072

Cost-benefit analysis of drug treatment services: review of the literature*

PubMed

Cartwright, William S.

2000-03-01

BACKGROUND: How valuable is public investment in treatment for drug abuse and dependency in the real world of everyday practice? Does drug abuse treatment provide benefits and how are they valued? What are the costs of obtaining outcomes and benefits? Cost-benefit analysis attempts to answer these questions in a standard analytic framework. AIMS: This paper reviews cost-benefit analyses with scientific merit so that analysts will have a current picture of the state of the research. It will also give public decision-makers information with regards to the available evidence for policy purposes. METHOD: Bibliographic searches were performed. Studies were obtained through the assistance of the Parklawn Health Library system, a component of the US Public Health Service. Selected studies were from the scientific literature with the exception of eight studies published as governmental reports. RESULTS: Cost-benefit studies have fallen into the following categories: (i) planning models for delivery systems in states and cities; (ii) short-term follow-up studies of individuals, (iii) single individual programs and (iv) state system's monitoring of outcomes. In 18 cost-benefit studies, a persistent finding is that benefits exceed costs, even when not all benefits are accounted for in the analysis. Much variation is found in the implementation of cost-benefit methods, and this is detailed across discussions of effectiveness, benefits and costs. Studies have emphasized the cost savings to society from the reduction in external costs created by the behavioral consequences of addiction and drug use. DISCUSSION: Economic analysis of drug treatment requires sophisticated conceptualization and measurement. Cost-benefit analysis of drug treatment has been a significant analytical exercise since the early 1970s when the public drug treatment system was founded in the United States. CONCLUSION: Drug abuse treatment services may be considered as contributing positive economic returns to society. However, considerable work needs to be done to standardize methods used in the studies. A striking area of omission is the absence of studies for adolescents and only one for women in treatment. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Finding a positive net social benefit should assist policy-makers with decisions related to drug abuse treatment expenditures. Additional work on allocation of budget dollars across various drug treatment services will be needed. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Government agencies and other stakeholders in national health care systems must realize that cost-benefit studies are an important tool for decision-making. Rational strategies can only be addressed by examining alternatives for the efficient allocation and equitable distribution of scarce resources. IMPLICATIONS FOR FURTHER RESEARCH: Future research should focus on standardizing the methods used in the cost-benefit analysis. Extensions should examine methods related to the willingness-to-pay approach. Studies are needed for drug abuse treatment targeted to adolescents and women. More studies should be published in the scientific literature.

Specialty pharmacy cost management strategies of private health care payers.

PubMed

Stern, Debbie; Reissman, Debi

2006-01-01

The rate of increase in spending on specialty pharmaceuticals is outpacing by far the rate of increase in spending for other drugs. To explore the strategies payers are using in response to challenges related to coverage, cost, clinical management, and access of specialty pharmaceuticals and to describe the potential implications for key stakeholders, including patients, physicians, and health care purchasers. Sources of information were identified in the course of providing consulting services in the subject area of specialty pharmaceuticals to health plans, pharmacy benefit managers, employers, and pharmaceutical manufacturers. Specialty pharmaceuticals represent the fastest growing segment of drug spending due to new product approvals, high unit costs, and increasing use. Health care payers are faced with significant challenges related to coverage, cost, clinical management, and access. A variety of short- and long-term strategies have been employed to address these challenges. Current management techniques for specialty pharmaceuticals often represent a stop-gap approach for controlling rising drug costs. Optimum cost and care management methods will evolve as further research identifies the true clinical and economic value of various specialty pharmaceuticals.

Implications of Technology on the Future Workforce

DTIC Science & Technology

2017-08-02

industrial base to obtain similar benefits and significant cost savings – Talent to be reallocated for core missions by reducing FTEs associated with...USN Representative Capt Thomas Koch, USMC Representative Mr. Taylor Glover 17-S-2249 CLEARED For Open Publication Aug 18, 2017 Department of Defense...OFFICE OF PREPUBLICATION AND SECURITY REVIEW These are the final briefing slides as approved by the Defense Business Board in the public meeting held

Small-scale non-industrial private forest ownership in the United States: rationale and implications for forest management

Treesearch

Yaoqi Zhang; Daowei Zhang; John Schelhas

2005-01-01

The transaction cost approach is used to explain why small non-industrial private forest (NIPF) ownerships are increasing in the U.S. We argue that the number of small NIPF owners have increased because: 1) a significant amount of forestland is no longer used economically if primarily for timber production, but rather for non-timber forest products and environmental...

Robots on the Battlefield. Contemporary Perspectives and Implications for the Future

DTIC Science & Technology

2014-01-01

is irreplaceable. This may, for example, involve the robot exploring an inaccessible environment or one presenting a significant risk ( contaminated ... contamination , etc.), and the high rate of attrition that it is logically ex- pected to undergo must not cause any problems in terms of cost.19 This quick...surveillance, the identification and designation of targets, neutralizing explosive devices, and reconnaissance in contaminated , polluted or booby

Improving air pollution control policy in China--A perspective based on cost-benefit analysis.

PubMed

Gao, Jinglei; Yuan, Zengwei; Liu, Xuewei; Xia, Xiaoming; Huang, Xianjin; Dong, Zhanfeng

2016-02-01

To mitigate serious air pollution, the State Council of China promulgated the Air Pollution Prevention and Control Action Plan in 2013. To verify the feasibility and validity of industrial energy-saving and emission-reduction policies in the action plan, we conducted a cost-benefit analysis of implementing these policies in 31 provinces for the period of 2013 to 2017. We also completed a scenario analysis in this study to assess the cost-effectiveness of different measures within the energy-saving and the emission-reduction policies individually. The data were derived from field surveys, statistical yearbooks, government documents, and published literatures. The results show that total cost and total benefit are 118.39 and 748.15 billion Yuan, respectively, and the estimated benefit-cost ratio is 6.32 in the S3 scenario. For all the scenarios, these policies are cost-effective and the eastern region has higher satisfactory values. Furthermore, the end-of-pipe scenario has greater emission reduction potential than energy-saving scenario. We also found that gross domestic product and population are significantly correlated with the benefit-cost ratio value through the regression analysis of selected possible influencing factors. The sensitivity analysis demonstrates that benefit-cost ratio value is more sensitive to unit emission-reduction cost, unit subsidy, growth rate of gross domestic product, and discount rate among all the parameters. Compared with other provinces, the benefit-cost ratios of Beijing and Tianjin are more sensitive to changes of unit subsidy than unit emission-reduction cost. These findings may have significant implications for improving China's air pollution prevention policy. Copyright © 2015 Elsevier B.V. All rights reserved.

An Assessment of Cost Improvements in the NASA COTS - CRS Program and Implications for Future NASA Missions

NASA Technical Reports Server (NTRS)

Zapata, Edgar

2017-01-01

This review brings rigorous life cycle cost (LCC) analysis into discussions about COTS program costs. We gather publicly available cost data, review the data for credibility, check for consistency among sources, and rigorously define and analyze specific cost metrics.

Extending the Aircraft Availability Model to a Constrained Depot Environment Using Activity-Based Costing and the Theory of Constraints

DTIC Science & Technology

2004-06-01

Overselling Activity-Based Concepts,” Management Accounting , September 1992:26-35. Kaplan, Robert S . and Robin Cooper. Cost & Effect. Using... Accounting .............................................14 Increasing Need for Cost Information...15 Implications for Costs Accounting Systems ....................................................17 Section 2 – Costs and Resources

Rapidly falling costs of battery packs for electric vehicles

NASA Astrophysics Data System (ADS)

Nykvist, Björn; Nilsson, Måns

2015-04-01

To properly evaluate the prospects for commercially competitive battery electric vehicles (BEV) one must have accurate information on current and predicted cost of battery packs. The literature reveals that costs are coming down, but with large uncertainties on past, current and future costs of the dominating Li-ion technology. This paper presents an original systematic review, analysing over 80 different estimates reported 2007-2014 to systematically trace the costs of Li-ion battery packs for BEV manufacturers. We show that industry-wide cost estimates declined by approximately 14% annually between 2007 and 2014, from above US$1,000 per kWh to around US$410 per kWh, and that the cost of battery packs used by market-leading BEV manufacturers are even lower, at US$300 per kWh, and has declined by 8% annually. Learning rate, the cost reduction following a cumulative doubling of production, is found to be between 6 and 9%, in line with earlier studies on vehicle battery technology. We reveal that the costs of Li-ion battery packs continue to decline and that the costs among market leaders are much lower than previously reported. This has significant implications for the assumptions used when modelling future energy and transport systems and permits an optimistic outlook for BEVs contributing to low-carbon transport.

Cost Implications of Organizing Nursing Home Workforce in Teams

PubMed Central

Mukamel, Dana B; Cai, Shubing; Temkin-Greener, Helena

2009-01-01

Objective To estimate the costs associated with formal and self-managed daily practice teams in nursing homes. Data Sources/Study Setting Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers. Study Design A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors. Data Collection Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports. Principal Findings Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians. Conclusions Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs. PMID:19486181

Spinal surgery: variations in health care costs and implications for episode-based bundled payments.

PubMed

Ugiliweneza, Beatrice; Kong, Maiying; Nosova, Kristin; Huang, Kevin T; Babu, Ranjith; Lad, Shivanand P; Boakye, Maxwell

2014-07-01

Retrospective, observational. To simulate what episodes of care in spinal surgery might look like in a bundled payment system and to evaluate the associated costs and characteristics. Episode-based payment bundling has received considerable attention as a potential method to help curb the rise in health care spending and is being investigated as a new payment model as part of the Affordable Care Act. Although earlier studies investigated bundled payments in a number of surgical settings, very few focused on spine surgery, specifically. We analyzed data from MarketScan. Patients were included in the study if they underwent cervical or lumbar spinal surgery during 2000-2009, had at least 2-year preoperative and 90-day postoperative follow-up data. Patients were grouped on the basis of their diagnosis-related group (DRG) and then tracked in simulated episodes-of-care/payment bundles that lasted for the duration of 30, 60, and 90 days after the discharge from the index-surgical hospitalization. The total cost associated with each episode-of-care duration was measured and characterized. A total of 196,918 patients met our inclusion criteria. Significant variation existed between DRGs, ranging from $11,180 (30-day bundle, DRG 491) to $107,642 (30-day bundle, DRG 456). There were significant cost variations within each individual DRG. Postdischarge care accounted for a relatively small portion of overall bundle costs (range, 4%-8% in 90-day bundles). Total bundle costs remained relatively flat as bundle-length increased (total average cost of 30-day bundle: $33,522 vs. $35,165 for 90-day bundle). Payments to hospitals accounted for the largest portion of bundle costs (76%). There exists significant variation in total health care costs for patients who undergo spinal surgery, even within a given DRG. Better characterization of impacts of a bundled payment system in spine surgery is important for understanding the costs of index procedure hospital, physician services, and postoperative care on potential future health care policy decision making. N/A.

Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience.

PubMed

Mouraviev, Vladimir; Nosnik, Israel; Sun, Leon; Robertson, Cary N; Walther, Philip; Albala, David; Moul, Judd W; Polascik, Thomas J

2007-02-01

To evaluate the financial implications of how the costs of new minimally invasive surgery such as laparoscopic robotic prostatectomy (LRP) and cryosurgical ablation of the prostate (CAP) technologies compare with those of conventional surgery. From January 2002 to July 2005, 452 consecutive patients underwent surgical treatment for clinically localized (Stage T1-T2) prostate cancer. The distribution of patients among the surgical procedures was as follows: group 1, radical retropubic prostatectomy (RRP) (n = 197); group 2, radical perineal prostatectomy (RPP) (n = 60); group 3, LRP (n = 137); and group 4, CAP (n = 58). The total direct hospital costs and grand total hospital costs were analyzed for each type of surgery. The mean length of stay in the CAP group was significantly lower (0.16 +/- 0.14 days) than that for RRP (2.79 +/- 1.46 days), RPP (2.87 +/- 1.43 days), and LRP (2.15 +/- 1.48 days; P <0.0005). The direct surgical costs were less for the RRP (2471 dollars +/- 636 dollars) and RPP (2788 dollars +/- 762 dollars) groups than for the technology-dependent procedures: LRP (3441 dollars +/- 545 dollars) and CAP (5702 dollars +/- 1606 dollars; P <0.0005). The total hospital cost differences, including pathologic assessment costs, were less for LRP (10,047 dollars +/- 107 dollars, median 9343 dollars) and CAP (9195 dollars +/- 1511 dollars, median 8796 dollars) than for RRP (10,704 dollars +/- 3468 dollars, median 9724 dollars) or RPP (10,536 dollars +/- 3088 dollars, median 9251 dollars), with significant differences (P <0.05) between the minimally invasive technique and open surgery groups. In our study, despite the relatively increased surgical expense of CAP compared with conventional surgical prostatectomy (RRP or RPP) and LRP, the overall direct costs were offset by the significantly lower nonoperative hospital costs. The cost advantages associated with CAP included a shorter length of stay in the hospital and the absence of pathologic costs and the need for blood transfusion.

Autonomous Aerobraking Using Thermal Response Surface Analysis

NASA Technical Reports Server (NTRS)

Prince, Jill L.; Dec, John A.; Tolson, Robert H.

2007-01-01

Aerobraking is a proven method of significantly increasing the science payload that can be placed into low Mars orbits when compared to an all propulsive capture. However, the aerobraking phase is long and has mission cost and risk implications. The main cost benefit is that aerobraking permits the use of a smaller and cheaper launch vehicle, but additional operational costs are incurred during the long aerobraking phase. Risk is increased due to the repeated thermal loading of spacecraft components and the multiple attitude and propulsive maneuvers required for successful aerobraking. Both the cost and risk burdens can be significantly reduced by automating the aerobraking operations phase. All of the previous Mars orbiter missions that have utilized aerobraking have increasingly relied on onboard calculations during aerobraking. Even though the temperature of spacecraft components has been the limiting factor, operational methods have relied on using a surrogate variable for mission control. This paper describes several methods, based directly on spacecraft component maximum temperature, for autonomously predicting the subsequent aerobraking orbits and prescribing apoapsis propulsive maneuvers to maintain the spacecraft within specified temperature limits. Specifically, this paper describes the use of thermal response surface analysis in predicting the temperature of the spacecraft components and the corresponding uncertainty in this temperature prediction.

A reevaluation of the costs of heart failure and its implications for allocation of health resources in the United States.

PubMed

Voigt, Jeff; Sasha John, M; Taylor, Andrew; Krucoff, Mitchell; Reynolds, Matthew R; Michael Gibson, C

2014-05-01

The annual cost of heart failure (HF) is estimated at $39.2 billion. This has been acknowledged to underestimate the true costs for care. The objective of this analysis is to more accurately assess these costs. Publicly available data sources were used. Cost calculations incorporated relevant factors such as Medicare hospital cost-to-charge ratios, reimbursement from both government and private insurance, and out-of-pocket expenditures. A recently published Atherosclerosis Risk in Communities (ARIC) HF scheme was used to adjust the HF classification scheme. Costs were calculated with HF as the primary diagnosis (HF in isolation, or HFI) or HF as one of the diagnoses/part of a disease milieu (HF syndrome, or HFS). Total direct costs for HF were calculated at $60.2 billion (HFI) and $115.4 billion (HFS). Indirect costs were $10.6 billion for both. Costs attributable to HF may represent a much larger burden to US health care than what is commonly referenced. These revised and increased costs have implications for policy makers.

Cost study : before, during and after AOS implementation (October 1996 - May 1999)

DOT National Transportation Integrated Search

This study compared AATA operating costs over two different time periods: before and during AOS installation. While neither additional operating costs nor operating costs savings were traceable to AOS at this time, the implications of this report, wh...

Treatment, survival, and costs of laryngeal cancer care in the elderly.

PubMed

Gourin, Christine G; Dy, Sydney M; Herbert, Robert J; Blackford, Amanda L; Quon, Harry; Forastiere, Arlene A; Eisele, David W; Frick, Kevin D

2014-08-01

To examine associations between treatment and volume with survival and costs in elderly patients with laryngeal squamous cell cancer (SCCA). Retrospective cross-sectional analysis of Surveillance, Epidemiology, and End Results-Medicare data. We evaluated 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic and generalized linear regression modeling, and survival analysis. Chemoradiation was significantly associated with supraglottic tumors (relative risk ratio: 2.6, 95% confidence interval [CI]: 1.7-4.0), additional cancer-directed treatment (odds ratio [OR]: 1.8, 95% CI: 1.2-2.7), and a reduced likelihood of surgical salvage (OR: 0.3, 95% CI: 0.2-0.6). Surgery with postoperative radiation was associated with significantly improved survival (hazard ratio [HR]: 0.7, 95% CI: 0.6-0.9), after controlling for patient and tumor variables including salvage. High-volume care was not associated with survival for nonoperative treatment but was associated with improved survival (HR: 0.7, 95% CI: 0.5-0.8) among surgical patients. Initial treatment and 5-year overall costs for chemoradiation were higher than for all other treatment categories. High-volume care was associated with significantly lower costs of care for surgical patients but was not associated with differences in costs of care for nonoperative treatment. Chemoradiation in elderly patients with laryngeal cancer was associated with increased costs, additional cancer-directed treatment, and a reduced likelihood of surgical salvage. Surgery with postoperative radiation was associated with improved survival in this cohort, and high-volume hospital surgical care was associated with improved survival and lower costs. These findings have implications for improving the quality of laryngeal cancer treatment at a time of both rapid growth in the elderly population and diminishing healthcare resources. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Imaging tests in staging and surveillance of non-metastatic breast cancer: changes in routine clinical practice and cost implications.

PubMed

De Placido, S; De Angelis, C; Giuliano, M; Pizzi, C; Ruocco, R; Perrone, V; Bruzzese, D; Tommasielli, G; De Laurentiis, M; Cammarota, S; Arpino, G; Arpino, G

2017-03-14

Although guidelines do not recommend computerised tomography (CT), positron emission tomography (PET) or magnetic resonance imaging (MRI) for the staging or follow-up of asymptomatic patients with non-metastatic breast cancer, they are often requested in routine clinical practice. The aim of this study was to determine the staging and follow-up patterns, and relative costs in a large population of breast cancer patients living and treated in a Southern Italian region. We analysed the clinical computerised information recorded by 567 primary-care physicians assisting about 650 000 inhabitants in the Campania region. Patients with non-metastatic breast cancer were identified and divided into calendar years from 2001 to 2010. The number of diagnostic tests prescribed per 100 patients (N/Pts) and the mean cost per patient was determined 3 months before diagnosis and up to 1 year after diagnosis. Costs are expressed in constant 2011 euros. We identified 4680 newly diagnosed cases of asymptomatic non-metastatic breast cancer. N/Pts increased significantly (P<0.0001) from 2001 to 2010. The mean number of prescribed mammograms, bone scans, abdominal ultrasound and chest X-rays ('routine tests'), and costs was unchanged. However, the number of CT, PET scans and MRI ('new tests')prescriptions almost quadrupled and the mean cost per patient related to these procedures significantly increased from [euro ]357 in 2001 to [euro ]830 in 2010 (P<0.0001). New test prescriptions and relative costs significantly and steadily increased throughout the study period. At present there is no evidence that the delivery of new tests to asymptomatic patients improves breast cancer outcome. Well-designed clinical trials are urgently needed to shed light on the impact of these tests on clinical outcome and overall survival.

The financial and service implications of splitting fixed-dose antiretroviral drugs - a case study.

PubMed

Taylor, R; Carlin, E; Sadique, Z; Ahmed, I; Adams, E J

2015-02-01

In 2010/2011, regional commissioners withdrew payment for the fixed-dose combination Combivir, forcing a switch to component drugs. This was deemed clinically acceptable and annual savings of £44 k expected. We estimated the true costs of switching and examined patient outcomes. Information for 46 patients using Combivir was extracted from case notes for each clinical contact in the 12 months pre- and post-switch (clinician seen, tests, antiretrovirals). Post-switch care costs £93/patient more annually versus pre-switch (95% CI £424 to £609), yielding £4278/year more post-switch for all patients. Drug and pathology costs were more expensive post-switch and extra clinical visits required. None of these results were statistically significant. Forty-two per cent of patients switched directly or in the subsequent year to an alternative fixed-dose combination rather than generics. Costs in this group were significantly higher post-switch driven by drug cost. Six patients (13%) reported problems with the switch including confusion around dosing and new side effects. As less-expensive generic antiretroviral drugs become available, it may appear cheaper to switch from fixed-dose combinations to component drugs. However, the additional clinical costs involved may outweigh the initial cost savings of the drugs and switching may cause confusion for some patients, risking loss of adherence. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Clinical Impact and Cost-Effectiveness of an Education Program for PD Patients: A Randomized Controlled Trial

PubMed Central

Ory-Magne, Fabienne; Arcari, Céline; Mohara, Christine; Pourcel, Laure; Derumeaux, Hélène; Bérard, Emilie; Bourrel, Robert; Molinier, Laurent; Brefel-Courbon, Christine

2016-01-01

Background Parkinson’s disease (PD) is characterized by its impact on quality of life, constituting a substantial economic burden on society. Education programs implicating patients more in the management of their illness and complementing medical treatment may be a beneficial adjunct in PD. This study assessed the impact of an education program on quality of life and its cost-effectiveness in PD patients. Methods This single-center, prospective, randomized study assessed an education program consisting of individual and group sessions over a 12-month period. A total of 120 PD patients were assigned to either the Treated by Behavioral Intervention group (TTBI) or the no TTBI group. The primary outcome criterion was quality of life assessed using PDQ39. The Unified Parkinson’s Disease Rating Scale (UPDRS) and psychological status were collected. An economic evaluation was performed, including calculations of incremental cost-effectiveness ratios (ICERs). Results After 12 months of follow-up, changes recorded in the PDQ39 between the groups were not significantly different but better changes were observed in each dimension in the TTBI group compared to the no TTBI group. UPDRS I, II and total score were significantly improved in TTBI group compared to the no TTBI group. Mean annual costs did not differ significantly between the two groups. Conclusion This study suggested that the education program positively impacts the perceived health of PD patients without increasing medical costs. PMID:27685455

The utilization of health care services by children with Foetal Alcohol Syndrome in the Western Cape, South Africa.

PubMed

Credé, Sarah; Sinanovic, Edina; Adnams, Colleen; London, Leslie

2011-06-01

The rates of Foetal Alcohol Syndrome (FAS) and Partial Foetal Alcohol Spectrum (PFAS) in South Africa are the highest reported worldwide. There is a paucity of research examining the health care costs of caring for children with FAS or PFAS in this country. A cross-sectional analytical study was conducted using an interviewer-administered questionnaire amongst caregivers of children (0-12 years) with FAS/PFAS in the Western Cape to estimate the utilization of health care services; the annual direct and indirect health care costs per child as well as the total cost to society for providing health care services to children with FAS/PFAS. It was found that the median number of annual visits to public health care facilities per child was 8 (IQR 4 to 14). The total average annual cost per child was $1039.38 (95% CI: $808.68; $1270.07) and the total annual societal cost for the Western Cape was $70,960,053.68 (95% CI: $5,528,895.48; $86,709,971.13). Caregivers in receipt of a social support grant reported spending significantly less on health care for a child with FAS/PFAS (Fisher's exact p=0.004). These study results confirm the significant burden of FAS/PFAS on the Western Cape economy and the health care system which has significant implications for FAS prevention. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

State estimation bias induced by optimization under uncertainty and error cost asymmetry is likely reflected in perception.

PubMed

Shimansky, Y P

2011-05-01

It is well known from numerous studies that perception can be significantly affected by intended action in many everyday situations, indicating that perception and related decision-making is not a simple, one-way sequence, but a complex iterative cognitive process. However, the underlying functional mechanisms are yet unclear. Based on an optimality approach, a quantitative computational model of one such mechanism has been developed in this study. It is assumed in the model that significant uncertainty about task-related parameters of the environment results in parameter estimation errors and an optimal control system should minimize the cost of such errors in terms of the optimality criterion. It is demonstrated that, if the cost of a parameter estimation error is significantly asymmetrical with respect to error direction, the tendency to minimize error cost creates a systematic deviation of the optimal parameter estimate from its maximum likelihood value. Consequently, optimization of parameter estimate and optimization of control action cannot be performed separately from each other under parameter uncertainty combined with asymmetry of estimation error cost, thus making the certainty equivalence principle non-applicable under those conditions. A hypothesis that not only the action, but also perception itself is biased by the above deviation of parameter estimate is supported by ample experimental evidence. The results provide important insights into the cognitive mechanisms of interaction between sensory perception and planning an action under realistic conditions. Implications for understanding related functional mechanisms of optimal control in the CNS are discussed.

Landscape context alters cost of living in honeybee metabolism and feeding

PubMed Central

Dixon, Kingsley W.; Didham, Raphael K.; Bradshaw, S. Donald

2017-01-01

Field metabolic rate (FMR) links the energy budget of an animal with the constraints of its ecosystem, but is particularly difficult to measure for small organisms. Landscape degradation exacerbates environmental adversity and reduces resource availability, imposing higher costs of living for many organisms. Here, we report a significant effect of landscape degradation on the FMR of free-flying Apis mellifera, estimated using 86Rb radio-isotopic turnover. We validated the relationship between 86Rb kb and metabolic rate for worker bees in the laboratory using flow-through respirometry. We then released radioisotopically enriched individuals into a natural woodland and a heavily degraded and deforested plantation. FMRs of worker bees in natural woodland vegetation were significantly higher than in a deforested landscape. Nectar consumption, estimated using 22Na radio-isotopic turnover, also differed significantly between natural and degraded landscapes. In the deforested landscape, we infer that the costs of foraging exceeded energetic availability, and honeybees instead foraged less and depended more on stored resources in the hive. If this is generally the case with increasing landscape degradation, this will have important implications for the provision of pollination services and the effectiveness and resilience of ecological restoration practice. PMID:28179522

Landscape context alters cost of living in honeybee metabolism and feeding.

PubMed

Tomlinson, Sean; Dixon, Kingsley W; Didham, Raphael K; Bradshaw, S Donald

2017-02-08

Field metabolic rate (FMR) links the energy budget of an animal with the constraints of its ecosystem, but is particularly difficult to measure for small organisms. Landscape degradation exacerbates environmental adversity and reduces resource availability, imposing higher costs of living for many organisms. Here, we report a significant effect of landscape degradation on the FMR of free-flying Apis mellifera , estimated using 86 Rb radio-isotopic turnover. We validated the relationship between 86 Rb k b and metabolic rate for worker bees in the laboratory using flow-through respirometry. We then released radioisotopically enriched individuals into a natural woodland and a heavily degraded and deforested plantation. FMRs of worker bees in natural woodland vegetation were significantly higher than in a deforested landscape. Nectar consumption, estimated using 22 Na radio-isotopic turnover, also differed significantly between natural and degraded landscapes. In the deforested landscape, we infer that the costs of foraging exceeded energetic availability, and honeybees instead foraged less and depended more on stored resources in the hive. If this is generally the case with increasing landscape degradation, this will have important implications for the provision of pollination services and the effectiveness and resilience of ecological restoration practice. © 2017 The Author(s).

Australian quad bike fatalities: what is the economic cost?

PubMed

Lower, Tony; Pollock, Kirrily; Herde, Emily

2013-04-01

To determine the economic costs associated with all quad bike-related fatalities in Australia, 2001 to 2010. A human capital approach to establish the economic costs of quad bike related fatalities to the Australian economy. The model included estimates on loss of earnings due to premature death and direct costs based on coronial records for ambulance, police, hospital, premature funeral, coronial and work safety authority investigation, and death compensation costs. All costs were calculated to 2010 dollars. The estimated total economic cost associated with quad bike fatalities over this period was $288.1 million, with an average cost for each fatality of $2.3 million. When assessing the average cost of incidents between age cohorts, those aged 25-34 years had the lowest number of fatalities but had the highest average cost ($4.2 million). Quad bike fatalities have a significant economic impact on Australian society that is increasing. Implications : Given the high cost to society, interventions to address quad bike fatalities have the potential to be highly cost-effective. Such interventions should focus on design approaches to improve the safety of quad bikes in terms of stability and protection in the event of a rollover. Additionally, relevant policy (e.g. no children under 16 years riding quads, no passengers) and intervention approaches (e.g. training and use of helmets) must also support the design modifications. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients.

PubMed

Wong, Frances Kam Yuet; Chau, June; So, Ching; Tam, Stanley Ku Fu; McGhee, Sarah

2012-12-24

Readmissions are costly and have implications for quality of care. Studies have been reported to support effects of transitional care programs in reducing hospital readmissions and enhancing clinical outcomes. However, there is a paucity of studies executing full economic evaluation to assess the cost-effectiveness of these transitional care programs. This study is therefore launched to fill this knowledge gap. Cost-effectiveness analysis was conducted alongside a randomized controlled trial that examined the effects of a Health-Social Transitional Care Management Program (HSTCMP) for medical patients discharged from an acute regional hospital in Hong Kong. The cost and health outcomes were compared between the patients receiving the HSTCMP and usual care. The total costs comprised the pre-program, program, and healthcare utilization costs. Quality of life was measured with SF-36 and transformed to utility values between 0 and 1. The readmission rates within 28 (control 10.2%, study 4.0%) and 84 days (control 19.4%, study 8.1%) were significantly higher in the control group. Utility values showed no difference between the control and study groups at baseline (p = 0.308). Utility values for the study group were significantly higher than in the control group at 28 (p < 0.001) and 84 days (p = 0.002). The study group also had a significantly higher QALYs gain (p < 0.001) over time at 28 and 84 days when compared with the control group. The intervention had an 89% chance of being cost-effective at the threshold of £20000/QALY. Previous studies on transitional care focused mainly on clinical outcomes and not too many included cost as an outcome measure. Studies examining the cost-effectiveness of the post-discharge support services are scanty. This study is the first to examine the cost-effectiveness of a transitional care program that used nurse-led services participated by volunteers. Results have shown that a health-social partnership transitional care program is cost-effective in reducing healthcare costs and attaining QALY gains. Economic evaluation helps to inform funders and guide decisions for the effective use of competing healthcare resources.

Cost of Stem Cell-Based Tissue-Engineered Airway Transplants in the United Kingdom: Case Series

PubMed Central

Culme-Seymour, Emily J.; Mason, Katrina; Vallejo-Torres, Laura; Carvalho, Carla; Partington, Leanne; Crowley, Claire; Hamilton, Nick J.; Toll, Ed C.; Butler, Colin R.; Elliott, Martin J.; Birchall, Martin A.; Lowdell, Mark W.

2016-01-01

Stem cell-based tissue-engineered tracheas are at an early stage in their product development cycle. Tens of patients have been treated worldwide in predominantly compassionate use settings, demonstrating significant promise. This potentially life-saving treatment is complex, and the cost and its implications for such treatments are yet to be fully understood. The costs are compounded by varying strategies for graft preparation and transplant, resulting in differing clinical and laboratory costs from different research groups. In this study, we present a detailed breakdown of the clinical and manufacturing costs for three of the United Kingdom (UK) patients treated with such transplants. All three patients were treated under Compassionate Use legislation, within the UK National Health Service (NHS) hospital setting. The total costs for the three UK patients treated ranged from $174,420 to $740,500. All three patients were in a state of poor health at time of treatment and had a number of complexities in addition to the restricted airway. This is the first time a cost analysis has been made for a tissue-engineered organ and provides a benchmark for future studies, as well as comparative data for use in reimbursement considerations. PMID:26559535

Cost of Stem Cell-Based Tissue-Engineered Airway Transplants in the United Kingdom: Case Series.

PubMed

Culme-Seymour, Emily J; Mason, Katrina; Vallejo-Torres, Laura; Carvalho, Carla; Partington, Leanne; Crowley, Claire; Hamilton, Nick J; Toll, Ed C; Butler, Colin R; Elliott, Martin J; Birchall, Martin A; Lowdell, Mark W; Mason, Chris

2016-02-01

Stem cell-based tissue-engineered tracheas are at an early stage in their product development cycle. Tens of patients have been treated worldwide in predominantly compassionate use settings, demonstrating significant promise. This potentially life-saving treatment is complex, and the cost and its implications for such treatments are yet to be fully understood. The costs are compounded by varying strategies for graft preparation and transplant, resulting in differing clinical and laboratory costs from different research groups. In this study, we present a detailed breakdown of the clinical and manufacturing costs for three of the United Kingdom (UK) patients treated with such transplants. All three patients were treated under Compassionate Use legislation, within the UK National Health Service (NHS) hospital setting. The total costs for the three UK patients treated ranged from $174,420 to $740,500. All three patients were in a state of poor health at time of treatment and had a number of complexities in addition to the restricted airway. This is the first time a cost analysis has been made for a tissue-engineered organ and provides a benchmark for future studies, as well as comparative data for use in reimbursement considerations.

Economic Burden of Hospitalizations for Heat-Related Illnesses in the United States, 2001-2010.

PubMed

Schmeltz, Michael T; Petkova, Elisaveta P; Gamble, Janet L

2016-09-08

Understanding how heat waves affect morbidity and mortality, as well as the associated economic costs, is essential for characterizing the human health impacts of extreme heat under a changing climate. Only a handful of studies have examined healthcare costs associated with exposures to high temperatures. This research explores costs associated with hospitalizations for heat-related illness (HRI) in the United States using the 2001 to 2010 Nationwide Inpatient Sample (NIS). Descriptive statistics of patient data for HRI hospitalizations were examined and costs of hospitalizations were reported using the all-payer inpatient cost-to-charge ratio. Costs were examined using a log-gamma model with patient and hospital characteristics included as fixed effects. Adjusted mean costs were then compared across racial groups. The mean costs of HRI hospitalizations were higher among racial/ethnic minorities compared to Whites, who accounted for almost 65% of all HRI hospitalizations. Observed differences in costs based on income, insurance, and gender were also significant. These results suggest that these populations are suffering disproportionately from health inequity, thus, they could shoulder greater disease and financial burdens due to climate change. These findings may have important implications in understanding the economic impact public health planning and interventions will have on preventing hospitalizations related to extreme heat.

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

PubMed Central

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

2013-01-01

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

Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis.

PubMed

Founou, Raspail Carrel; Founou, Luria Leslie; Essack, Sabiha Yusuf

2017-01-01

Despite evidence of the high prevalence of antibiotic resistant infections in developing countries, studies on the clinical and economic impact of antibiotic resistance (ABR) to inform interventions to contain its emergence and spread are limited. The aim of this study was to analyze the published literature on the clinical and economic implications of ABR in developing countries. A systematic search was carried out in Medline via PubMed and Web of Sciences and included studies published from January 01, 2000 to December 09, 2016. All papers were considered and a quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). Of 27 033 papers identified, 40 studies met the strict inclusion and exclusion criteria and were finally included in the qualitative and quantitative analysis. Mortality was associated with resistant bacteria, and statistical significance was evident with an odds ratio (OR) 2.828 (95%CI, 2.231-3.584; p = 0.000). ESKAPE pathogens was associated with the highest risk of mortality and with high statistical significance (OR 3.217; 95%CIs; 2.395-4.321; p = 0.001). Eight studies showed that ABR, and especially antibiotic-resistant ESKAPE bacteria significantly increased health care costs. ABR is associated with a high mortality risk and increased economic costs with ESKAPE pathogens implicated as the main cause of increased mortality. Patients with non-communicable disease co-morbidities were identified as high-risk populations.

Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis

PubMed Central

Founou, Luria Leslie; Essack, Sabiha Yusuf

2017-01-01

Introduction Despite evidence of the high prevalence of antibiotic resistant infections in developing countries, studies on the clinical and economic impact of antibiotic resistance (ABR) to inform interventions to contain its emergence and spread are limited. The aim of this study was to analyze the published literature on the clinical and economic implications of ABR in developing countries. Methods A systematic search was carried out in Medline via PubMed and Web of Sciences and included studies published from January 01, 2000 to December 09, 2016. All papers were considered and a quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). Results Of 27 033 papers identified, 40 studies met the strict inclusion and exclusion criteria and were finally included in the qualitative and quantitative analysis. Mortality was associated with resistant bacteria, and statistical significance was evident with an odds ratio (OR) 2.828 (95%CI, 2.231–3.584; p = 0.000). ESKAPE pathogens was associated with the highest risk of mortality and with high statistical significance (OR 3.217; 95%CIs; 2.395–4.321; p = 0.001). Eight studies showed that ABR, and especially antibiotic-resistant ESKAPE bacteria significantly increased health care costs. Conclusion ABR is associated with a high mortality risk and increased economic costs with ESKAPE pathogens implicated as the main cause of increased mortality. Patients with non-communicable disease co-morbidities were identified as high-risk populations. PMID:29267306

Cost of a roller skating rink to the local accident and emergency department.

PubMed Central

Nayeem, N; Shires, S E; Porter, J E

1990-01-01

A 14 month retrospective study was undertaken to determine the cost implications of the opening of a roller skating rink to the local hospital accident and emergency department (A and E). A total of 398 patients attended following injury at the roller skating rink, of whom 384 were included in the study. The estimated cost of their injuries was determined by the hospital accounts department. The average cost per patient attending the A and E department following roller skating injury was about 100 pounds. The total cost to the A and E department of all injuries sustained at the rink over this period was 38,412 pounds. The cost implications of opening a roller skating rink for the A and E department are considerable. If proposals for self-budgeting are applied, A and E departments will have to seek additional funding if such leisure facilities are opened in their vicinity. PMID:2097020

Five-year healthcare utilization and costs among lower-risk drinkers following alcohol treatment.

PubMed

Kline-Simon, Andrea H; Weisner, Constance M; Parthasarathy, Sujaya; Falk, Daniel E; Litten, Raye Z; Mertens, Jennifer R

2014-02-01

Lower-risk drinking is increasingly being examined as a treatment outcome for some patients following addiction treatment. However, few studies have examined the relationship between drinking status (lower-risk drinking in particular) and healthcare utilization and cost, which has important policy implications. Participants were adults with alcohol dependence and/or abuse diagnoses who received outpatient alcohol and other drug treatment in a private, nonprofit integrated healthcare delivery system and had a follow-up interview 6 months after treatment entry (N = 995). Associations between past 30-day drinking status at 6 months (abstinence, lower-risk drinking defined as nonabstinence and no days of 5+ drinking, and heavy drinking defined as 1 or more days of 5+ drinking) and repeated measures of at least 1 emergency department (ED), inpatient or primary care visit, and their costs over 5 years were examined using mixed-effects models. We modeled an interaction between time and drinking status to examine trends in utilization and costs over time by drinking group. Heavy drinkers and lower-risk drinkers were not significantly different from the abstainers in their cost or utilization at time 0 (i.e., 6 months postintake). Heavy drinkers had increasing odds of inpatient (p < 0.01) and ED (p < 0.05) utilization over 5 years compared with abstainers. Lower-risk drinkers and abstainers did not significantly differ in their service use in any category over time. No differences were found in changes in primary care use among the 3 groups over time. The cost analyses paralleled the utilization results. Heavy drinkers had increasing ED (p < 0.05) and inpatient (p < 0.001) costs compared with the abstainers; primary care costs did not significantly differ. Lower-risk drinkers did not have significantly different medical costs compared with those who were abstinent over 5 years. However, post hoc analyses found lower-risk drinkers and heavy drinkers to not significantly differ in their ED use or costs over time. Performance measures for treatment settings that consider treatment outcomes may need to take into account both abstinence and reduction to nonheavy drinking. Future research should examine whether results are replicated in harm reduction treatment, or whether such outcomes are found only in abstinence-based treatment. Copyright © 2013 by the Research Society on Alcoholism.

The burden of prenatal exposure to alcohol: revised measurement of cost.

PubMed

Stade, Brenda; Ali, Alaa; Bennett, Dainel; Campbell, Douglas; Johnston, Mary; Lens, Cynthia; Tran, Sofia; Koren, Gideon

2009-01-01

In Canada the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. FASD is the leading cause of developmental and cognitive disabilities in Canada. Only one study has examined the cost of FASD in Canada. In that study we did not include prospective data for infants under the age of one year, costs for adults beyond 21 years or costs for individuals living in institutions. To calculate a revised estimate of direct and indirect costs associated with FASD at the patient level. Cross-sectional study design was used. Two-hundred and fifty (250) participants completed the study tool. Participants included caregivers of children, youth and adults, with FASD, from day of birth to 53 years, living in urban and rural communities throughout Canada participated. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total average costs per individual with FASD were calculated by summing the costs for each in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs associated with FASD. Total adjusted annual costs associated with FASD at the individual level was $21,642 (95% CI, $19,842; $24,041), compared to $14,342 (95% CI, $12,986; $15,698) in the first study. Severity of the individual's condition, age, and relationship of the individual to the caregiver (biological, adoptive, foster) were significant determinants of costs (p < 0.001). Cost of FASD annually to Canada of those from day of birth to 53 years old, was $5.3 billion (95% CI, $4.12 billion; $6.4 billion). Study results demonstrated the cost burden of FASD in Canada was profound. Inclusion of infants aged 0 to 1 years, adults beyond the age of 21 years and costs associated with residing in institutions provided a more accurate estimate of the costs of FASD. Implications for practice, policy, and research are discussed. Key words: Alcohol, pregnancy, cost, economic burden, fetal alcohol spectrum disorder.

The economic impact of chronic pain in adolescence: methodological considerations and a preliminary costs-of-illness study.

PubMed

Sleed, Michelle; Eccleston, Christopher; Beecham, Jennifer; Knapp, Martin; Jordan, Abbie

2005-12-15

Chronic pain in adulthood is one of the most costly conditions in modern western society. However, very little is known about the costs of chronic pain in adolescence. This preliminary study explored methods for collecting economic-related data for this population and estimated the cost-of-illness of adolescent chronic pain in the United Kingdom. The client service receipt inventory was specifically adapted for use with parents of adolescent chronic pain patients to collect economic-related data (CSRI-Pain). This method was compared and discussed in relation to other widely used methods. The CSRI-Pain was sent to 52 families of adolescents with chronic pain to complete as a self-report retrospective questionnaire. These data were linked with unit costs to estimate the total care cost package for each family. The economic impact of adolescent chronic pain was found to be high. The mean cost per adolescent experiencing chronic pain was approximately 8,000 pounds per year, including direct and indirect costs. The adolescents attending a specialised pain management unit, who had predominantly non-inflammatory pain, accrued significantly higher costs, than those attending rheumatology outpatient clinics, who had mostly inflammatory diagnoses. Extrapolating the mean total cost to estimated UK prevalence data of adolescent chronic pain demonstrates a cost-of-illness to UK society of approximately 3,840 million pounds in one year. The implications of the study are discussed.

Is scratch-cooking a cost-effective way to prepare healthy school meals with US Department of Agriculture foods?

PubMed

Woodward-Lopez, Gail; Kao, Janice; Kiesel, Kristin; Lewis Miller, Markell; Boyle, Maria; Drago-Ferguson, Soledad; Braff-Guajardo, Ellen; Crawford, Patricia

2014-09-01

Despite the resurgence of interest in scratch-cooking as a way to increase the quality and appeal of school meals, many school districts are concerned about the cost implications of switching to scratch-cooking. US Department of Agriculture (USDA) Foods are the single largest source of ingredients for school meals, and about half of USDA Foods are diverted for processing before being sent to the school district. We aimed to determine whether school lunch entrées made in a district from basic or raw USDA Foods ingredients can be healthier and less expensive to prepare than those sent to external processors. This cross-sectional study examined the relationship between the extent of scratch-cooking and the nutritional content and cost to prepare entrées. Information was gathered by interview with school foodservice personnel and from school foodservice records from a convenience sample of 10 school districts in California that employed varying degrees of scratch-cooking and is diverse in terms of geographic location and the sociodemographics of the student body. The sample included all elementary school lunch entrées that contain USDA Foods offered during October 2010 for a total sample of 146 entrées. Ordinary least squares regressions were used to test for statistically significant differences in cost and nutrient content of entrées according to the level of scratch-cooking. There was no significant relationship between total costs and level of scratch-cooking. Entrées with the highest scratch-cooking scores had significantly lower food costs, higher labor costs, and not significantly different total costs compared with entrées with no scratch-cooking. Nutrient content was not consistently associated with scratch-cooking, but scratch-cooked entrées did include a larger variety of non-fast-food-type entrées. The findings suggest that scratch-cooking can be a cost-effective way to expand the variety of healthy school lunches prepared with USDA Foods. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Economic impact of ovarian stimulation with corifollitropin alfa versus conventional daily gonadotropins in oocyte donors: a randomized study.

PubMed

Cruz, María; Alamá, Pilar; Muñoz, Manuel; Collado, Diana; Blanes, Carlos; Solbes, Enrique; Requena, Antonio

2017-06-01

Assisted reproductive technologies are well-established treatments for many types of subfertility representing substantial economic and healthcare implications for patients, healthcare providers and society as a whole. In order to optimize outcomes according to the type of gonadotrophins within an oocyte donor programme, we performed an economic evaluation based on data collected in a multicentre, prospective, randomized study within three private clinics belonging to the IVI Group. Results showed no relevant between-group differences in the clinical variables. According to the economic analysis, ovarian stimulation with corifollitropin alfa increased the overall cost of the treatment as well as the cost per retrieved and effective oocyte, although the differences were not statistically significant. In conclusion, cost savings can be achieved using cheaper gonadotrophins during ovarian stimulation. The cost of corifollitropin alfa compared with recombinant FSH and highly purified human menopausal gonadotrophin should be considered when making treatment decisions. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

The costs of rape.

PubMed

Perilloux, Carin; Duntley, Joshua D; Buss, David M

2012-10-01

The current study examined costs experienced by victims of completed rape (n=49) and attempted sexual assault (n=91) using quantitative analyses of 13 domains: health, self-esteem, self-perceived attractiveness, self-perceived mate value, family relationships,work life, social life, social reputation, sexual reputation, desire to have sex, frequency of sex, enjoyment of sex, and long-term, committed relationships. Women also provided descriptive accounts of their experiences, and we used these to illustrate the costs in the victims' own words.Compared to victims of an attempted sexual assault, victims of a completed rape reported significantly more negative outcomes in 11 of the 13 domains. The most negatively affected domains were self-esteem, sexual reputation, frequency of sex, desire to have sex, and self-perceived mate value. Although victims of rape experienced more negative effects than victims of attempted sexual assault,both groups of victims reported negative effects in every domain.Discussion focuses on the implications of the differing degrees and patterns of the costs of attempted and completed sexual victimization.

Training Costs with Reference to the Industrial Training Act.

ERIC Educational Resources Information Center

Garbutt, Douglas

Provisions and implications of the British Industrial Training Act of 1964 (including the system of training grants and levies) are set forth. Procedures for accounting and budgeting for training costs, routines for collecting training information, documents (budgets, cost sheets, control statements) for collecting and controlling costs, means of…

Otoacoustic Emissions in Rural Nicaragua: Cost Analysis and Implications for Newborn Hearing Screening.

PubMed

Wong, Lye-Yeng; Espinoza, Francisca; Alvarez, Karen Mojica; Molter, Dave; Saunders, James E

2017-05-01

Objective (1) Determine the incidence and risk factors for congenital hearing loss. (2) Perform cost analysis of screening programs. Study Design Proportionally distributed cross-sectional survey. Setting Jinotega, Nicaragua. Subjects and Methods Otoacoustic emissions (OAEs) were used to screen 640 infants <6 months of age from neonatal intensive care unit, institutional, and home birth settings. Data on 15 risk factors were analyzed. Cost of 4 implementation strategies was studied: universal screening, screening at the regional health center (RHC), targeted screening, and screening at the RHC plus targeted screening. Cost-effectiveness analysis over 10 years was based on disability-adjusted life year estimates, with the World Health Organization standard of cost-effectiveness ratio (CER) / gross domestic product (GDP) <3, with GDP set at $4884.15. Results Thirty-eight infants failed the initial OAE (5.94%). In terms of births, 325 (50.8%) were in the RHC, 69 (10.8%) in the neonatal intensive care unit, and 29 (4.5%) at home. Family history and birth defect were significant in univariate analysis; birth defect was significant in multivariate analysis. Cost-effectiveness analysis demonstrated that OAE screening is cost-effective without treatment (CER/GDP = 0.06-2.00) and with treatment (CER/GDP = 0.58-2.52). Conclusions Our rate of OAE failures was comparable to those of developed countries and lower than hearing loss rates noted among Nicaraguan schoolchildren, suggesting acquired or progressive etiology in the latter. Birth defects and familial hearing loss correlated with OAE failure. OAE screening of infants is feasible and cost-effective in rural Nicaragua, although highly influenced by estimated hearing loss severity in identified infants and the high travel costs incurred in a targeted screening strategy.

Gedanken Experiments in Educational Cost Effectiveness

ERIC Educational Resources Information Center

Brudner, Harvey J.

1978-01-01

Discusses the effectiveness of cost determining techniques in education. The areas discussed are: education and management; cost-effectiveness models; figures of merit determination; and the implications as they relate to the areas of audio-visual and computer educational technology. (Author/GA)

Drug tendering: drug supply and shortage implications for the uptake of biosimilars

PubMed Central

Dranitsaris, George; Jacobs, Ira; Kirchhoff, Carol; Popovian, Robert; Shane, Lesley G

2017-01-01

Due to the continued increase in global spending on health care, payers have introduced a number of programs, policies, and agreements on pharmaceutical pricing in order to control costs. While incentives to increase generic drug use have achieved significant savings, other cost-containment measures are required. Tendering is a formal procedure to purchase medications using competitive bidding for a particular contract. Although useful for cost containment, tendering can lead to decreased competition in a given market. Consequently, drug shortages can occur, resulting in changes to treatment plans to products that may have lower efficacy and/or an increased risk of adverse effects. Therefore, care must be taken to ensure that tendering does not negatively impact patient care or the health care system. A large and expanding portion of total pharmaceutical expenditure is for biologic therapies. These agents have revolutionized the treatment of many diseases, including cancer and inflammatory conditions; however, patient access to biologic drugs can be limited due to availability, insurance coverage, and cost. As branded biologic therapies reach the end of patent- and data-protection periods, biosimilars are being approved as lower-cost alternatives. Biosimilars are products that are highly similar to the originator product with no clinically meaningful differences in terms of safety, purity, or potency. As more biosimilars receive regulatory approval and adoption increases, these therapies are expected to have an impact on global health care spending and should result in overall savings. However, the use of tendering to maximize the potential benefits of biosimilars has varied across the world. Therefore, the objectives of this review are to examine the drug-tendering process and its implications on drug supply and drug shortages, as well as to describe biosimilars and how tendering may influence their uptake. PMID:29033595

Essential and non-essential paediatric surgery: implications for the future delivery of state health care in the UK.

PubMed

Farrelly, Paul J; Losty, Paul D

2015-09-01

Delivery of health care in the UK faces enormous challenges with the Department of Health driving significant financial cost savings to ensure viability of public health services. We have analysed and modelled the concept of 'essential' and 'non-essential' paediatric surgery linked to the delivery of children's surgery in the NHS in England. Operation codes for surgical operations in newborns, children and adolescents were identified and Healthcare Resource Group tariffs-£Stg matched. Operations were designated as 'essential' or 'non-essential' based on the criteria-(1) life saving-neonatal surgery, emergency general surgery of childhood, cancer surgery; (2) debility if uncorrected; (3) aesthetics and (4) culture/attitude. Hospital Episode Statistics (HES) data were accessed and sampled for the total number of paediatric surgical operations-(age range 0-14 years) performed in NHS hospitals from 2009 to 2010. Annual costs (£) of both 'essential' and 'non-essential' operations were then calculated. The commonest 'essential' operations performed in children and adolescents in the year 2009-2010 was appendicectomy at a cost of over £51 million pounds. Costs of performing a selection of 'non-essential' paediatric surgery operations were >£14 million pounds/year. The NHs funds for example almost 11,000 paediatric circumcisions annually at a cost of >£8 million pounds-50% are performed for non-therapeutic reasons. Surgeons must engage and work actively with health care systems to ensure diminishing financial resources prioritise 'essential' operations for children. Commissioners must embrace evidence-based surgery. 'Essential' and 'non-essential' surgery has wide implications for the sustainability of the NHS and concepts herein developed can be applied to nations worldwide.

Principles for funding on a case mix basis: construction of case weights (RIWs).

PubMed

Botz, C K

1991-01-01

The construct of Resource Intensity Weights (RIWs) contains implicit financial incentives if they are used for hospital funding purposes. This paper compares the RIW (funding) credit to the expected average per diem cost for each of the new subcategories (typicals, deaths, transfers, signouts and outliers) of Case Mix Groups (CMGs). RIW construction, and inherent incentives for a hospital to reduce costs or length of stay (LOS), differ significantly for each subcategory. At some point or points in a patient's LOS, when RIW credit equals case cost, RIWs are incentive neutral. However, it can also be demonstrated that RIW credit is not generally congruent with average costs on each day of a patient's stay. Financial incentives (both positive and negative) arise when RIW credit and costs differ. Only by being fully aware of these differences can hospitals determine how to respond to the introduction of case mix funding to maintain financial viability. Funding agencies, too, need to appreciate the sometimes subtle policy implications that come with the adoption of RIWs for funding purposes.

Economics of gynecologic morcellation.

PubMed

Bortoletto, Pietro; Friedman, Jaclyn; Milad, Magdy P

2018-02-01

As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood. Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation. At the same time, researchers have focused on the true benefits of the power morcellator from a safety and cost perspective, and consistently found that with careful patient selection, by preventing laparotomies, it can be a cost-effective tool. Changes since 2014 have resulted in new techniques and technologies to allow these minimally invasive procedures to continue to be offered in a safe manner. With this rapid change, physicians are altering their practice and patients are attempting to educate themselves to decide what is best for them. This evolution has allowed us to refocus on the cost implications of new developments, allowing stakeholders the opportunity to maximize patient safety and surgical outcomes while minimizing cost.

Technical considerations for designing low-cost, long-wave infrared objectives

NASA Astrophysics Data System (ADS)

Desroches, Gerard; Dalzell, Kristy; Robitaille, Blaise

2014-06-01

With the growth of uncooled infrared imaging in the consumer market, the balance between cost implications and performance criteria in the objective lens must be examined carefully. The increased availability of consumer-grade, long-wave infrared cameras is related to a decrease in military usage but it is also due to the decreasing costs of the cameras themselves. This has also driven up demand for low-cost, long-wave objectives that can resolve smaller pixels while maintaining high performance. Smaller pixels are traditionally associated with high cost objectives because of higher resolution requirements but, with careful consideration of all the requirements and proper selection of materials, costs can be moderated. This paper examines the cost/performance trade-off implications associated with optical and mechanical requirements of long-wave infrared objectives. Optical performance, f-number, field of view, distortion, focus range and thermal range all affect the cost of the objective. Because raw lens material cost is often the most expensive item in the construction, selection of the material as well as the shape of the lens while maintaining acceptable performance and cost targets were explored. As a result of these considerations, a low-cost, lightweight, well-performing objective was successfully designed, manufactured and tested.

Cost and workforce implications of subjecting all physicians to aviation industry work-hour restrictions.

PubMed

Payette, Michael; Chatterjee, Abhishek; Weeks, William B

2009-06-01

Efforts to improve patient safety have attempted to incorporate aviation industry safety standards. We sought to evaluate the cost and workforce implications of applying aviation duty-hour restrictions to the entire practicing physician workforce. The work hours and personnel deficit for United States residents and practicing physicians that would be created by the adoption of aviation standards were calculated. Application of aviation standards to the resident workforce creates an estimated annual cost of $6.5 billion, requiring a 174% increase in the number of residents to meet the deficit. Its application to practicing physicians creates an additional annual cost of $80.4 billion, requiring a 71% increase in the physician workforce. Adding in the aviation industry's mandatory retirement age (65 years) increases annual costs by $10.5 billion. The cost per life-year saved would be $1,035,227. Application of aviation duty-hour restrictions to the United States health care system would be prohibitively costly. Alternate approaches for improving patient safety are warranted.

Stratified cost-utility analysis of C-Leg versus mechanical knees: Findings from an Italian sample of transfemoral amputees.

PubMed

Cutti, Andrea Giovanni; Lettieri, Emanuele; Del Maestro, Martina; Radaelli, Giovanni; Luchetti, Martina; Verni, Gennero; Masella, Cristina

2017-06-01

The fitting rate of the C-Leg electronic knee (Otto-Bock, D) has increased steadily over the last 15 years. Current cost-utility studies, however, have not considered the patients' characteristics. To complete a cost-utility analysis involving C-Leg and mechanical knee users; "age at the time of enrollment," "age at the time of first prosthesis," and "experience with the current type of prosthesis" are assumed as non-nested stratification parameters. Cohort retrospective. In all, 70 C-Leg and 57 mechanical knee users were selected. For each stratification criteria, we evaluated the cost-utility of C-Leg versus mechanical knees by computing the incremental cost-utility ratio, that is, the ratio of the "difference in cost" and the "difference in utility" of the two technologies. Cost consisted of acquisition, maintenance, transportation, and lodging expenses. Utility was measured in terms of quality-adjusted life years, computed on the basis of participants' answers to the EQ-5D questionnaire. Patients over 40 years at the time of first prosthesis were the only group featuring an incremental cost-utility ratio (88,779 €/quality-adjusted life year) above the National Institute for Health and Care Excellence practical cost-utility threshold (54,120 €/quality-adjusted live year): C-Leg users experience a significant improvement of "mobility," but limited outcomes on "usual activities," "self-care," "depression/anxiety," and reduction of "pain/discomfort." The stratified cost-utility results have relevant clinical implications and provide useful information for practitioners in tailoring interventions. Clinical relevance A cost-utility analysis that considered patients characteristics provided insights on the "affordability" of C-Leg compared to mechanical knees. In particular, results suggest that C-Leg has a significant impact on "mobility" for first-time prosthetic users over 40 years, but implementation of specific low-cost physical/psychosocial interventions is required to retun within cost-utility thresholds.

The folly of using RCCs and RVUs for intermediate product costing.

PubMed

Young, David W

2007-04-01

Two measures for computing the cost of intermediate projects--a ratio of cost to charges and relative value units--are highly flawed and can have serious financial implications for the hospitals that use them. Full-cost accounting, using the principles of activity-based costing, enables hospitals to measure their costs more accurately, both for competitive bidding purposes and to manage them more effectively.

Health impacts from cyanobacteria harmful algae blooms: Implications for the North American Great Lakes.

PubMed

Carmichael, Wayne W; Boyer, Gregory L

2016-04-01

Harmful cyanobacterial blooms (cHABs) have significant socioeconomic and ecological costs, which impact drinking water, fisheries, agriculture, tourism, real estate, water quality, food web resilience and habitats, and contribute to anoxia and fish kills. Many of these costs are well described, but in fact are largely unmeasured. Worldwide cHABs can produce toxins (cyanotoxins), which cause acute or chronic health effects in mammals (including humans) and other organisms. There are few attempts to characterize the full health-related effects other than acute incidences, which may go unrecorded. At present these are difficult to access and evaluate and may be ascribed to other causes. Such information is fundamental to measure the full costs of cHABs and inform the need for often-costly management and remediation. This paper synthesizes information on cHABs occurrence, toxicology and health effects, and relates this to past and current conditions in the Great Lakes, a major global resource which supplies 84% of the surface water in North America. This geographic region has seen a significant resurgence of cHABs since the 1980s. In particular we focus on Lake Erie, where increased reporting of cHABs has occurred from the early 1990's. We evaluate available information and case reports of cHAB-related illness and death and show that cHABs occur throughout the basin, with reports of animal illness and death, especially dogs and livestock. Lake Erie has consistently experienced cHABs and cyanotoxins in the last decade with probable cases of human illness, while the other Great Lakes show intermittent cHABs and toxins, but no confirmed reports on illness or toxicity. The dominant toxigenic cyanobacterium is the genus Microcystis known to produce microcystins. The presence of other cyanotoxins (anatoxin-a, paralytic shellfish toxins) implicates other toxigenic cyanobacteria such as Anabaena (Dolichospermum) and Lyngbya. Copyright © 2016 Elsevier B.V. All rights reserved.

Inadequate pelvic radiographs: implications of not getting it right the first time.

PubMed

Parker, S; Nagra, N S; Kulkarni, K; Pegrum, J; Barry, S; Hughes, R; Ghani, Y

2017-09-01

Introduction Pelvic radiography is a frequent investigation. European guidelines aim to ensure appropriate use and adequate quality. When initial images are inadequate, repeat radiographs are often required, which may have significant patient safety and economic implications. Objectives The study aimed to assess the adequacy of pelvic imaging across three orthopaedic centres, to identify causes for inadequate imaging and to establish the cost of inadequate imaging from financial and patient safety perspectives. Methods Pelvic radiographs were identified on Picture Archiving and Communication System software at three UK hospitals. Radiographs were assessed against European guidelines and indications for repeat imaging were analysed. Results A total of 1,531 sequential pelvic radiographs were reviewed. The mean age of patients was 60 years (range 5 months to 101 years). Of this total, 51.9% of images were suboptimal, with no significant difference across the three hospitals (P > 0.05). Hospital 3 repeated radiographs in 6.3% of cases, compare with 18.1% and 19.7% at hospitals 1 and 2, respectively (P > 0.05). Hospital 3 identified pathology missed on the initial radiograph in 1% of cases, compared with 5.4% and 5.5% at hospitals 1 and 2, respectively (P > 0.05). Out-of-hours imaging is associated with a higher rate of suboptimal quality (69.1%) compared with normal working hours (51.3%; P = 0.006). Adequacy rates vary with age (χ 2 = 43.62, P < 0.001). Risk of having a suboptimal radiograph increases above the age of 60-years (χ 2 = 4.45, P < 0.05). The annual cost of repeat radiographs was £56,200 per hospital. Discussion and conclusion High rates of pelvic radiograph inadequacy can lead to missed pathology and the requirement for repeat imaging, which has significant patient safety and financial implications. Risk factors for inadequate radiographs include older patients and those having out-of-hours imaging.

Attention-Deficit/Hyperactivity Disorder Subtype Differentially Predicts Smoking Expectancies in Adolescents

PubMed Central

Foster, Ida; Racicot, Simon; McGrath, Jennifer J.

2017-01-01

Purpose Attention deficit hyperactivity disorder (ADHD) is an established risk factor for smoking; however, no studies have considered whether precursors to smoking behavior differ among adolescents with ADHD. Smoking expectancies are beliefs about the potential consequences of smoking, and they develop before smoking initiation. ADHD characteristics may contribute to the formation of expectancies and eventual smoking behavior. We evaluated whether clinical levels of ADHD subtypes differentially predicted smoking expectancies. Methods Adolescents (n = 221; age mean = 12.67 years) completed the Smoking Expectancy Scale for Adolescents, answered standardized questions about their smoking behavior, and provided expired breath samples to verify never-smoking status. Parents completed the Conners’ Parent Rating Scale for ADHD symptoms of inattention and hyperactivity/impulsivity. Results Adolescents with clinical levels of inattention were significantly less likely to endorse negative consequences, including Expected Costs (odds ratio [OR] = .16), Appearance–Presentation Costs (OR = .29), Social Costs (OR = .19), Health Costs (OR = .21), and Addiction Costs (OR = .39). Inattentive female adolescents were significantly more likely to endorse Weight Control as a consequence. Adolescents with clinical levels of hyperactivity/impulsivity were more likely to endorse positive consequences, including Expected Benefits (OR = 5.31), Affect Control (OR = 2.60), and Boredom Reduction (OR = 3.14); they were less likely to endorse Social Costs (OR = .27). Conclusions ADHD subtype differentially predicted smoking expectancies. Adolescents with ADHD may be more vulnerable to developing pro-smoking expectancies due to subtype-related deficits in neurocognitive processing. These findings have potential implications for developing targeted smoking prevention programs. PMID:22999841

Specialty hospitals emulating focused factories: a case study.

PubMed

Kumar, Sameer

2010-01-01

For 15 years general hospital managers faced new competition from for-profit specialty hospitals that operate on a "focused factory" model, which threaten to siphon-off the most profitable patients. This paper aims to discuss North American specialty hospitals and to review rising costs impact on general hospital operations. The focus is to discover whether specialty hospitals are more efficient than general hospitals; if so, how significant is the difference and also what can general hospitals do in light of the rising specialty hospitals. The case study involves stochastic frontier regression analysis using Cobb-Douglas and Translog cost functions to compare Minnesota general and specialty hospital efficiency. Analysis is based on data from 117 general and 19 specialty hospitals. The results suggest that specialty hospitals are significantly more efficient than general hospitals. Overall, general hospitals were found to be more than twice as inefficient compared with specialty hospitals in the sample. Some cost-cutting factors highlighted can be implemented to trim rising costs. The case study highlights some managerial levers that general hospital operational managers might use to control rising costs. This also helps them compete with specialty hospitals by reducing overheads and other major costs. The study is based on empirical modeling for an important healthcare operational challenge and provides additional in-depth information that has health policy implications. The analysis and findings enable healthcare managers to guide their institutions in a new direction during a time of change within the industry.

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

PubMed Central

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

2013-01-01

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

Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization.

PubMed

Panni, Roheena Z; Ashfaq, Awais; Amanullah, Muhammad M

2011-12-29

Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively; among patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan. A prevalence based cost of illness study design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children ≤ 5 years of age from June 2006 to June 2009. A total of 120 patients were enrolled after obtaining an informed consent and the data was collected using a pre-tested questionnaire. The mean age at the time of surgery in group A (1-12 mo age) was 6.08 ± 2.80 months and in group B (1-5 yrs) was 37.10 ± 19.94 months. The cost of surgical admission was found to be significantly higher in the older group, p = 0.001. The total number and cost of post-operative outpatient visits was also higher in group B, p = 0.003. Pre and post operative hospital admissions were not found to be significantly different among the two groups, p = 0.166 and 0.627, respectively. The number of complications were found to be different between the two groups (p = 0.019). Majority of these were contributed by hemorrhage and post-operative seizures. This study concluded that significant expenditure is incurred by people with CHD; with the implication that resources could be saved by earlier detection and awareness campaigns.

The cost of postabortion care and legal abortion in Colombia.

PubMed

Prada, Elena; Maddow-Zimet, Isaac; Juarez, Fatima

2013-09-01

Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.

A review of economic impact of targeted oral anticancer medications.

PubMed

Shen, Chan; Chien, Chun-Ru; Geynisman, Daniel M; Smieliauskas, Fabrice; Shih, Ya-Chen T

2014-02-01

There has been a rapid increase in the use of targeted oral anticancer medications (OAMs) in the past decade. As OAMs are often expensive, economic consideration play a significant role in the decision to prescribe, receive or cover them. This paper performs a systematic review of costs or budgetary impact of targeted OAMs to better understand their economic impact on the healthcare system, patients as well as payers. We present our review in a summary table that describes the method and main findings, take into account multiple factors, such as country, analytical approach, cost type, study perspective, timeframe, data sources, study population and care setting when we interpret the results from different papers, and discuss the policy and clinical implications. Our review raises a concern regarding the role of sponsorship on findings of economic analyses as the vast majority of pharmaceutical company-sponsored studies reported cost advantages toward the sponsor's drugs.

Fire assisted pastoralism vs. sustainable forestry--the implications of missing markets for carbon in determining optimal land use in the wet-dry tropics of Australia.

PubMed

Ockwell, David; Lovett, Jon C

2005-04-01

Using Cape York Peninsula, Queensland, Australia as a case study, this paper combines field sampling of woody vegetation with cost-benefit analysis to compare the social optimality of fire-assisted pastoralism with sustainable forestry. Carbon sequestration is estimated to be significantly higher in the absence of fire. Integration of carbon sequestration benefits for mitigating future costs of climate change into cost-benefit analysis demonstrates that sustainable forestry is a more socially optimal land use than fire-assisted pastoralism. Missing markets for carbon, however, imply that fire-assisted pastoralism will continue to be pursued in the absence of policy intervention. Creation of markets for carbon represents a policy solution that has the potential to drive land use away from fire-assisted pastoralism towards sustainable forestry and environmental conservation.

Does informal care impact utilization of healthcare services? Evidence from a longitudinal study of stroke patients.

PubMed

Torbica, Aleksandra; Calciolari, Stefano; Fattore, Giovanni

2015-01-01

Understanding the interplay between informal care and formal healthcare is important because it sheds light on the financial implications of such interactions and may result in different policies. On the basis of a major database on 532 Italian stroke patients enrolled in the period 2007-2008, we investigate whether the presence of a potential caregiver and the amount of informal care provided influences the use and the costs of healthcare services, and in particular rehabilitation, in the post-acute phase. Primary caregivers of stroke patients were interviewed at 3, 6 and 12 months after the acute event and use of healthcare and informal care were documented. The panel dataset included socio-demographic, clinical and economic data on patients and caregivers. A longitudinal log-linear model was applied to test the impact of informal care on total healthcare costs in the observation period. A double hurdle model was used to investigate the impact of informal care on rehabilitation costs. A total of 476 of stroke survivors in 44 hospitals were enrolled in the study and presence of informal caregiver was reported in approximately 50% of the sample (range 48.2-52.5% across the three periods). Healthcare costs at 12 months after the acute event are €5825 per patient, with rehabilitation costs amounting to €3985 (68.4%). Healthcare costs are significantly different between the patients with and without caregiver in all three periods. The presence of the caregiver is associated with 54.7% increase in direct healthcare costs (p < 0.01). Instead, the amount of informal care provided does not influence significantly direct healthcare costs. The presence of caregiver significantly increases the probability of access to rehabilitation services (β = 0.648, p = 0.039) while, once the decision on access is made, it doesn't influence the amount of services used. Our results suggest that informal caregivers facilitate or even promote the access to healthcare services. Copyright © 2014 Elsevier Ltd. All rights reserved.

Compliance to clinical pathways in the management of suspected pulmonary embolus: are there cost implications?

PubMed

Rehman, Ata; Yelf, Eric; Pearson, Jacqueline; Yeo, Wilf

2017-04-01

This study investigated the cost implications of poor compliance to established guidelines for management of suspected pulmonary embolism (PE) in two NSW public hospitals. A retrospective audit showed that the prevalence of PE overall was 9.9% (4.3% in the low-risk groups) in 436 patients. An estimated total of $32 454 (14%) was spent on unnecessary tests. © 2017 Royal Australasian College of Physicians.

Determinants of nursing home costs in Florida: policy implications and support in national research findings.

PubMed Central

Traxler, H G

1982-01-01

Descriptive and econometric analysis of the major nonquality determinants of nursing home costs for Florida shows that mean costs, size, and occupancy rate increased between 1971 and 1976, that per diem costs and occupancy rate were inversely related, and that the per diem cost was lower in rural than in urban areas. Regression of the data shows that--next to inflation, as expressed by the Consumer Price Index--the occupancy rate accounts for most of the variation in per diem costs, followed by size, urban-rural location, and by type of control. The hypothetical "optimal," defined as lowest cost-size range, was calculated to be more than 350 beds. Recent research substantiates most of these findings. Medicaid Cost Reports from Florida's nursing homes were the source of the information analyzed; by 1976, the sixth year of the study, the data base covered nearly 9 of 10 licensed beds in the State. Some policy implications can be drawn from the analysis. Reductions in per diem costs could be achieved by higher occupancy rates, especially in the larger nursing homes, and a reduction in the rate of inflation would reduce the rate of increase in nursing home costs. PMID:6815706

Global financial crisis and surgical practice: the Greek paradigm.

PubMed

Karidis, Nikolaos P; Dimitroulis, Dimitrios; Kouraklis, Gregory

2011-11-01

Apart from the significant implications of recent financial crisis in overall health indices and mortality rates, the direct effect of health resources redistribution in everyday clinical practice is barely recognized. In the case of Greece, health sector reform and health spending cuts have already had a major impact on costly interventions, particularly in surgical practice. An increase in utilization of public health resources, lack of basic and advanced surgical supplies, salary deductions, and emerging issues in patient management have contributed to serious dysfunction of a public health system unable to sustain current needs. In this context, significant implications arise for the surgeons and patients as proper perioperative management is directly affected by reduced public health funding. The surgical community has expressed concerns about the quality of surgical care and the future of surgical progress in the era of the European Union. Greek surgeons are expected to support reform while maintaining a high level of surgical care to the public. The challenge of cost control in surgical practice provides, nevertheless, an excellent opportunity to reconsider health economics while innovation through a more traditional approach to the surgical patient should not be precluded. A Greek case study on the extent of the current situation is presented with reference to health policy reform, serving as an alarming paradigm for the global community under the pressure of a profound financial recession.

The Economic Costs of Childhood Disability

ERIC Educational Resources Information Center

Stabile, Mark; Allin, Sara

2012-01-01

Childhood disabilities entail a range of immediate and long-term economic costs that have important implications for the well-being of the child, the family, and society but that are difficult to measure. In an extensive research review, Mark Stabile and Sara Allin examine evidence about three kinds of costs--direct, out-of-pocket costs incurred…

Cost analysis and outcomes of simple elbow dislocations

PubMed Central

Panteli, Michalis; Pountos, Ippokratis; Kanakaris, Nikolaos K; Tosounidis, Theodoros H; Giannoudis, Peter V

2015-01-01

AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations. METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level I trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation (LOI), patients were divided in three groups (Group I, < 2 wk; Group II, 2-3 wk; and Group III, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100° (from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed. RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d (median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d (median 57 d; range 10-351 d). Group III (prolonged immobilisation) had a statistically significant worse outcome in comparison to Group I and II (P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups I and II (P = 0.30). No statistically significant difference in the direct medical costs between the groups was identified. CONCLUSION: The length of elbow immobilization doesn’t influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome. PMID:26301180

Eliminating the use of intravenous glass bottles using a FOCUS-PDCA model and providing a practical stability reference guide.

PubMed

Maraiki, Fatma; Farooq, Faiyaz; Ahmed, Mohamed

2016-08-01

To identify the intravenous (IV) medications that are prepared in glass bottles at the institution and establish which of these medications can be prepared in flexible IV bags such as polyvinyl chloride (PVC) or non-PVC instead of glass bottles. The cost implication of switching from glass bottles to flexible IV bags was calculated. A study using FOCUS-PDCA model to identify IV medications prepared in glass bottles and establish which of these medications could be prepared in IV bags (PVC or non-PVC). The cost impact of switching from glass bottles to IV plastic bags (including PVC or non-PVC) was calculated. The stability data obtained were used as a reference for updating pharmacy internal IV preparation charts. A total of 17 IV medications were found to be prepared in IV glass bottles. Of these 17 medications, only 8 (47%) were prepared in IV glass bottles due to incompatibility with PVC bags. For 7 (41%) of the medications, of which 6 were monoclonal antibodies (MABs), the reason for preparation in glass bottles was unclear as these medications are compatible with either PVC or non-PVC or both. The potential cost savings associated with switching all of the identified medications to IV plastic bags (either non-PVC or PVC) exceeded $200 000. The elimination of glass bottles within the institution resulted in a significant cost saving. The use of FOCUS-PDCA model can help healthcare institution achieve significant improvements in process and realize significant cost savings. © 2016 Royal Pharmaceutical Society.

One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs

PubMed Central

Maben, Jill; Penfold, Clarissa; Simon, Michael; Anderson, Janet E; Robert, Glenn; Pizzo, Elena; Hughes, Jane; Murrells, Trevor; Barlow, James

2016-01-01

Background and objectives There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. Methods Mixed methods pre/post ‘move’ comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. Results Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. Conclusions Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. PMID:26408568

A Selective Role for Dopamine in Learning to Maximize Reward But Not to Minimize Effort: Evidence from Patients with Parkinson's Disease.

PubMed

Skvortsova, Vasilisa; Degos, Bertrand; Welter, Marie-Laure; Vidailhet, Marie; Pessiglione, Mathias

2017-06-21

Instrumental learning is a fundamental process through which agents optimize their choices, taking into account various dimensions of available options such as the possible reward or punishment outcomes and the costs associated with potential actions. Although the implication of dopamine in learning from choice outcomes is well established, less is known about its role in learning the action costs such as effort. Here, we tested the ability of patients with Parkinson's disease (PD) to maximize monetary rewards and minimize physical efforts in a probabilistic instrumental learning task. The implication of dopamine was assessed by comparing performance ON and OFF prodopaminergic medication. In a first sample of PD patients ( n = 15), we observed that reward learning, but not effort learning, was selectively impaired in the absence of treatment, with a significant interaction between learning condition (reward vs effort) and medication status (OFF vs ON). These results were replicated in a second, independent sample of PD patients ( n = 20) using a simplified version of the task. According to Bayesian model selection, the best account for medication effects in both studies was a specific amplification of reward magnitude in a Q-learning algorithm. These results suggest that learning to avoid physical effort is independent from dopaminergic circuits and strengthen the general idea that dopaminergic signaling amplifies the effects of reward expectation or obtainment on instrumental behavior. SIGNIFICANCE STATEMENT Theoretically, maximizing reward and minimizing effort could involve the same computations and therefore rely on the same brain circuits. Here, we tested whether dopamine, a key component of reward-related circuitry, is also implicated in effort learning. We found that patients suffering from dopamine depletion due to Parkinson's disease were selectively impaired in reward learning, but not effort learning. Moreover, anti-parkinsonian medication restored the ability to maximize reward, but had no effect on effort minimization. This dissociation suggests that the brain has evolved separate, domain-specific systems for instrumental learning. These results help to disambiguate the motivational role of prodopaminergic medications: they amplify the impact of reward without affecting the integration of effort cost. Copyright © 2017 the authors 0270-6474/17/376087-11$15.00/0.

Health and productivity as a business strategy: a multiemployer study.

PubMed

Loeppke, Ronald; Taitel, Michael; Haufle, Vince; Parry, Thomas; Kessler, Ronald C; Jinnett, Kimberly

2009-04-01

To explore methodological refinements in measuring health-related lost productivity and to assess the business implications of a full-cost approach to managing health. Health-related lost productivity was measured among 10 employers with a total of 51,648 employee respondents using the Health and Work Performance Questionnaire combined with 1,134,281 medical and pharmacy claims. Regression analyses were used to estimate the associations of health conditions with absenteeism and presenteeism using a range of models. Health-related productivity costs are significantly greater than medical and pharmacy costs alone (on average 2.3 to 1). Chronic conditions such as depression/anxiety, obesity, arthritis, and back/neck pain are especially important causes of productivity loss. Comorbidities have significant non-additive effects on both absenteeism and presenteeism. Executives/Managers experience as much or more monetized productivity loss from depression and back pain as Laborers/Operators. Testimonials are reported from participating companies on how the study helped shape their corporate health strategies. A strong link exists between health and productivity. Integrating productivity data with health data can help employers develop effective workplace health human capital investment strategies. More research is needed to understand the impacts of comorbidity and to evaluate the cost effectiveness of health and productivity interventions from an employer perspective.

Do Nurse-Led Skill Training Interventions Affect Informal Caregivers’ Out-of-Pocket Expenditures?

PubMed Central

Van Houtven, Courtney Harold; Thorpe, Joshua M.; Chestnutt, Deborah; Molloy, Margory; Boling, John C.; Davis, Linda Lindsey

2013-01-01

Purpose of the Study: This paper is a report of a study of the Assistance, Support, and Self-health Initiated through Skill Training (ASSIST) randomized control trial. The aim of this paper is to understand whether participating in ASSIST significantly changed the out-of-pocket (OOP) costs for family caregivers of Alzheimer’s disease (AD) or Parkinson's disease (PD) patients. Design and Methods: Secondary analysis of randomized control trial data, calculating average treatment effects of the intervention on OOP costs. Enrollment in the ASSIST trial occurred between 2002 and 2007 at 2 sites: Durham, North Carolina, and Birmingham, Alabama. We profile OOP costs for caregivers who participated in the ASSIST study and use 2-part expenditure models to examine the average treatment effect of the intervention on caregiver OOP expenditures. Results: ASSIST-trained AD and PD caregivers reported monthly OOP expenditures that averaged $500–$600. The intervention increased the likelihood of caregivers spending any money OOP by 26 percentage points over usual care, but the intervention did not significantly increase overall OOP costs. Implications: The ASSIST intervention was effective and inexpensive to the caregiver in direct monetary outlays; thus, there are minimal unintended consequences of the trial on caregiver financial well-being. PMID:22459694

Methanol infrastructure — will it affect the introduction of SPFC vehicles?

NASA Astrophysics Data System (ADS)

Hart, D.; Leach, M. A.; Fouquet, R.; Pearson, P. J.; Bauen, A.

The possibility that future solid polymer fuel cell vehicles will be fuelled by methanol has been suggested. If this is the case, it will have significant implications for the future structure of the methanol supply industry, and methanol supply and availability may have an impact on the take-up of these SPFC vehicles. In this study, a model assessing the possible future penetration of methanol SPFC vehicles was constructed. This suggested that it would be possible for SPFC vehicles to achieve rapid market penetration after an initially slow start. A further model indicated that methanol supply would be adequate for vehicle demand until about 2013, when significant new capacity would be required. The cost of this new capacity was estimated, along with the cost of providing refuelling infrastructure such as road tankers, storage, and suitable fuelling stations. Amortising the cost over a short period (to 2013) could double the pre-tax price of methanol as a fuel, while over a longer timeframe (to 2029) it would add less than 10% to this value. The model suggests that methanol capacity need not be a constraint to the future introduction of SPFC vehicles using it as a fuel, but that other factors such as fuel purity and safety must be carefully considered before real costs can be calculated.

Cost and Price Increases in Higher Education: Evidence of a Cost Disease on Higher Education Costs and Tuition Prices and the Implications for Higher Education Policy

ERIC Educational Resources Information Center

Trombella, Jerry

2011-01-01

As concern over rapidly rising college costs and tuition sticker prices have increased, a variety of research has been conducted to determine potential causes. Most of this research has focused on factors unique to higher education. In contrast, cost disease theory attempts to create a comparative context to explain cost increases in higher…

The Policy Implications of the Cost Structure of Home Health Agencies

PubMed Central

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

2014-01-01

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

Assigning Resources to Health Care Use for Health Services Research: Options and Consequences

PubMed Central

Fishman, Paul A.; Hornbrook, Mark C.

2013-01-01

Aims Our goals are threefold: 1) to review the leading options for assigning resource coefficients to health services utilization; 2) to discuss the relative advantages of each option; and, 3) provide examples where the research question had marked implications for the choice of which resource measure to employ. Methods Three approaches have been used to establish relative resource weights in health services research: a) direct estimation of production costs through micro-costing or step down allocation methods; b) macro-costing/regression analysis; and, c) standardized resource assignment. We describe each of these methods and provide examples of how the study question drove the choice of resource use measure. Findings All empirical resource-intensity weighting systems contain distortions that limit their universal application. Hence, users must select the weighting system that matches the needs of their specific analysis. All systems require significant data resources and data processing. However, inattention to the distortions contained in a complex resource weighting system may undermine the validity and generalizability of an economic evaluation. Conclusions Direct estimation of production costs are useful for empirical analyses, but they contain distortions that undermine optimal resource allocation decisions. Researchers must ensure that the data being used meets both the study design and the question being addressed. They also should ensure that the choice of resource measure is the best fit for the analysis. Implications for Research and Policy Researchers should consider which of the available measures is the most appropriate for the question being addressed rather than take ‘cost’ or utilization as a variable over which they have no control PMID:19536002

The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

PubMed

Vered, Oded; Simon-Tuval, Tzahit; Yagupsky, Pablo; Malul, Miki; Cicurel, Assi; Davidovitch, Nadav

2015-01-01

Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU). Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS) enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470). Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410). HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391). Before diagnosis (baseline), the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05), however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001). Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001). Additional elevated costs were 3.6 times higher laboratory tests (P<0.001), 2.8 times higher emergency room visits (P<0.001), 1.8 times higher medication (P<0.001) and 1.3 times higher diagnostic procedures (P<0.001). We conclude that human brucellosis is associated with elevated HCU costs. Considering these results in cost-effective analyses may be crucial for both reducing health inequities and optimal allocation of health systems' scarce resources.

Patient costs associated with accessing HIV/AIDS care in Malawi

PubMed Central

Pinto, Andrew D; van Lettow, Monique; Rachlis, Beth; Chan, Adrienne K; Sodhi, Sumeet K

2013-01-01

Introduction The decentralization of HIV services has been shown to improve equity in access to care for the rural poor of sub-Saharan Africa. This study aims to contribute to our understanding of the impact of decentralization on costs borne by patients. Such information is valuable for economic evaluations of anti-retroviral therapy programmes that take a societal perspective. We compared costs reported by patients who received care in an urban centralized programme to those in the same district who received care through rural decentralized care (DC). Methods A cross-sectional survey on patient characteristics and costs associated with accessing HIV care was conducted, in May 2010, on 120 patients in centralized care (CC) at a tertiary referral hospital and 120 patients in DC at five rural health centres in Zomba District, Malawi. Differences in costs borne by each group were compared using χ2 and t-tests, and a regression model was developed to adjust for confounders, using bootstrapping to address skewed cost data. Results There was no significant difference between the groups with respect to sex and age. However, there were significant differences in socio-economic status, with higher educational attainment (p<0.001), personal income (p=0.007) and household income per person (p=0.005) in CC. Travel times were similar (p=0.65), as was time waiting at the clinic (p=0.63) and total time spent seeking care (p=0.65). There was a significant difference in travel-related expenses (p<0.001) related to the type of travel participants noted that they used. In CC, 60% of participants reported using a mini-bus to reach the clinic; in DC only 4% reported using a mini-bus, and the remainder reported travelling on foot or by bicycle. There were no significant differences between the groups in the amount of lost income reported or other out-of-pocket costs. Approximately 91 Malawi Kwacha (95% confidence intervals: 1–182 MKW) or US$0.59 represents the adjusted difference in total costs per visit between CC and DC. Conclusions Even within a system of HIV/AIDS care where patients do not pay to see clinicians or for most medications, they still incur costs. We found that most costs are travel related. This has important implications for poorer patients who live at a distance from health facilities for whom these costs may be significant. PMID:23517716

A feasibility study of orbiter flight control experiments

NASA Technical Reports Server (NTRS)

Geissler, W. H.

1978-01-01

The results of a feasibility study of orbiter flight control experiments performed are summarized. Feasibility studies were performed on a group of 14 experiments selected from a candidate list of 35 submitted to the study contractor by the flight control community. Concepts and requirements were developed for the 14 selected experiments and they were ranked on a basis of technical value, feasibility, and cost. It was concluded that all the selected experiments can be considered as potential candidates for the Orbiter Experiment program, which is being formulated for the Orbiter Flight Tests and subsequent operational flights, regardless of the relative ranking established during the study. None of the selected experiments has significant safety implications and the cost of most was estimated to be less than $200K.

Smokers' rights to coronary artery bypass graft surgery.

PubMed

Heath, Janie; Braun, Mary Ann; Brindle, Margaret

2002-06-01

Imagine a health maintenance organization creating a policy to deny all smokers access to nonemergent coronary artery bypass graft surgery. The cost savings to the organization and society would be potentially significant. Now envision the smoker, a hardworking father with daily angina, and the provider, writing costly prescriptions to manage the angina. What ethical and legal questions do you suppose would present in that setting? Now imagine how you would respond if given this scenario of denying smokers access to nonemergent coronary artery bypass graft. This article discusses the implications of resource allocation with self-inflicted health behaviors such as smoking. Tough questions are raised that explore both the pros and the cons of smokers' rights to coronary artery bypass graft.

Implications of multiplane-multispeed balancing for future turbine engine design and cost

NASA Technical Reports Server (NTRS)

Badgley, R. H.

1974-01-01

This paper describes several alternative approaches, provided by multiplane-multispeed balancing, to traditional gas turbine engine manufacture and assembly procedures. These alternatives, which range from addition of trim-balancing at the end of the traditional assembly process to modular design of the rotating system for assembly and balancing external to the engine, require attention by the engine designer as an integral part of the design process. Since multiplane-multispeed balancing may be incorporated at one or more of several points during manufacture-assembly, its deliberate use is expected to provide significant cost and performance (reduced vibration) benefits. Moreover, its availability provides the designer with a firm base from which he may advance, with reasonable assurance of success, into the flexible rotor dynamic regime.

Cost and Health Care Utilization Implications of Bariatric Surgery Versus Intensive Lifestyle and Medical Intervention for Type 2 Diabetes.

PubMed

Banerjee, Souvik; Garrison, Louis P; Flum, David R; Arterburn, David E

2017-09-01

The aim of this study was to compare the cost and health care utilization of patients with obesity and type 2 diabetes mellitus (T2DM) randomized into either Roux-en-Y gastric bypass (RYGB) surgery or an intensive lifestyle and medical intervention (ILMI). This analysis (N = 745) is based on 2-year follow-up of a small randomized controlled trial (RCT); adult patients with obesity and T2DM were recruited between 2011 and 2012 from Kaiser Permanente Washington. Comparisons were made for patients randomized into either RYGB (N = 15) or ILMI (N = 17). There were no significant cost savings for RYGB versus ILMI patients through the follow-up years. Pharmacy cost was lower for RYGB versus ILMI patients by about $900 in year 2 versus year 0; however, inpatient and emergency room costs were higher for surgery patients in follow-up years relative to year 0. Median total cost for nonrandomized patients was higher in year 0 and in year 2 compared to randomized patients. Bariatric surgery is not cost saving in the short term. Moreover, the costs of patients who enter into RCTs of RYGB may differ from the costs of those who do not enter RCTs, suggesting use of caution when using such data to draw inferences about the general population with obesity. © 2017 The Obesity Society.

Accurate coding in sepsis: clinical significance and financial implications.

PubMed

Chin, Y T; Scattergood, N; Thornber, M; Thomas, S

2016-09-01

Sepsis is a major healthcare problem and leading cause of death worldwide. UK hospital mortality statistics and payments for patient episodes of care are calculated on clinical coding data. The accuracy of these data depends on the quality of coding. This study aimed to investigate whether patients with significant bacteraemia are coded for sepsis and to estimate the financial costs of miscoding. Of 54 patients over a one-month period with a significant bacteraemia, only 19% had been coded for sepsis. This is likely to lead to falsely high calculated hospital mortality. Furthermore, this resulted in an underpayment of £21,000 for one month alone. Copyright © 2016 The Healthcare Infection Society. All rights reserved.

Adenosine-stress cardiac magnetic resonance imaging in suspected coronary artery disease: a net cost analysis and reimbursement implications.

PubMed

Pilz, Guenter; Patel, Pankaj A; Fell, Ulrich; Ladapo, Joseph A; Rizzo, John A; Fang, Hai; Gunnarsson, Candace; Heer, Tobias; Hoefling, Berthold

2011-01-01

The health and economic implications of new imaging technologies are increasingly relevant policy issues. Cardiac magnetic resonance imaging (CMR) is currently not or not sufficiently reimbursed in a number of countries including Germany, presumably because of a limited evidence base. It is unknown, however, whether it can be effectively used to facilitate medical decision-making and reduce costs by serving as a gatekeeper to invasive coronary angiography. We investigated whether the application of CMR in patients suspected of having coronary artery disease (CAD) reduces costs by averting referrals to cardiac catheterization. We used propensity score methods to match 218 patients from a CMR registry to a previously studied cohort in which CMR was demonstrated to reliably identify patients who were low-risk for major cardiac events. Covariates over which patients were matched included comorbidity profiles, demographics, CAD-related symptoms, and CAD risk as measured by Morise scores. We determined the proportion of patients for whom cardiac catheterization was deferred based upon CMR findings. We then calculated the economic effects of practice pattern changes using data on cardiac catheterization and CMR costs. CMR reduced the utilization of cardiac catheterization by 62.4%. Based on estimated catheterization costs of € 619, the utilization of CMR as a gatekeeper reduced per-patient costs by a mean of € 90. Savings were realized until CMR costs exceeded € 386. Cost savings were greatest for patients at low-risk for CAD, as measured by baseline Morise scores, but were present for all Morise subgroups with the exception of patients at the highest risk of CAD. CMR significantly reduces the utilization of cardiac catheterization in patients suspected of having CAD. Per-patient savings range from € 323 in patients at lowest risk of CAD to € 58 in patients at high-risk but not in the highest risk stratum. Because a negative CMR evaluation has high negative predictive value, its application as a gatekeeper to cardiac catheterization should be further explored as a treatment option.

Adenosine-stress cardiac magnetic resonance imaging in suspected coronary artery disease: a net cost analysis and reimbursement implications

PubMed Central

Patel, Pankaj A.; Fell, Ulrich; Ladapo, Joseph A.; Rizzo, John A.; Fang, Hai; Gunnarsson, Candace; Heer, Tobias; Hoefling, Berthold

2010-01-01

The health and economic implications of new imaging technologies are increasingly relevant policy issues. Cardiac magnetic resonance imaging (CMR) is currently not or not sufficiently reimbursed in a number of countries including Germany, presumably because of a limited evidence base. It is unknown, however, whether it can be effectively used to facilitate medical decision-making and reduce costs by serving as a gatekeeper to invasive coronary angiography. We investigated whether the application of CMR in patients suspected of having coronary artery disease (CAD) reduces costs by averting referrals to cardiac catheterization. We used propensity score methods to match 218 patients from a CMR registry to a previously studied cohort in which CMR was demonstrated to reliably identify patients who were low-risk for major cardiac events. Covariates over which patients were matched included comorbidity profiles, demographics, CAD-related symptoms, and CAD risk as measured by Morise scores. We determined the proportion of patients for whom cardiac catheterization was deferred based upon CMR findings. We then calculated the economic effects of practice pattern changes using data on cardiac catheterization and CMR costs. CMR reduced the utilization of cardiac catheterization by 62.4%. Based on estimated catheterization costs of € 619, the utilization of CMR as a gatekeeper reduced per-patient costs by a mean of € 90. Savings were realized until CMR costs exceeded € 386. Cost savings were greatest for patients at low-risk for CAD, as measured by baseline Morise scores, but were present for all Morise subgroups with the exception of patients at the highest risk of CAD. CMR significantly reduces the utilization of cardiac catheterization in patients suspected of having CAD. Per-patient savings range from € 323 in patients at lowest risk of CAD to € 58 in patients at high-risk but not in the highest risk stratum. Because a negative CMR evaluation has high negative predictive value, its application as a gatekeeper to cardiac catheterization should be further explored as a treatment option. PMID:20524070

The Health Care Cost Implications of Overweight and Obesity during Childhood

PubMed Central

Au, Nicole

2012-01-01

Objective To investigate whether childhood overweight at age 4–5 increases publicly funded health care costs during childhood, and to explore the role of timing and duration of overweight on health costs. Data Sources The Longitudinal Study of Australian Children (2004–2008) and linked records from Medicare, Australia's public health insurance provider (2004–2009). Study Design The influence of overweight status on non-hospital Medicare costs incurred by children over a 5-year period was estimated using two-part models and one-part generalized linear models (GLM). All models controlled for demographic, socioeconomic, and parental characteristics. Principal Findings Being overweight at age 4–5 is associated with significantly higher pharmaceutical and medical care costs. The results imply that for all children aged 4 and 5 in 2004–2005, those who were overweight had a combined 5-year Medicare bill that was AUD$9.8 million higher than that of normal weight children. Results from dynamic analyses show that costs of childhood overweight occur contemporaneously, and the duration of overweight is positively associated with medical costs for children who became overweight after age 5. Conclusions This study reveals that the financial burden to the public health system of childhood overweight and obesity occurs even during the first 5 years of primary school. PMID:22092082

The effect of normative social forces on managed care organizations: implications for strategic management.

PubMed

Kirby, E G; Sebastian, J G

1998-01-01

Drawing on institutional theory, this study examines how adherence to a number of "institutional" and "technical" environmental forces can influence the business success of managed care organizations (MCOs). The standards studied include: (1) institutional forces: socially accepted procedures for delivering care (access to quality care, availability of information, and delivery of care in a personal manner); and (2) technical forces: industry standards for cost control and efficient use of financial and medical resources. The most significant finding is that successful MCOs must conform to both institutional and technical forces to be successful. MCOs that conform to either one or the other type of standard were no more successful than those that conformed to neither. These findings have several important implications for MCO strategy. First, to be successful, MCO executives must understand the external environment in which they operate. They must anticipate and respond to shifts in that environment. Second, this understanding of the external environment must place equal emphasis on societal demands (e.g., for accessible care and information) and on technical demands (e.g., for cost-efficient care). These findings may well reflect that once managed care penetration reaches relatively high levels, marketshare can no longer be gained through cost-efficiency alone; rather, enrollee satisfaction based on societal demands becomes a key factor in maintaining and gaining marketshare. Institutional theory provides' some strategies for accomplishing these goals. Cost-containment strategies include implementing policies for cutting costs in areas that do not affect the quality of care, such as using generic drugs and reducing administrative excesses and redundancies. At the same time, MCOs must implement strategies aimed at improving conformity to prevailing societal perceptions of appropriate care, including providing patients more freedom to choose their physicians and encouraging and rewarding care providers for being friendly and personable. An MCO should work to inform the public of the organization's efforts to provide high-quality, low-cost medical care in a friendly, convenient manner.

Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness.

PubMed

Polignano, Francesco M; Quyn, Aaron J; de Figueiredo, Rodrigo S M; Henderson, Nikola A; Kulli, Christoph; Tait, Iain S

2008-12-01

Reduction in hospital stay, blood loss, postoperative pain and complications are common findings after laparoscopic liver resection, suggesting that the laparoscopic approach may be a suitable alternative to open surgery. Some concerns have been raised regarding cost effectiveness of this procedure and potential implications of its large-scale application. Our aim has been to determine cost effectiveness of laparoscopic liver surgery by a case-matched, case-control, intention-to-treat analysis of its costs and short-term clinical outcomes compared with open surgery. Laparoscopic liver segmentectomies and bisegmentectomies performed at Ninewells Hospital and Medical School between 2005 and 2007 were considered. Resections involving more than two Couinaud segments, or involving any synchronous procedure, were excluded. An operation-magnitude-matched control group was identified amongst open liver resections performed between 2004 and 2007. Hospital costs were obtained from the Scottish Health Service Costs Book (ISD Scotland) and average national costs were calculated. Cost of theatre time, disposable surgical devices, hospital stay, and high-dependency unit (HDU) and intensive care unit (ICU) usage were the main endpoints for comparison. Secondary endpoints were morbidity and mortality. Statistical analysis was performed with Student's t-test, chi(2) and Fisher exact test as most appropriate. Twenty-five laparoscopic liver resections were considered, including atypical resection, segmentectomy and bisegmentectomy, and they were compared to 25 matching open resections. The two groups were homogeneous by age, sex, coexistent morbidity, magnitude of resection, prevalence of liver cirrhosis and indications. Operative time (p < 0.03), blood loss (p < 0.0001), Pringle manoeuvre (p < 0.03), hospital stay (p < 0.003) and postoperative complications (p < 0.002) were significantly reduced in the laparoscopic group. Overall hospital cost was significantly lower in the laparoscopic group by an average of 2,571 pounds sterling (p < 0.04). Laparoscopic liver segmentectomy and bisegmentectomy are feasible, safe and cost effective compared to similar open resections. Large-scale application of laparoscopic liver surgery could translate into significant savings to hospitals and health care programmes.

Increased Patient Cost-Sharing, Weak US Economy, and Poor Health Habits: Implications for Employers and Insurers.

PubMed

Haren, Melinda C; McConnell, Kirk; Shinn, Arthur F

2009-04-01

Many healthcare stakeholders, including insurers and employers, agree that growth in healthcare costs is inevitable. But the current trend toward further cost-shifting to employees and other health plan members is unsustainable. In 2008, the Zitter Group conducted a large national study on the relationship between insurers and employers, to understand how these 2 healthcare stakeholders interact in the creation of health benefit design. The survey results were previously summarized and discussed in the February/March 2009 issue of this journal. The present article aims to assess the implications of those results in the context of the growing tendency to increase patient cost-sharing, a weak US economy, and poor health habits. Increasing cost-sharing is a blunt instrument: although it may reduce utilization of frivolous services, it may also result in individuals forgoing medically necessary care. Increases in deductibles will lead to an overall decrease in optimal care-seeking behavior as families juggle healthcare costs with a weak economy and stagnating wages.

Increased Patient Cost-Sharing, Weak US Economy, and Poor Health Habits: Implications for Employers and Insurers

PubMed Central

Haren, Melinda C.; McConnell, Kirk; Shinn, Arthur F.

2009-01-01

Many healthcare stakeholders, including insurers and employers, agree that growth in healthcare costs is inevitable. But the current trend toward further cost-shifting to employees and other health plan members is unsustainable. In 2008, the Zitter Group conducted a large national study on the relationship between insurers and employers, to understand how these 2 healthcare stakeholders interact in the creation of health benefit design. The survey results were previously summarized and discussed in the February/March 2009 issue of this journal. The present article aims to assess the implications of those results in the context of the growing tendency to increase patient cost-sharing, a weak US economy, and poor health habits. Increasing cost-sharing is a blunt instrument: although it may reduce utilization of frivolous services, it may also result in individuals forgoing medically necessary care. Increases in deductibles will lead to an overall decrease in optimal care-seeking behavior as families juggle healthcare costs with a weak economy and stagnating wages. PMID:25126283

Cost Efficiency Implications of International Cooperation (Implications de rentabilite de la cooperation internationale)

DTIC Science & Technology

2015-04-01

CZECH REPUBLIC Col. Zdenek Petras Centre for Security and Military Strategic Studies University of Defence Kounicova 156/65 66210 Brno Email...military systems in order to reduce costs. Nine Nations are cooperating with Lockheed Martin to develop and produce the next generation fighter jets...is led by the technologically first-tier Nation, the US, where Lockheed Martin is the managing authority on the supply side and the US F-35 Joint

Irinotecan in second-line treatment of metastatic colorectal cancer: improved survival and cost-effect compared with infusional 5-FU.

PubMed

Iveson, T J; Hickish, T; Schmitt, C; Van Cutsem, E

1999-12-01

In a recent multicentre, randomised, controlled, open-label study (Rougier and colleagues, Lancet 1998, 352, 1407-1412), irinotecan significantly increased survival without any deterioration in quality of life compared with best-estimated infusional 5-fluorouracil (5-FU) therapy in the setting of second-line treatment for metastatic colorectal cancer. The aim of the cost-effectiveness analysis reported here was to compare the economic implications, from a U.K. perspective, of replacing 5-FU therapy [either as a single agent (Lokich regimen, B2) or in combination with folinic acid (de Gramont regimen, B1, or AIO regimen, B3)] with irinotecan as second-line therapy for metastatic colorectal cancer. Resource utilisation data collected prospectively during the study, supplemented by both a questionnaire to investigators and local expert clinical opinion, were used as a basis for estimating cumulative drug dosage, chemotherapy administration and treatment of complications. Drug acquisition costs were derived from the British National Formulary (March 1998), and unit costs for clinical consultation and services were derived from relevant 1996/1997 cost databases. Although cumulative drug acquisition costs per patient were higher with irinotecan than with infusional 5-FU therapy, these were at least partially offset by lower cumulative costs per patient associated with administration of therapy and treatment of complications in the irinotecan arm than in the 5-FU arm. Based on the incremental costs per life year gained (LYG), irinotecan was considered to be cost-effective by commonly accepted criteria compared with either the B1 or B2 regimens. Irinotecan was cost-saving compared with the B3 regimen (that is significant survival gain and a reduction in costs). Thus, not only is there strong evidence for the use of irinotecan as standard second-line therapy in metastatic colorectal cancer,but the results of this prospective economic evaluation have shown that irinotecan also represents good value for money in this clinical setting.

Implications of Using Computer-Based Training with the AN/SQQ-89(v) Sonar System: Operating and Support Costs

DTIC Science & Technology

2012-06-01

Visibility and Management of Operating and Support Costs (VAMOSC...VAMOSC Visibility and Management of Operating and Support Costs VMA Variant Manning Average WAP Weapons Alternate Processor WCS Work Center...Visibility and Management of Operating and Support Costs (VAMOSC), under Unit Level Consumption and Manhours—Organizational Corrective Maintenance. C

Trends in Cost-Sharing in the US and Potential International Implications

ERIC Educational Resources Information Center

Taylor, Barrett J.; Morphew, Christopher C.

2015-01-01

"Cost­-sharing" refers to the principle that a variety of sources contribute to the cost of higher education. This study utilizes university-­level data from the United States to explore the increasing shift of cost burdens from governments to students. Panel regression results suggest that the share of expenditures drawn from tuition…

An improved synthesis of haloaceteamidine-based inactivators of protein arginine deiminase 4 (PAD4).

PubMed

Causey, Corey P; Thompson, Paul R

2008-07-07

Protein arginine deiminase 4 (PAD4) is an enzyme that hydrolyzes peptidyl arginine residues to form citrulline and ammonia. This enzyme has been implicated in several disease states, e.g. rheumatoid arthritis, and therefore represents a unique target for the development of a novel therapeutic. A solution-phase synthesis of Cl-amidine, the most potent PAD4 inactivator described to date, has been developed. This synthesis proceeds in 80% yield over 4 steps at a significantly (12-fold) lower cost.

Implications of the Third Industrial Revolution on the Elements of National Power and Their Impact on National Security Strategy

DTIC Science & Technology

1992-03-16

34A Hidden U.S. Export: Higher Education ." The WashinQton Post, 16 February 1992, H1 and H4. Brandin , David H., and Michael A. Harrison. The...frequent significant technological change now occurs within the individual person’s working lifespan, life-long education is a necessity to remain...INDUSTRIAL REVOLUTION The phenomenal increase in speed and in raw power of computer processors, the shrinking size and cost of basic computing systems, the

Pure versus hybrid: performance implications of Porter's generic strategies.

PubMed

Kumar, K; Subramanian, R; Yauger, C

1997-01-01

This article identifies the strategic types in the hospital industry based on the hospital's use of Porter's generic strategies in their pure and hybrid forms. The article also examines differences in performance of hospitals across strategic types. Results indicate that hospitals that follow a focussed cost leadership strategy, in general, have superior performance on a variety of performance measures, while hospitals that use a combination of cost leadership and differentiation perform the poorest. Implications of findings for hospital administrators are also discussed.

Effect of a food waste disposer policy on solid waste and wastewater management with economic implications of environmental externalities.

PubMed

Maalouf, Amani; El-Fadel, Mutasem

2017-11-01

In this study, the carbon footprint of introducing a food waste disposer (FWD) policy was examined in the context of its implications on solid waste and wastewater management with economic assessment of environmental externalities emphasizing potential carbon credit and increased sludge generation. For this purpose, a model adopting a life cycle inventory approach was developed to integrate solid waste and wastewater management processes under a single framework and test scenarios for a waste with high organic food content typical of developing economies. For such a waste composition, the results show that a FWD policy can reduce emissions by nearly ∼42% depending on market penetration, fraction of food waste ground, as well as solid waste and wastewater management schemes, including potential energy recovery. In comparison to baseline, equivalent economic gains can reach ∼28% when environmental externalities including sludge management and emissions variations are considered. The sensitivity analyses on processes with a wide range in costs showed an equivalent economic impact thus emphasizing the viability of a FWD policy although the variation in the cost of sludge management exhibited a significant impact on savings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Lead zirconate titanate thin films directly on copper electrodes for ferroelectric, dielectric and piezoelectric applications

NASA Astrophysics Data System (ADS)

Kingon, Angus I.; Srinivasan, Sudarsan

2005-03-01

Replacement of noble metal electrodes by base metals significantly lowers the cost of ferroelectric, piezoelectric and dielectric devices. Here, we demonstrate that it is possible to process lead zirconate (Pb(Zr0.52Ti0.48)O3, or PZT) thin films directly on base metal copper foils. We explore the impact of the oxygen partial pressure during processing, and demonstrate that high-quality films and interfaces can be achieved through control of the oxygen partial pressure within a narrow window predicted by thermodynamic stability considerations. This demonstration has broad implications, opening up the possibility of the use of low-cost, high-conductivity copper electrodes for a range of Pb-based perovskite materials, including PZT films in embedded printed circuit board applications for capacitors, varactors and sensors; multilayer PZT piezoelectric stacks; and multilayer dielectric and electrostrictive devices based on lead magnesium niobate-lead titanate. We also point out that the capacitors do not fatigue on repeated switching, unlike those with Pt noble metal electrodes. Instead, they appear to be fatigue-resistant, like capacitors with oxide electrodes. This may have implications for ferroelectric non-volatile memories.

As Health Costs Skyrocket, Colleges and Employees Ail.

ERIC Educational Resources Information Center

Lifely, Kit

2000-01-01

Examines implications of increasing health costs borne by colleges and universities and their employees. Notes that institutions of higher education have a wide spectrum of plans with increased costs this year averaging over 12 percent. Also finds decreased competition among insurance companies and physician networks and political complications…

Costs of Juvenile Violence: Policy Implications.

ERIC Educational Resources Information Center

Miller, Ted; Fisher, Deborah A.; Cohen, Mark A.

2001-01-01

Investigated the magnitude of juvenile violence in Pennsylvania in terms of victimization and perpetration. Used archival data on violent crimes in Pennsylvania during 1993 to develop cost estimates reflecting the costs incurred by society for both victims and perpetrators. Overall, violence against children and adolescents proved to be a much…

Airport costs and production technology : a translog cost function analysis with implications for economic development.

DOT National Transportation Integrated Search

2011-07-01

Based upon 50 large and medium hub airports over a 13 year period, this research estimates one and two : output translog models of airport short run operating costs. Output is passengers transported on non-stop : segments and pounds of cargo shipped....

A cost evaluation of cross-border truck emissions testing using heavy duty remote sensing equipment : final report 601.

DOT National Transportation Integrated Search

2008-06-01

The objective of this research study was to perform a thorough evaluation of the feasibility and cost implications for initial system installation and ongoing program and maintenance costs for a land port of entry truck emissions program utilizing he...

Airport costs and production technology : a translog cost function analysis with implications for economic development.

DOT National Transportation Integrated Search

2011-12-01

Based upon 50 large and medium hub airports over a 13 year period, this research estimates one and two : output translog models of airport short run operating costs. Output is passengers transported on non-stop : segments and pounds of cargo shipped....

School Finance Adequacy: What Is It and How Do We Measure It?

ERIC Educational Resources Information Center

Picus, Lawrence O.

2001-01-01

Discusses legal definition of school-finance "adequacy" and four methods for determining the cost of an adequate system: Cost function, observational methods, professional judgment, and costs of a comprehensive school design. Draws implications for school districts' resource-allocation decisions based on adequacy. (Contains 21 references.) (PKP)

Costing Educational Wastage: A Pilot Simulation Study. Current Surveys and Research in Statistics.

ERIC Educational Resources Information Center

Berstecher, D.

This pilot simulation study examines the important methodological problems involved in costing educational wastage, focusing specifically on the cost implications of educational wastage in primary education. Purpose of the study is to provide a clearer picture of the underlying rationale and interrelated consequences of reducing educational…

Benefit-Cost Analysis of the Perry Preschool Program and Its Policy Implications.

ERIC Educational Resources Information Center

Barnett, W. Steven

1985-01-01

Benefit-cost analysis is applied to the Perry Preschool Program and its long-term follow-up in order to examine preschool education as a social investment. The net present value of benefits and costs is positive, indicating that the program was a profitable social investment. (Author/LMO)

SunShot 2030 for Photovoltaics (PV): Envisioning a Low-cost PV Future

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

Cole, Wesley J.; Frew, Bethany A.; Gagnon, Pieter J.

In this report we summarize the implications, impacts, and deployment potential of reaching the SunShot 2030 targets for the electricity system in the contiguous United States. We model 25 scenarios of the U.S. power sector using the Regional Energy Deployment Systems (ReEDS) and Distributed Generation (dGen) capacity expansion models. The scenarios cover a wide range of sensitivities to capture future uncertainties relating to fuel prices, retirements, renewable energy capital costs, and load growth. We give special attention to the potential for storage costs to also rapidly decline due to its large synergies with low-cost solar. The ReEDS and dGen modelsmore » project utility- and distributed-scale power sector evolution, respectively, for the United States. Both models have been designed with special emphasis on capturing the unique traits of renewable energy, including variability and grid integration requirements. Across the suite of scenarios modeled, we find that reaching the SunShot 2030 target has the potential to lead to significant capacity additions of PV in the United States. By 2050, PV penetration levels are projected to reach 28-46 percent of total generation. If storage also sees significant reductions in cost, then the 2050 solar penetration levels could reach 41-64 percent. PV deployment is projected to occur in all of the lower 48 states, though the specific deployment level is scenario dependent. The growth in PV is projected to be dominated by utility-scale systems, but the actual mix between utility and distributed systems could ultimately vary depending on how policies, system costs, and rate structures evolve.« less

The Economic Burden of Child Maltreatment in the United States and Implications for Prevention

ERIC Educational Resources Information Center

Fang, Xiangming; Brown, Derek S.; Florence, Curtis S.; Mercy, James A.

2012-01-01

Objectives: To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. Methods: This study used the best available secondary data to develop cost per case estimates. For each cost category, the paper used…

Costs of living for juvenile Chinook salmon (Oncorhynchus tshawytscha) in an increasingly warming and invaded world

USGS Publications Warehouse

Kuehne, Lauren M.; Olden, Julian D.; Duda, Jeffrey J.

2012-01-01

Rapid environmental change in freshwater ecosystems has created a need to understand the interactive effects of multiple stressors, with temperature and invasive predators identified as key threats to imperiled fish species. We tested the separate and interactive effects of water temperature and predation by non-native smallmouth bass (Micropterus dolomieu) on the lethal (mortality) and sublethal (behavior, physiology, and growth) effects for juvenile Chinook salmon (Oncorhynchus tshawytscha) in seminatural stream channel experiments. Over 48 h trials, there was no difference in direct predation with warmer temperatures, but significant interactive effects on sublethal responses of juvenile salmon. Warmer temperatures resulted in significantly stronger and more variable antipredator responses (surface shoaling and swimming activity), while physiological indicators (plasma glucose, plasma cortisol) suggested suppression of physiological mechanisms in response to the combined stressors. These patterns corresponded with additive negative growth in predation, temperature, and combined treatments. Our results suggest that chronic increases in temperature may not increase direct predation over short periods, but can result in significant sublethal costs with negative implications for long-term development, disease resistance, and subsequent size-selective mortality of Pacific salmon.

Improving quality and patient satisfaction in a pediatric resident continuity clinic through advanced access scheduling.

PubMed

Tuli, Sanjeev Y; Thompson, Lindsay A; Ryan, Kathleen A; Srinivas, Ganga L; Fillipps, Donald J; Young, Christopher M; Tuli, Sonal S

2010-06-01

To evaluate the impact of advanced access scheduling in a pediatric residency clinic on resident and patient satisfaction, medical education, practice quality, and efficiency. Residents were assigned to either the advanced access template (10 appointments available to patients and 2 physician overbooks) or the prior template (5 available and 8 overbooks). Outcomes included resident and patient satisfaction, appointment availability, and continuity of care and clinic costs. Patient satisfaction improved in 7 areas (P < .001). Residents in either template did not report an impact on medical education experiences. Significant increases were realized with appointment availability and the number of patients seen. Continuity also increased as the overflow/acute visits decreased (P < .001). Overall costs per visit decreased 22%. Because of the significant improvements in access, continuity, and efficiency, all residents were switched to the advanced access template after completion of the study. Improvement in access to the primary physician has a significant impact on patient satisfaction with health care delivery. This model optimizes the limited time that residents have in continuity clinic, and it has implications for health care delivery quality improvement.

Modelling the cost-effectiveness of public awareness campaigns for the early detection of non-small-cell lung cancer.

PubMed

Hinde, S; McKenna, C; Whyte, S; Peake, M D; Callister, M E J; Rogers, T; Sculpher, M

2015-06-30

Survival rates in lung cancer in England are significantly lower than in many similar countries. A range of Be Clear on Cancer (BCOC) campaigns have been conducted targeting lung cancer and found to improve the proportion of diagnoses at the early stage of disease. This paper considers the cost-effectiveness of such campaigns, evaluating the effect of both the regional and national BCOC campaigns on the stage distribution of non-small-cell lung cancer (NSCLC) at diagnosis. A natural history model of NSCLC was developed using incidence data, data elicited from clinical experts and model calibration techniques. This structure is used to consider the lifetime cost and quality-adjusted survival implications of the early awareness campaigns. Incremental cost-effectiveness ratios (ICERs) in terms of additional costs per quality-adjusted life-years (QALYs) gained are presented. Two scenario analyses were conducted to investigate the role of changes in the 'worried-well' population and the route of diagnosis that might occur as a result of the campaigns. The base-case theoretical model found the regional and national early awareness campaigns to be associated with QALY gains of 289 and 178 QALYs and ICERs of £13 660 and £18 173 per QALY gained, respectively. The scenarios found that increases in the 'worried-well' population may impact the cost-effectiveness conclusions. Subject to the available evidence, the analysis suggests that early awareness campaigns in lung cancer have the potential to be cost-effective. However, significant additional research is required to address many of the limitations of this study. In addition, the estimated natural history model presents previously unavailable estimates of the prevalence and rate of disease progression in the undiagnosed population.

Modelling the cost-effectiveness of public awareness campaigns for the early detection of non-small-cell lung cancer

PubMed Central

Hinde, S; McKenna, C; Whyte, S; Peake, M D; Callister, M E J; Rogers, T; Sculpher, M

2015-01-01

Background: Survival rates in lung cancer in England are significantly lower than in many similar countries. A range of Be Clear on Cancer (BCOC) campaigns have been conducted targeting lung cancer and found to improve the proportion of diagnoses at the early stage of disease. This paper considers the cost-effectiveness of such campaigns, evaluating the effect of both the regional and national BCOC campaigns on the stage distribution of non-small-cell lung cancer (NSCLC) at diagnosis. Methods: A natural history model of NSCLC was developed using incidence data, data elicited from clinical experts and model calibration techniques. This structure is used to consider the lifetime cost and quality-adjusted survival implications of the early awareness campaigns. Incremental cost-effectiveness ratios (ICERs) in terms of additional costs per quality-adjusted life-years (QALYs) gained are presented. Two scenario analyses were conducted to investigate the role of changes in the ‘worried-well' population and the route of diagnosis that might occur as a result of the campaigns. Results: The base-case theoretical model found the regional and national early awareness campaigns to be associated with QALY gains of 289 and 178 QALYs and ICERs of £13 660 and £18 173 per QALY gained, respectively. The scenarios found that increases in the ‘worried-well' population may impact the cost-effectiveness conclusions. Conclusions: Subject to the available evidence, the analysis suggests that early awareness campaigns in lung cancer have the potential to be cost-effective. However, significant additional research is required to address many of the limitations of this study. In addition, the estimated natural history model presents previously unavailable estimates of the prevalence and rate of disease progression in the undiagnosed population. PMID:26010412

UAH/NASA Workshop on Space Science Platform

NASA Technical Reports Server (NTRS)

Wu, S. T. (Editor); Morgan, S. (Editor)

1978-01-01

The scientific user requirements for a space science platform were defined. The potential user benefits, technological implications and cost of space platforms were examined. Cost effectiveness of the platforms' capabilities were also examined.

An economic analysis of implementing the SIGN third molar guideline: implications for the design and analysis of implementation studies.

PubMed

Tilley, Colin; McIntosh, Emma; Bahrami, Maryam; Clarkson, Jan; Deery, Chris; Pitts, Nigel

2005-07-01

To compare the cost-effectiveness of four third molar guideline implementation strategies. Fifty-one dental practices in Scotland were randomized to one of four implementation strategies. The effectiveness of the strategies was measured by general dental practitioners' compliance with the guideline. The effectiveness of the guideline depended crucially upon the type of patient treated. In particular, for a minority of patients (14%) with no clinical signals of their 'type', the implementation strategies generate potentially large gains in evidence-based practice. However, the cost per patient of achieving these gains is large given that the costs are incurred for all patients, but benefits accrue only to a minority. The results show that the type of patient presenting for treatment can influence the effectiveness, cost-effectiveness and therefore policy conclusions. Consequently, the design and analysis of studies need to be sufficiently sensitive to detect subtle interaction effects. This may explain the dearth of guideline implementation trials with significant findings. The results also suggest that a more cost-effective implementation method in primary care dentistry may be to subsidize treatment conditional upon patient type.

Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome.

PubMed

Knauert, Melissa; Naik, Sreelatha; Gillespie, M Boyd; Kryger, Meir

2015-09-01

To provide an overview of the healthcare and societal consequences and costs of untreated obstructive sleep apnea syndrome. PubMed database for English-language studies with no start date restrictions and with an end date of September 2014. A comprehensive literature review was performed to identify all studies that discussed the physiologic, clinical and societal consequences of obstructive sleep apnea syndrome as well as the costs associated with these consequences. There were 106 studies that formed the basis of this analysis. Undiagnosed and untreated obstructive sleep apnea syndrome can lead to abnormal physiology that can have serious implications including increased cardiovascular disease, stroke, metabolic disease, excessive daytime sleepiness, work-place errors, traffic accidents and death. These consequences result in significant economic burden. Both, the health and societal consequences and their costs can be decreased with identification and treatment of sleep apnea. Treatment of obstructive sleep apnea syndrome, despite its consequences, is limited by lack of diagnosis, poor patient acceptance, lack of access to effective therapies, and lack of a variety of effective therapies. Newer modes of therapy that are effective, cost efficient and more accepted by patients need to be developed.

The Energy Future.

PubMed

Newman, John; Bonino, Christopher A; Trainham, James A

2018-06-07

The foreseeable energy future will be driven by economics of known technologies and the desire to reduce CO 2 emissions to the atmosphere. Renewable energy options are compared with each other and with the use of fossil fuels with carbon capture and sequestration (CCS). Economic analysis is used to determine the best of several alternatives. One can disagree on the detailed costs, including externalities such as climate change and air and water pollution. But the differences in capital and operating costs between known technologies are so significant that one can draw clear conclusions. Results show that renewable energy cannot compete with fossil fuels on a cost basis alone because energy is intrinsic to the molecule, except for hydroelectricity. However, fossil fuels are implicated in climate change. Using renewable energy exclusively, including transportation and electricity needs, could reduce the standard of living in the United States by 43% to 62%, which would correspond to the level in about 1970. If capture and sequester of CO 2 are implemented, the cost of using fossil fuels will increase, but they beat renewable energy handily as an economic way to produce clean energy.

Cost implications in the management of induction of labour.

PubMed

Taylor, S J; Armour, C L

1997-11-01

For many years the standard treatment of induction of labour has been amniotomy followed by intravenous oxytocin. More recently prostaglandin E2 (PGE2; dinoprostone), in various preparations, has been used to both ripen the cervix before amniotomy and administration of oxytocin, and to induce labour on its own. Since the acquisition cost of PGE2 is approximately 15 times that of oxytocin, it is important to justify the use of PGE2. In this paper, literature from 1970 to 1996 has been reviewed and outcomes following the use of PGE2, plus amniotomy and oxytocin if necessary, have been compared with outcomes following the use of amniotomy plus oxytocin alone. No significant differences in the mode of delivery and no serious adverse effects in mothers or babies were detected. Three economic analyses of these approaches to induction of labour have been reviewed. While under certain conditions there may be some cost savings associated with the use of PGE2, neither of the studies reviewed showed substantial, reliable cost savings. Further research is required to identify the patients who would gain most benefit from the use of PGE2.

Efficacy of Behavioural Graded Activity Compared with Conventional Exercise Therapy in Chronic Non-Specific Low Back Pain: Implication for Direct Health Care Cost.

PubMed

Bello, A I; Quartey, Jna; Lartey, M

2015-09-01

The relative efficacy of conventional exercise therapy (CET) and behavioural graded activity (BGA) has not been fully established to inform the preference in clinical practice. To compare CET and BGA on the treatment outcome of chronic non-specific low back pain (LBP). Participants were assigned into either BGA or CET group in this randomized feasibility intervention. The CET group received supervised exercise therapy while BGA group engaged in individually prescribed sub-maximal activities based on time-contingent principles. Interventions were carried out twice weekly and over a period of 12 weeks. Outcome measures were numerical rating scale and RAND 36-item health survey which were administered at baseline, week 4 and week 12. Health care cost questionnaire was also administered to evaluate physiotherapy cost after 12 weeks. Mixed design two-way ANOVA with level of significance set as priori at p<0.05 was used to compare both groups. Seventy-seven and half percent (62) participants (CET=29 and BGA=33) with mean ages 45.0±12.2 and 43.1±13.2 years respectively, completed the study. Both groups improved significantly (p<0.001) during the intervention. However, there were no significant differences (p>0.05) between the treatment groups at any time points and for any measures assessed. Therapeutic benefits in both groups have bearing on direct health care costs. The results indicate that CET and BGA have similar outcomes in patients with chronic nonspecific LBP with regard to the pain and quality of life. Effective application may however be hampered by the cost-related factors thus suggesting evaluation of health care system in Ghana.

Transition to Ultra-Low-Sulfur Diesel Fuel: Effects on Prices and Supply, The

EIA Publications

2001-01-01

This report discusses the implications of the new regulations for vehicle fuel efficiency and examines the technology, production, distribution, and cost implications of supplying diesel fuel to meet the new standards.

Fertility and the economy.

PubMed

Becker, G S

1992-08-01

Fertility and the economy is examined in the context of the Malthusian question about the links between family choices and longterm economic growth. Micro level differences are not included not are a comprehensive range of economic or determinant variables. Specific attention is paid to income and price effects, the quality of children, overlapping generations, mortality effects, uncertainty, and economic growth. Fertility and the demand for children in linked to parental incomes and the cost of rearing children, which is affected by public policies that change the costs. Demand is also related to child and adult mortality, and uncertainty about sex of the child. Fertility in one generation affects fertility in the next. Malthusian and neoclassical models do not capture the current model of modern economies with rising income/capita and human and physical capital, extensive involvement of married women in the labor force, and declining fertility to very low levels. In spite of the present advances in firm knowledge about the relationships between fertility and economic and social variables, there is still much greater ignorance of the interactions. The Malthusian utility function that says fertility rises and falls with income did hold up to 2 centuries of scrutiny, and the Malthusian inclusion of the shifting tastes in his analysis could be translated in the modern context to include price of children. The inclusion of net cost has significant consequences, i.e., rural fertility can be higher because the cost of rearing when children contribute work to maintaining the farm is lower than in the city. An income tax deduction for children in the US reduces cost. Economic growth raises the cost of children due the time spent on child care becoming more valuable. The modern context has changed from Malthusian time, and the cost of education, training, and medical care is relevant. The implication is that a rise in income could reduce the demand for children when education and training of children increases. Quality is substituted for quantity. The neoclassical model that "the capital-labor ratio and the degree of capital deepening" is affected by population growth is examined as well as the modern approach, and the implications are expressed, i.e., intergenerational transfers and parental altruism.

Alternative arrangements for the delivery of eye care services within staff model managed care organizations.

PubMed

Soroka, Mort; Reis, Lesley; Krumholz, David; Krasner, Mel; Portello, Joan

2003-11-01

Eye care services, though accounting for only a small fraction of healthcare costs, encompass a unique spectrum of professional staffing options that can enhance efficiency and decrease costs within staff model managed care organizations. This study was designed to describe and assess alternative staffing arrangements and cost implications for the delivery of eye care services by optometrists, ophthalmologists, and primary care physicians within staff model managed care organizations. The clinical records of individual patients--rather than administrative and billing files--at three managed care organizations are the principal source of information. Clinical auditors extracted data on ambulatory eye care services provided for conjunctivitis, corneal abrasion/erosion, cataract, diabetic retinopathy, glaucoma, and macular degeneration. Our findings document the substantial role optometrists play in the delivery of eye care, whether they provide the care independently or in collaboration with an ophthalmologist. The levels of remuneration for optometrists are roughly one third to one half the annual rate for ophthalmologists. Staffing arrangements that use optometrists to the full extent of their professional training can provide significant cost savings. The cost-effectiveness of using the services of optometrists capable of delivering high-quality eye care can be demonstrated. Potential cost savings for staff model managed care organizations may accrue if the roles, functions, and availability of eye providers are adjusted.

Cost analysis of cetuximab (Erbitux) plus radiotherapy (ERT) versus concomitant cisplatin plus radiotherapy (CRT) within an NHS oncology unit (single institution): a pilot study.

PubMed

Caroline, Brammer; Sundus, Yahya; Dawn, Dawson; Carol, Glaister; Susan, Merrick

2016-12-01

The aim of this feasibility study is to define the resource effectiveness of cetuximab vs cisplatin given concomitantly with radiotherapy for squamous cell carcinoma within a National Health Service clinical oncology unit. 20 patients with Stage 3 or 4 head and neck squamous cell cancers were randomized to receive either cetuximab with radiotherapy (ERT) or cisplatin with radiotherapy concurrent with external beam radiotherapy 70 Gy in 35 fractions on a 1 : 1 basis over a 12-month duration. The study compared the resource utilization of ERT vs cisplatin with radiotherapy taking into account drug costs, clinical management and the costs of managing treatment-related toxicity from first fraction of radiotherapy to 6 months after the completion of therapy. Outcome measures were quality of life (recorded at the entry, end of radiotherapy, 6 weeks post treatment and 6 months post treatment), admissions to hospital, delays to radiotherapy, locoregional control and survival. Total drug costs including cost of nutritional supplements for patients treated with cetuximab were £7407.45 compared with £3959.07 for patients treated with cisplatin. Unscheduled admissions for toxicity management were significantly more common in the ERT arm. Healthcare personnel spent significantly more time delivering unscheduled outpatient care for patients receiving cisplatin than for those receiving cetuximab (p = 0.01). No significant difference in the quality of life was suggested at baseline, 6 weeks and 6 months. The mean time to removal of percutaneous gastrostomy (PEG) after completion of radiotherapy was 49.7 weeks in the cisplatin arm and 18.5 weeks in the cetuximab arm (p = 0.04). There was a statistically significant difference in patient-reported use of PEG between the cisplatin and cetuximab arms at 6 months following completion of treatment (p = 0.04). At 21 months, overall survival was 80% in the cisplatin arm vs 50% in the cetuximab (p = 0.332), with disease-free survival being 80% in the cisplatin arm vs 40% in the cetuximab (p = 0.097). Cetuximab is still more expensive in simple drug cost terms than cisplatin when delivered with radiotherapy taking into account costs of drugs for toxicity management and nutritional supplements but other resource implications such as inpatient admission, time spent delivering unscheduled care and cost of additional investigations to manage toxicity for patients treated with cisplatin significantly reduce differential. The study suggested significant differences in patient-reported PEG use at 6 months and in time to PEG removal in favour of the cetuximab arm. Advances in knowledge: There is paucity of randomized data on cost analysis for cisplatin vs cetuximab radiotherapy; this trial informs on the cost analysis between the two approaches.

The costs of training a nurse practitioner in primary care: the importance of allowing for the cost of education and training when making decisions about changing the professional-mix.

PubMed

Curtis, Lesley; Netten, Ann

2007-05-01

What is already known on this topic * Cost containment through the most effective mix of staff achievable within available resources and organisational priorities is of increasing importance in most health systems. However, there is a dearth of information about the full economic implications of changing skill mix. * In the UK a major shift in the primary care workforce is likely in response to the rapidly developing role of nurse practitioners and policies aimed to encourage GP practices to transfer some of their responsibilities to other, less costly, professionals. * Previous research has developed an approach to incorporating the costs of qualifications, and thus the investment required to develop a skilled workforce, for a variety of health service professionals including GPs. What this study adds * This paper describes a methodology of costing nurse practitioners that incorporates the human capital cost implications of developing a skilled nurse practitioner workforce. With appropriate sources of data the method could be adapted for use internationally. * Including the full cost of qualifications results in nearly a 24 per cent increase in the unit cost of a Nurse Practitioner. * Allowing for all investment costs and adjusting for length of consultation, the cost of a GP consultation was nearly 60 per cent higher than that of a Nurse Practitioner.

Evaluative conditioning may incur attentional costs.

PubMed

Pleyers, Gordy; Corneille, Olivier; Yzerbyt, Vincent; Luminet, Olivier

2009-04-01

Evaluative conditioning (EC) refers to changes in the liking of an affectively neutral stimulus (conditioned stimulus, or CS) after pairing this stimulus with an affect-laden stimulus (unconditioned stimulus, or US). Several authors proposed that EC incurs little or no attentional cost. Using a rigorous design, we provide evidence that a reduction in attentional resources may have a negative impact on EC. Additional analyses also revealed that participants correctly encoded fewer CS-US pairings when their attentional resources were depleted. Replicating Pleyers, Corneille, Luminet, and Yzerbyt's (2007) findings, EC was also obtained only for CSs that could be correctly linked to their associated US in the context of an identification task. This research clarifies the role of higher order processes in EC and has significant practical implications. Copyright (c) 2009 APA, all rights reserved.

The competitive response of Blue Cross and Blue Shield to the health maintenance organization in Northern California and Hawaii.

PubMed

Goldberg, L G; Greenberg, W

1979-10-01

The health maintenance organization (HMO) can provide an alternative to the predominant form of health care delivery in the United States, fee-for-service. Although market penetration of the HMO is relatively low in most parts of the country, the HMO has achieved a significant market share in a number of states. This paper examines the competitive response of Blue Cross and Blue Shield to the introduction of the HMO in two geographic regions with significant HMO activity, northern California and Hawaii. The evidence obtained from extensive interviews indicates that Blue Cross and Blue Shield plans have responded to HMO competitive pressure by establishing their own HMOs and by altering traditional procedures. HMO competition has stimulated Blue Cross and Blue Shield to make greater cost control efforts and to offer larger benefit packages. These results can have important policy implications for the role that HMOs are to play in cost containment.

A sensitivity analysis of central flat-plate photovoltaic systems and implications for national photovoltaics program planning

NASA Technical Reports Server (NTRS)

Crosetti, M. R.

1985-01-01

The sensitivity of the National Photovoltaic Research Program goals to changes in individual photovoltaic system parameters is explored. Using the relationship between lifetime cost and system performance parameters, tests were made to see how overall photovoltaic system energy costs are affected by changes in the goals set for module cost and efficiency, system component costs and efficiencies, operation and maintenance costs, and indirect costs. The results are presented in tables and figures for easy reference.

Cost analysis and facility reimbursement in the long-term health care industry.

PubMed Central

Ullmann, S G

1984-01-01

This article examines costs and develops a system of prospective reimbursement for the industry committed to long-term health care. Together with estimates of average cost functions--for purposes of determining those factors affecting the costs of long-term health care, the author examines in depth the cost effects of patient mix and facility quality. Policy implications are indicated. The article estimates cost savings and predicted improvements in facility performance resulting from adoption of a prospective reimbursement system. PMID:6427138

Anabolic-androgenic steroids and decision making: Probability and effort discounting in male rats.

PubMed

Wallin, Kathryn G; Alves, Jasmin M; Wood, Ruth I

2015-07-01

Anabolic-androgenic steroid (AAS) abuse is implicated in maladaptive behaviors such as increased aggression and risk taking. Impaired judgment due to changes in the mesocorticolimbic dopamine system may contribute to these behavioral changes. While AAS are known to influence dopamine function in mesocorticolimbic circuitry, the effects on decision making are unknown. This was the focus of the present study. Adolescent male Long-Evans rats were treated chronically with high-dose testosterone (7.5 mg/kg) or vehicle (13% cyclodextrin in water), and tested for cost/benefit decision making in two discounting paradigms. Rats chose between a small reward (1 sugar pellet) and a large discounted reward (3 or 4 pellets). Probability discounting (PD) measures sensitivity to reward uncertainty by decreasing the probability (100, 75, 50, 25, 0%) of receiving the large reward in successive blocks of each daily session. Effort discounting (ED) measures sensitivity to a work cost by increasing the lever presses required to earn the large reward (1, 2, 5, 10, 15 presses). In PD, testosterone-treated rats selected the large/uncertain reward significantly less than vehicle-treated controls. However, during ED, testosterone-treated rats selected the large/high effort reward significantly more than controls. These studies show that testosterone has divergent effects on different aspects of decision making. Specifically, testosterone increases aversion to uncertainty but decreases sensitivity to the output of effort for reward. These results have implications for understanding maladaptive behavioral changes in human AAS users. Copyright © 2015 Elsevier Ltd. All rights reserved.

Considerations in pharmaceutical conversion: focus on antihistamines.

PubMed

Garbus, S B; Moulton, B W; Meltzer, E O; Reich, P R; Weinreb, L F; Friedman, J A; Orland, B I

1997-04-01

The practice of pharmaceutical conversion, which encompasses three types of drug interchange (generic, brand, and therapeutic substitution), is increasing in managed care settings. Pharmaceutical conversion has numerous implications for managed care organizations, their healthcare providers, and their customers. Although drug cost may be a driving consideration in pharmaceutical conversion, a number of other considerations are of equal or greater importance in the decision-making process may affect the overall cost of patient care. Among these considerations are clinical, psychosocial, and safety issues; patient adherence; patient satisfaction; and legal implications of pharmaceutical conversion. Patient-centered care must always remain central to decisions about pharmaceutical conversion. This article discusses the issues related to, and implications of, pharmaceutical conversion utilizing the antihistamines class of drugs as the case situation.

Sustaining the environment through recycling: an empirical study.

PubMed

Ramayah, T; Lee, Jason Wai Chow; Lim, Shuwen

2012-07-15

This paper examines the determinants of recycling behaviour among 200 university students from the perspective of the theory of planned behaviour (TPB). Data was analysed using Structural Equation Modelling technique. Findings indicate that environmental awareness was significantly related to attitude towards recycling, whilst attitude and social norms had significant impact on recycling behaviour. However, convenience and cost of recycling were not significant reasons for recycling. The study has enhanced the understanding of the determinants of recycling behaviour and has implications for schools and governmental agencies in educating and encouraging positive recycling behaviour. It also confirms the appropriateness of the TPB in examining studies of this nature. Further suggestions for future research are offered. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evaluating the impact of new anticoagulants in the hospital setting

PubMed Central

Braidy, Nady; Bui, Khai; Bajorek, Beata

2010-01-01

The short-comings of current anticoagulants have led to the development of newer, albeit more expensive, oral alternatives. Objective To explore the potential impact the new anticoagulants dabigatran and rivaroxaban in the local hospital setting, in terms of utilisation and subsequent costing. Method A preliminary costing analysis was performed based on a prospective 2-week clinical audit (29th June - 13th July 2009). Data regarding current anticoagulation management were extracted from the medical files of patients admitted to Ryde Hospital. To model potential costing implications of using the newer agents, the reported incidence of VTE/stroke and bleeding events were obtained from key clinical trials. Results Data were collected for 67 patients treated with either warfarin (n=46) or enoxaparin (n=21) for prophylaxis of VTE/stroke. At least two-thirds of all patients were deemed suitable candidates for the use of newer oral anticoagulants (by current therapy: warfarin: 65.2% (AF), 34.8% (VTE); enoxaparin: 100%, (VTE)). The use of dabigatran in VTE/stroke prevention was found to be more cost- effective than warfarin and enoxaparin due to significantly lower costs of therapeutic monitoring and reduced administration costs. Rivaroxaban was more cost-effective than warfarin and enoxaparin for VTE/stroke prevention when supplier-rebates (33%) were factored into costing. Conclusion This study highlights the potential cost- effectiveness of newer anticoagulants, dabigatran and rivaroxaban, compared to warfarin and enoxaparin. These agents may offer economic advantages, as well as clinical benefits, in the hospital-based management of anticoagulated patients. PMID:25132883

Cost prediction model for various payloads and instruments for the Space Shuttle Orbiter

NASA Technical Reports Server (NTRS)

Hoffman, F. E.

1984-01-01

The following cost parameters of the space shuttle were undertaken: (1) to develop a cost prediction model for various payload classes of instruments and experiments for the Space Shuttle Orbiter; and (2) to show the implications of various payload classes on the cost of: reliability analysis, quality assurance, environmental design requirements, documentation, parts selection, and other reliability enhancing activities.

Towards cost-effective reliability through visualization of the reliability option space

NASA Technical Reports Server (NTRS)

Feather, Martin S.

2004-01-01

In planning a complex system's development there can be many options to improve its reliability. Typically their sum total cost exceeds the budget available, so it is necessary to select judiciously from among them. Reliability models can be employed to calculate the cost and reliability implications of a candidate selection.

Evaluating the Treatment Costs for Uncomplicated Malaria at a Public Healthcare Facility in Nigeria and the Implications.

PubMed

Ezenduka, Charles C; Falleiros, Daniel Resende; Godman, Brian B

2017-09-01

Accurate information on the facility costs of treatment is essential to enhance decision making and funding for malaria control. The objective of this study was to estimate the costs of providing treatment for uncomplicated malaria through a public health facility in Nigeria. Hospital costs were estimated from a provider perspective, applying a standard costing procedure. Capital and recurrent expenditures were estimated using an ingredient approach combined with step-down methodology. Costs attributable to malaria treatment were calculated based on the proportion of malaria cases to total outpatient visits. The costs were calculated in local currency [Naira (N)] and converted to US dollars at the 2013 exchange rate. Total annual costs of N28.723 million (US$182,953.65) were spent by the facility on the treatment of uncomplicated malaria, at a rate of US$31.49 per case, representing approximately 25% of the hospital's total expenditure in the study year. Personnel accounted for over 82.5% of total expenditure, followed by antimalarial medicines at 6.6%. More than 45% of outpatients visits were for uncomplicated malaria. Changes in personnel costs, drug prices and malaria prevalence significantly impacted on the study results, indicating the need for improved efficiency in the use of hospital resources. Malaria treatment currently consumes a considerable amount of resources in the facility, driven mainly by personnel cost and a high proportion of malaria cases. There is scope for enhanced efficiency to prevent waste and reduce costs to the provider and ultimately the consumer.

Evidence on the cost and cost-effectiveness of palliative care: a literature review.

PubMed

Smith, Samantha; Brick, Aoife; O'Hara, Sinéad; Normand, Charles

2014-02-01

In the context of limited resources, evidence on costs and cost-effectiveness of alternative methods of delivering health-care services is increasingly important to facilitate appropriate resource allocation. Palliative care services have been expanding worldwide with the aim of improving the experience of patients with terminal illness at the end of life through better symptom control, coordination of care and improved communication between professionals and the patient and family. To present results from a comprehensive literature review of available international evidence on the costs and cost-effectiveness of palliative care interventions in any setting (e.g. hospital-based, home-based and hospice care) over the period 2002-2011. Key bibliographic and review databases were searched. Quality of retrieved papers was assessed against a set of 31 indicators developed for this review. PubMed, EURONHEED, the Applied Social Sciences Index and the Cochrane library of databases. A total of 46 papers met the criteria for inclusion in the review, examining the cost and/or utilisation implications of a palliative care intervention with some form of comparator. The main focus of these studies was on direct costs with little focus on informal care or out-of-pocket costs. The overall quality of the studies is mixed, although a number of cohort studies do undertake multivariate regression analysis. Despite wide variation in study type, characteristic and study quality, there are consistent patterns in the results. Palliative care is most frequently found to be less costly relative to comparator groups, and in most cases, the difference in cost is statistically significant.

Cost-effectiveness of a smokeless tobacco control mass media campaign in India.

PubMed

Murukutla, Nandita; Yan, Hongjin; Wang, Shuo; Negi, Nalin Singh; Kotov, Alexey; Mullin, Sandra; Goodchild, Mark

2017-08-10

Tobacco control mass media campaigns are cost-effective in reducing tobacco consumption in high-income countries, but similar evidence from low-income countries is limited. An evaluation of a 2009 smokeless tobacco control mass media campaign in India provided an opportunity to test its cost-effectiveness. Campaign evaluation data from a nationally representative household survey of 2898 smokeless tobacco users were compared with campaign costs in a standard cost-effectiveness methodology. Costs and effects of the Surgeon campaign were compared with the status quo to calculate the cost per campaign-attributable benefit, including quit attempts, permanent quits and tobacco-related deaths averted. Sensitivity analyses at varied CIs and tobacco-related mortality risk were conducted. The Surgeon campaign was found to be highly cost-effective. It successfully generated 17 259 148 additional quit attempts, 431 479 permanent quits and 120 814 deaths averted. The cost per benefit was US$0.06 per quit attempt, US$2.6 per permanent quit and US$9.2 per death averted. The campaign continued to be cost-effective in sensitivity analyses. This study suggests that tobacco control mass media campaigns can be cost-effective and economically justified in low-income and middle-income countries. It holds significant policy implications, calling for sustained investment in evidence-based mass media campaigns as part of a comprehensive tobacco control strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Valuing urban open space using the travel-cost method and the implications of measurement error.

PubMed

Hanauer, Merlin M; Reid, John

2017-08-01

Urbanization has placed pressure on open space within and adjacent to cities. In recent decades, a greater awareness has developed to the fact that individuals derive multiple benefits from urban open space. Given the location, there is often a high opportunity cost to preserving urban open space, thus it is important for both public and private stakeholders to justify such investments. The goals of this study are twofold. First, we use detailed surveys and precise, accessible, mapping methods to demonstrate how travel-cost methods can be applied to the valuation of urban open space. Second, we assess the degree to which typical methods of estimating travel times, and thus travel costs, introduce bias to the estimates of welfare. The site we study is Taylor Mountain Regional Park, a 1100-acre space located immediately adjacent to Santa Rosa, California, which is the largest city (∼170,000 population) in Sonoma County and lies 50 miles north of San Francisco. We estimate that the average per trip access value (consumer surplus) is $13.70. We also demonstrate that typical methods of measuring travel costs significantly understate these welfare measures. Our study provides policy-relevant results and highlights the sensitivity of urban open space travel-cost studies to bias stemming from travel-cost measurement error. Copyright © 2017 Elsevier Ltd. All rights reserved.

The financial performance of selected investor-owned and not-for-profit system hospitals before and after Medicare prospective payment.

PubMed Central

Friedman, B; Shortell, S

1988-01-01

This article analyzes determinants of cost and profitability, including the influence of Medicare prospective payment (PPS), between 1983 and 1985 for nearly 300 hospitals belonging to investor-owned (IO) and not-for-profit (NFP) systems. Using approaches that assure comparability of financial data, and including case mix, quality, competition, and regulation measures, the findings indicate that (1) in both years, competitive environment, case mix, age of facility, and scope of diversified services were important determinants of average cost, while a process measure of quality was insignificant and the independent effect of ownership type was insignificant for cost; (2) effects of HMO competition and hospital strategy were stronger in 1985 than in 1983; (3) operating margins for all types of hospitals showed increases, with a somewhat greater improvement for NFP system members; and (4) significantly greater declines in volume of care occurred for IO system members. Implications for future research are discussed. PMID:3133323

The impact of HIV / AIDS on Kenya's commercial sector.

PubMed

Forsythe, S; Roberts, M

1995-02-01

AIDSCAP is undertaking a project designed to encourage Kenya's private sector to participate in HIV/AIDS prevention efforts. Part of that project involves estimating the impact of HIV/AIDS on Kenya's commercial sector. AIDSCAP and Kenyan researcher estimates are based upon financial data from a sugar estate, a transportation company, a wood processing plant, a textile factory, and a light manufacturing company, a small sample representing the diversity of industries in the country. Most are medium-sized companies with 1200-2200 employees. Preliminary results suggest that absenteeism, training costs, and HIV-related health care will cause the greatest losses to Kenyan businesses. Projections show that the HIV/AIDS epidemic could increase labor costs for some Kenyan businesses by 17% by the year 2005. Despite increasing labor costs, however, the epidemic may not cause a significant drop in profits for larger, capital-intensive Kenyan businesses. Some companies could still find their profits cut by 15-25% within the next 10 years. Study findings and implications for workplace prevention programs are discussed.

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 ...

DEEP-SaM - Energy-Efficient Provisioning Policies for Computing Environments

NASA Astrophysics Data System (ADS)

Bodenstein, Christian; Püschel, Tim; Hedwig, Markus; Neumann, Dirk

The cost of electricity for datacenters is a substantial operational cost that can and should be managed, not only for saving energy, but also due to the ecologic commitment inherent to power consumption. Often, pursuing this goal results in chronic underutilization of resources, a luxury most resource providers do not have in light of their corporate commitments. This work proposes, formalizes and numerically evaluates DEEP-Sam, for clearing provisioning markets, based on the maximization of welfare, subject to utility-level dependant energy costs and customer satisfaction levels. We focus specifically on linear power models, and the implications of the inherent fixed costs related to energy consumption of modern datacenters and cloud environments. We rigorously test the model by running multiple simulation scenarios and evaluate the results critically. We conclude with positive results and implications for long-term sustainable management of modern datacenters.

Economic implications of resistance to antimalarial drugs.

PubMed

Phillips, M; Phillips-Howard, P A

1996-09-01

The widespread evolution of drug resistance in malarial parasites has seriously hampered efforts to control this debilitating disease. Chloroquine, the mainstay of malaria treatment for many decades, is now proving largely ineffective in many parts of the world, particularly against the most severe form of malaria--falciparum. Alternative drugs have been developed, but they are frequently less safe and are all between 50 and 700% more expensive than chloroquine. Choice of drug clearly has important budgetary implications and national malaria control programmes need to weigh up the costs and benefits in deciding whether to change to more effective but more expensive drugs. The growth in drug resistance also has implications for the choice of diagnostic tool. Clinical diagnosis of malaria is relatively cheap, but less specific than some technological approaches. As more expensive drugs are employed, the cost of wasted treatment on suspected cases who do not in fact have malaria rises and the more worthwhile it becomes to invest in more specific diagnostic techniques. This paper presents an economic framework for analysing the various malaria drug and diagnostic tool options available. It discusses the nature of the key factors that need to be considered when making choices of malaria treatment (including treatment costs, drug resistance, the costs of treatment failure and compliance) and diagnosis (including diagnosis cost and accuracy, and the often overlooked costs associated with delayed treatment), and uses some simple equations to illustrate the impact of these on the relative cost effectiveness of the alternatives being considered. On the basis of some simplifying assumptions and illustrative calculations, it appears that in many countries more effective drugs and more specific and rapid diagnostic approaches will be worth adopting even although they imply additional expense.

Bringing antiretroviral therapy (ART) closer to the end-user through mobile clinics and home-based ART: systematic review shows more evidence on the effectiveness and cost effectiveness is needed.

PubMed

Mdege, Noreen Dadirai; Chindove, Stanley

2014-01-01

Home-based antiretroviral therapy (ART) and ART through mobile clinics can potentially increase access to ART for large numbers of people, including hard-to-reach populations. We reviewed literature on the effectiveness and cost implications of the home-based ART and mobile clinic ART models. We searched Medline, Embase, PsycInfo, CINAHL, Cochrane Library, Web of Knowledge and Current Controlled Trials Register for articles published up to March 2012. We included non-randomised and randomised controlled clinical trials that recruited HIV/AIDS positive adults with or without prior exposure to ART. Six studies were included in the review, with only four effectiveness studies (all evaluating home-based ART and none for mobile clinic ART) and four studies reporting on the cost implications. The evidence suggests home-based ART is as effective as health facility-based ART, including on clinical outcomes, viral load and CD4+ count. However, three of these studies were very small. Studies suggest health facility-based ART is the most cost-effective, followed by mobile-clinic ART, with home-based ART being the least cost-effective. Evidence on the effectiveness and cost implications of mobile clinic and home-based ART is currently limited. Although the few available studies suggest home-based ART can potentially be as effective as health facility-based ART, there is need for more research before robust conclusions can be made. Results from the few available studies also suggest that health facility-based ART is the most cost-effective. Copyright © 2013 John Wiley & Sons, Ltd.

Modeling economic implications of alternative treatment strategies for acute bacterial skin and skin structure infections.

PubMed

Revankar, Nikhil; Ward, Alexandra J; Pelligra, Christopher G; Kongnakorn, Thitima; Fan, Weihong; LaPensee, Kenneth T

2014-10-01

The economic implications from the US Medicare perspective of adopting alternative treatment strategies for acute bacterial skin and skin structure infections (ABSSSIs) are substantial. The objective of this study is to describe a modeling framework that explores the impact of decisions related to both the location of care and switching to different antibiotics at discharge. A discrete event simulation (DES) was developed to model the treatment pathway of each patient through various locations (emergency department [ED], inpatient, and outpatient) and the treatments prescribed (empiric antibiotic, switching to a different antibiotic at discharge, or a second antibiotic). Costs are reported in 2012 USD. The mean number of days on antibiotic in a cohort assigned to a full course of vancomycin was 11.2 days, with 64% of the treatment course being administered in the outpatient setting. Mean total costs per patient were $8671, with inpatient care accounting for 58% of the costs accrued. The majority of outpatient costs were associated with parenteral administration rather than drug acquisition or monitoring. Scenarios modifying the treatment pathway to increase the proportion of patients receiving the first dose in the ED, and then managing them in the outpatient setting or prescribing an oral antibiotic at discharge to avoid the cost associated with administering parenteral therapy, therefore have a major impact and lower the typical cost per patient by 11-20%. Since vancomycin is commonly used as empiric therapy in clinical practice, based on these analyses, a shift in treatment practice could result in substantial savings from the Medicare perspective. The choice of antibiotic and location of care influence the costs and resource use associated with the management of ABSSSIs. The DES framework presented here can provide insight into the potential economic implications of decisions that modify the treatment pathway.

Air transportation energy efficiency - Alternatives and implications

NASA Technical Reports Server (NTRS)

Williams, L. J.

1976-01-01

Results from recent studies of air transportation energy efficiency alternatives are discussed, along with some of the implications of these alternatives. The fuel-saving alternatives considered include aircraft operation, aircraft modification, derivative aircraft, and new aircraft. In the near-term, energy efficiency improvements should be possible through small improvements in fuel-saving flight procedures, higher density seating, and higher load factors. Additional small near-term improvements could be obtained through aircraft modifications, such as the relatively inexpensive drag reduction modifications. Derivatives of existing aircraft could meet the requirements for new aircraft and provide energy improvements until advanced technology is available to justify the cost of a completely new design. In order to obtain significant improvements in energy efficiency, new aircraft must truly exploit advanced technology in such areas as aerodynamics, composite structures, active controls, and advanced propulsion.

Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy.

PubMed

Mansilha, Armando; Sousa, Joel

2018-06-05

Chronic venous disease (CVD) is a common pathology, with significant physical and psychological impacts for patients and high economic costs for national healthcare systems. Throughout the last decades, several risk factors for this condition have been identified, but only recently, have the roles of inflammation and endothelial dysfunction been properly assessed. Although still incompletely understood, current knowledge of the pathophysiological mechanisms of CVD reveals several potential targets and strategies for therapeutic intervention, some of which are addressable by currently available venoactive drugs. The roles of these drugs in the clinical improvement of venous tone and contractility, reduction of edema and inflammation, as well as in improved microcirculation and venous ulcer healing have been studied extensively, with favorable results reported in the literature. Here, we aim to review these pathophysiological mechanisms and their implications regarding currently available venoactive drug therapies.

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

Calvin, Katherine V.; Wise, Marshall A.; Kyle, G. Page

Many papers have shown that bioenergy and land-use are potentially important elements in a strategy to limit anthropogenic climate change. But, significant expansion of bioenergy production can have a large terrestrial footprint. In this paper, we test the implications for land use, the global energy system, carbon cycle, and carbon prices of meeting a specific climate target, using a single fossil fuel and industrial sector policy instrument—the carbon tax, but with five alternative bioenergy and land-use policy architectures. We find that the policies we examined have differing effects on the different segments of the economy. Comprehensive land policies can reducemore » land-use change emissions, increasing allowable emissions in the energy system, but have implications for the cost of food. Bioenergy taxes and constraints, on the other hand, have little effect on food prices, but can result in increased carbon and energy prices.« less

Variations in county-level costs between traditional medicare and medicare advantage have implications for premium support.

PubMed

Biles, Brian; Casillas, Giselle; Guterman, Stuart

2015-01-01

Concern about the future growth of Medicare spending has led some in Congress and elsewhere to promote converting Medicare to a "premium support" system. Under premium support, Medicare would provide a "defined contribution" to each Medicare beneficiary to purchase either a Medicare Advantage (MA)-type private health plan or the traditional Medicare public plan. To better understand the implications of such a shift, we compared the average costs per beneficiary of providing Medicare benefits at the county level for traditional Medicare and four types of MA plans. We found that the relative costs of Medicare Advantage and traditional Medicare varied greatly by MA plan type and by geographic location. The costs of health maintenance organization-type plans averaged 7 percent less than those of traditional Medicare, but the costs of the more loosely structured preferred provider organization and private fee-for-service plans averaged 12-18 percent more than those of traditional Medicare. In some counties MA plan costs averaged 28 percent less than costs in traditional Medicare, while in other counties MA plan costs averaged 26 percent more than traditional Medicare costs. Enactment of a Medicare premium-support proposal could trigger cost increases for beneficiaries participating in Medicare Advantage as well as those in traditional Medicare. Project HOPE—The People-to-People Health Foundation, Inc.

Speech-in-speech perception and executive function involvement

PubMed Central

Perrone-Bertolotti, Marcela; Tassin, Maxime

2017-01-01

This present study investigated the link between speech-in-speech perception capacities and four executive function components: response suppression, inhibitory control, switching and working memory. We constructed a cross-modal semantic priming paradigm using a written target word and a spoken prime word, implemented in one of two concurrent auditory sentences (cocktail party situation). The prime and target were semantically related or unrelated. Participants had to perform a lexical decision task on visual target words and simultaneously listen to only one of two pronounced sentences. The attention of the participant was manipulated: The prime was in the pronounced sentence listened to by the participant or in the ignored one. In addition, we evaluate the executive function abilities of participants (switching cost, inhibitory-control cost and response-suppression cost) and their working memory span. Correlation analyses were performed between the executive and priming measurements. Our results showed a significant interaction effect between attention and semantic priming. We observed a significant priming effect in the attended but not in the ignored condition. Only priming effects obtained in the ignored condition were significantly correlated with some of the executive measurements. However, no correlation between priming effects and working memory capacity was found. Overall, these results confirm, first, the role of attention for semantic priming effect and, second, the implication of executive functions in speech-in-noise understanding capacities. PMID:28708830

The Use of Parenteral Nutrition Support in an Acute Care Hospital and the Cost Implications of Short-term Parenteral Nutrition.

PubMed

Wong, Alvin Tc; Ong, Jeannie Pl; Han, Hsien Hwei

2016-06-01

Parenteral nutrition (PN) is indicated for patients who are unable to progress to oral or enteral nutrition. There are no local studies done on estimating the cost of PN in acute settings. The aims of this study are to describe the demographics, costs of PN and manpower required; and to determine the avoidable PN costs for patients and hospital on short-term PN. Patient data between October 2011 and December 2013 were reviewed. Data collected include demographics, length of stay (LOS), and the indication/duration of PN. PN administration cost was based on the cost of the PN bags, blood tests and miscellaneous items, adjusted to subsidy levels. Manpower costs were based on the average hourly rate. Costs for PN and manpower were approximately S$1.2 million for 2791 PN days. Thirty-six cases (18.8%) of 140 PN days were short-term and considered to be avoidable where patients progressed to oral/enteral diet within 5 days. These short-term cases totalled $59,154.42, where $42,183.15 was payable by the patients. The daily costs for PN is also significantly higher for patients on short-term PN (P <0.001). In our acute hospital, 90% of patients referred for PN were surgical patients. Majority of the cost comes from the direct daily cost of the bag and blood tests, while extensive manpower cost was borne by the hospital; 18.8% of our cohort had short-term avoidable PN. Daily PN may cost up to 60% more in patients receiving short-term PN. Clinicians should assess patient's suitability for oral/enteral feeding to limit the use of short-term PN.

Cost-of-illness of cholera to households and health facilities in rural Malawi

PubMed Central

Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A.; Cavailler, Philippe; Gessner, Bradford D.; Le Gargasson, Jean-Bernard

2017-01-01

Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients’ households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera. PMID:28934285

Cost-of-illness of cholera to households and health facilities in rural Malawi.

PubMed

Ilboudo, Patrick G; Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A; Cavailler, Philippe; Gessner, Bradford D; Le Gargasson, Jean-Bernard

2017-01-01

Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

Point-of-care controls for nosocomial legionellosis combined with chlorine dioxide potable water decontamination: a two-year survey at a Welsh teaching hospital.

PubMed

Hosein, I K; Hill, D W; Tan, T Y; Butchart, E G; Wilson, K; Finlay, G; Burge, S; Ribeiro, C D

2005-10-01

This study reports a two-year programme of attempted eradication of Legionella colonization in the potable water supply of a 1000-bed tertiary care teaching hospital in Wales. There was a simultaneous, point-of-care, sterile-water-only policy for all intensive care units (ICU) and bone marrow and renal transplant units in order to prevent acquisition of nosocomial Legionnaires' disease. The programme was initiated following a case of nosocomial pneumonia caused by Legionella pneumophila serogroup 1-Bellingham-like genotype A on the cardiac ICU. The case occurred 14 days after mitral and aortic valve replacement surgery. Clinical and epidemiological investigations implicated aspiration of hospital potable water as the mechanism of infection. Despite interventions with chlorine dioxide costing over 25000 UK pounds per annum, Legionella has remained persistently present in significant numbers (up to 20000 colony forming units/L) and with little reduction in the number of positive sites. Two further cases of nosocomial disease occurred over the following two-year period; in one case, aspiration of tap water was implicated again, and in the other case, instillation of contaminated water into the right main bronchus via a misplaced nasogastric tube was implicated. These cases arose because of inadvertent non-compliance with the sterile-water-only policy in high-risk locations. Enhanced clinical surveillance over the same two-year period detected no other cases of nosocomial disease. This study suggests that attempts at eradication of Legionella spp. from complex water systems may not be a cost-effective measure for prevention of nosocomial infections, and to the best of our knowledge is the first study from the UK to suggest that the introduction of a sterile-water-only policy for ICUs and other high-risk units may be a more cost-effective approach.

Financial Burden Faced by Families due to Out-of-pocket Expenses during the Treatment of their Cancer Children: An Indian Perspective.

PubMed

Sneha, Latha M; Sai, Jeyanth; Ashwini, S; Ramaswamy, Sunitha; Rajan, Mahalakshmi; Scott, Julius X

2017-01-01

Life-saving cancer therapy is costly and may result in financial burden for these families. Financial costs for treating childhood cancer care are traditionally assessed based on the amount spent for diagnostic tests, hospitalization, and chemotherapy. The financial costs for travel, accommodation, out-of-pocket expenses for food, phone bills, and loss of income due to reduction or termination of parental employment are hidden nonmedical expenses that are rarely accounted for. Studies on the financial implications of pediatric cancer treatment are based on the Western model of healthcare with good government/state insurance coverage and hence literature on lifestyle implications for families in developing nations with limited resources is still scarce. The aim of this study is to find out the details of out-of-pocket expenses incurred by the families during their treatment of cancer children and its implications on their quality of life. Settings and Design: This study was conducted in a tertiary care center for pediatric malignancies for over 1-year period. About seventy families whose children were diagnosed with acute leukemia and undergoing treatment at our center were asked to fill a questionnaire detailing their out-of-pocket expenses. Nonmedical expenses accounts for about 46% of their monthly household income of parents from rural areas and 22% of their household income from urban areas. On an average, a family from rural area spends four times the normal amount spent on home for their daily food expenditure. Thirty-eight percent of families have borrowed money from money lenders with an average interest rate of about 12.5% which pushes them to a state of debt for the next few years. Out-of-pocket expenses contribute a significant proportion to the financial burden of the families with childhood malignancies and these invisible expenses should be recognized and provide adequate support to lessen the burden of this economic impact.

Implications of Transaction Costs for Acquisition Program Cost Breaches

DTIC Science & Technology

2013-06-01

scope of the work, communicating the basis on which the estimate is built, identifying the quality of the data, determining the level of risk, and...projects such as bases, schools, missile storage facilities, maintenance facilities, medical/ dental clinics, libraries, and military family housing...was established as a threshold for measuring cost growth. This prevents a program from rebaselining to avoid a Nunn- McCurdy cost threshold breach. In

Costing nursing education programs. It's as easy as 1-2-3.

PubMed

Fisher, M L; Hume, R; Emerick, R

1998-01-01

Staff development departments are pressured to reveal the costs of their educational programs and to compete with outside vendors for programming. The process of implementing a spreadsheet template for costing out staff development programs is described. The template is easy to use and supports "what if" analysis. This model allows educators to evaluate cost implications of curricular decisions and to better negotiate with internal and external customers.

Executive cognitive functioning and the recognition of facial expressions of emotion in incarcerated violent offenders, non-violent offenders, and controls.

PubMed

Hoaken, Peter N S; Allaby, David B; Earle, Jeff

2007-01-01

Violence is a social problem that carries enormous costs; however, our understanding of its etiology is quite limited. A large body of research exists, which suggests a relationship between abnormalities of the frontal lobe and aggression; as a result, many researchers have implicated deficits in so-called "executive function" as an antecedent to aggressive behaviour. Another possibility is that violence may be related to problems interpreting facial expressions of emotion, a deficit associated with many forms of psychopathology, and an ability linked to the prefrontal cortex. The current study investigated performance on measures of executive function and on a facial-affect recognition task in 20 violent offenders, 20 non-violent offenders, and 20 controls. In support of our hypotheses, both offender groups performed significantly more poorly on measures of executive function relative to controls. In addition, violent offenders were significantly poorer on the facial-affect recognition task than either of the other two groups. Interestingly, scores on these measures were significantly correlated, with executive deficits associated with difficulties accurately interpreting facial affect. The implications of these results are discussed in terms of a broader understanding of violent behaviour. Copyright 2007 Wiley-Liss, Inc.

Altered selection during language processing in individuals at high risk for psychosis.

PubMed

Vargas, T; Snyder, H; Banich, M; Newberry, R; Shankman, Stewart A; Strauss, Gregory P; Mittal, V A

2018-06-19

Performance in the executive function (EF) domain has been linked to symptoms and functional outcomes in psychosis. Studies have found that UHR populations have difficulty with verbal fluency, which involves multiple facets of EF. Two potentially implicated EF facets were examined to explore whether these could be dissociated in UHR populations: selection among alternatives (measured by selection costs) and retrieval from semantic memory retrieval (measured by retrieval costs). A total of 45 UHR individuals and 46 healthy controls (HVs) were assessed with a verb generation task. Differences in selection cost (RT difference between high and low selection demand conditions) and retrieval cost (RT difference between high and low retrieval demand conditions) were examined and participants were also assessed for clinical symptoms. The UHR group showed greater selection costs relative to HVs, F (1, 91) = 4.39, p = 0.039. However, there were no group differences on retrieval cost, F (1, 91) = 0.63, p = 0.43. A positive association (r = 0.41) was found between disorganized and negative symptoms and selection costs (but not retrieval costs) in the UHR group. There was no significant association between selection costs and positive symptoms. Increased selection costs may reflect impaired performance in the neural inhibition domain of EF in the UHR population, potentially underlying a mechanistically distinct EF subdomain that affects the group's ability to efficiently select between competing options. Findings suggest that UHR individuals may exhibit impairment in selecting among alternatives, but not in retrieval from semantic memory. Copyright © 2018 Elsevier B.V. All rights reserved.

Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.

PubMed

Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella M; Bornschein, Bernhard; Eccleston, David; Walters, Darren L; Rankin, James; De Bruyne, Bernard; Fearon, William F; Pijls, Nico H; Harper, Richard

2014-06-01

The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Cost Comparison Model: Blended eLearning versus traditional training of community health workers.

PubMed

Sissine, Mysha; Segan, Robert; Taylor, Mathew; Jefferson, Bobby; Borrelli, Alice; Koehler, Mohandas; Chelvayohan, Meena

2014-01-01

Another one million community healthcare workers are needed to address the growing global population and increasing demand of health care services. This paper describes a cost comparison between two training approaches to better understand costs implications of training community health workers (CHWs) in Sub-Saharan Africa. Our team created a prospective model to forecast and compare the costs of two training methods as described in the Dalburge Report - (1) a traditional didactic training approach ("baseline") and (2) a blended eLearning training approach ("blended"). After running the model for training 100,000 CHWs, we compared the results and scaled up those results to one million CHWs. A substantial difference exists in total costs between the baseline and blended training programs. RESULTS indicate that using a blended eLearning approach for training community health care workers could provide a total cost savings of 42%. Scaling the model to one million CHWs, the blended eLearning training approach reduces total costs by 25%. The blended eLearning savings are a result of decreased classroom time, thereby reducing the costs associated with travel, trainers and classroom costs; and using a tablet with WiFi plus a feature phone rather than a smartphone with data plan. The results of this cost analysis indicate significant savings through using a blended eLearning approach in comparison to a traditional didactic method for CHW training by as much as 67%. These results correspond to the Dalberg publication which indicates that using a blended eLearning approach is an opportunity for closing the gap in training community health care workers.

Cost Spreading in College Athletic Spending in the United States: Estimates and Implications

ERIC Educational Resources Information Center

Lipford, Jody W.; Slice, Jerry K.

2017-01-01

With rising costs, mounting student debt, and many schools experiencing financial hardship, the higher education industry faces unwanted scrutiny from the popular media and political sector. College athletics too have come under close examination because of rising costs and internal subsidies. In this paper, we provide estimates of the per-student…

Avoidable costs of comprehensive case management.

PubMed

Issel, L M; Anderson, R A

1999-01-01

Comprehensive case management has become an industry standard and its pervasiveness raises questions about the ubiquitous need for this service. Analyzed from the perspective of transaction cost analysis and access, we argue that in some cases comprehensive case management is an avoidable cost incurred because of system problems that limit access to otherwise eligible clients. Implications are discussed.

Price-Cost Ratios in Higher Education: Subsidy Structure and Policy Implications

ERIC Educational Resources Information Center

Xie, Yan

2010-01-01

The diversity of US institutions of higher education is manifested in many ways. This study looks at that diversity from the economic perspective by studying the subsidy structure through the distribution of institutional price-cost ratio (PCR), defined as the sum of net tuition price divided by total supplier cost and equals to one minus…

An Investigation of Possible Discriminating Earned Value Variables in Department of Defense Major Acquisition Program Cancellation

DTIC Science & Technology

2013-06-01

distribution is unlimited 12b. DISTRIBUTION CODE A 13. ABSTRACT (maximum 200 words) Some major defense acquisition programs (MDAPs) are cancelled...68 VI. PRACTICAL IMPLICATIONS FOR DEFENSE ACQUISITION .....................73 A . OVERVIEW...Contract Performance Report C /SCSC Cost/Schedule Control Systems Criteria CV Cost Variance CV % Cost Variance Percentage DAE Defense Acquisition

Cost Comparison of Early Intensive Behavioral Intervention and Special Education for Children with Autism

ERIC Educational Resources Information Center

Chasson, Gregory S.; Harris, Gerald E.; Neely, Wendy J.

2007-01-01

The financial implications of the increased prevalence of autism, though rarely discussed, will be extremely important to society. We compared the costs associated with 18 years of special education to the costs associated with the implementation of an average of 3 years of Discrete Trial Training as an Early Intensive Behavioral Intervention…

A cost-effectiveness analysis of two different repositioning strategies for the prevention of pressure ulcers.

PubMed

Marsden, Grace; Jones, Katie; Neilson, Julie; Avital, Liz; Collier, Mark; Stansby, Gerard

2015-12-01

To assess the cost effectiveness of two repositioning strategies and inform the 2014 National Institute for Health and Care Excellence clinical guideline recommendations on pressure ulcer prevention. Pressure ulcers are distressing events, caused when skin and underlying tissues are placed under pressure sufficient to impair blood supply. They can have a substantial impact on quality of life and have significant resource implications. Repositioning is a key prevention strategy, but can be resource intensive, leading to variation in practice. This economic analysis was conducted to identify the most cost-effective repositioning strategy for the prevention of pressure ulcers. The economic analysis took the form of a cost-utility model. The clinical inputs to the model were taken from a systematic review of clinical data. The population in the model was older people in a nursing home. The economic model was developed with members of the guideline development group and included costs borne by the UK National Health Service. Outcomes were expressed as costs and quality adjusted life years. Despite being marginally more clinically effective, alternating 2 and 4 hourly repositioning is not a cost-effective use of UK National Health Service resources (compared with 4 hourly repositioning) for this high risk group of patients at a cost-effectiveness threshold of £20,000 per quality adjusted life years. These results were used to inform the clinical guideline recommendations for those who are at high risk of developing pressure ulcers. © 2015 John Wiley & Sons Ltd.

Public health implications of sleep loss: the community burden.

PubMed

Hillman, David R; Lack, Leon C

2013-10-21

Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%-35%). These difficulties are generally more prevalent among females, with the exception of snoring and related difficulties. While about half of these problems are likely to be attributable to specific sleep disorders, the balance appears attributable to poor sleep habits or choices to limit sleep opportunity. Study of the economic impact of sleep disorders demonstrates financial costs to Australia of $5.1 billion per year. This comprises $270 million for health care costs for the conditions themselves, $540 million for care of associated medical conditions attributable to sleep disorders, and about $4.3 billion largely attributable to associated productivity losses and non-medical costs resulting from sleep loss-related accidents. Loss of life quality added a substantial further non-financial cost. While large, these costs were for sleep disorders alone. Additional costs relating to inadequate sleep from poor sleep habits in people without sleep disorders were not considered. Based on the high prevalence of such problems and the known impacts of sleep loss in all its forms on health, productivity and safety, it is likely that these poor sleep habits would add substantially to the costs from sleep disorders alone.

Costs of day hospital and community residential chemical dependency treatment.

PubMed

Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya; Witbrodt, Jane

2008-03-01

Patient placement criteria developed by the American Society of Addiction Medicine (ASAM) have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher levels of severity. A recent clinical trial found similar outcomes at social model residential treatment and clinically-oriented day hospital programs, but did not report on costs. This paper addresses whether the similar outcomes in the recent trial were delivered with comparable costs, overall and within gender and ethnicity stratum. This paper reports on clients not at environmental risk who participated in a randomized trial conducted in three metropolitan areas served by a large pre-paid health plan. Cost data were collected using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Costs per episode were calculated by multiplying DATCAP-derived program-specific costs by each client's length of stay. Differences in length of stay, and in per-episode costs, were compared between residential and day hospital subjects. Lengths of stay at residential treatment were significantly longer than at day hospital, in the sample overall and in disaggregated analyses. This difference was especially marked among non-Whites. The average cost per week was USD 575 per week at day hospital, versus USD 370 per week at the residential programs. However, because of the longer stays in residential, per-episode costs were significantly higher in the sample overall and among non-Whites (and marginally higher for men). These cost results must be considered in light of the null findings comparing outcomes between subjects randomized to residential versus day hospital programs. The longer stays in the sample overall and for non-White clients at residential programs came at higher costs but did not lead to better rates of abstinence. The short stays in day hospital among non-Whites call into question the attractiveness of day hospital for minority clients. Outcomes and costs at residential versus day hospital programs were similar for women and for Whites. For non-Whites, and marginally for men, a preference for residential care would appear to come at a higher cost. Lengths of stay in residential treatment were significantly longer than in day hospital, but costs per week were lower. Women and Whites appear to be equally well-served in residential and day hospital programs, with no significant cost differential. Provision of residential treatment for non-Whites may be more costly than day hospital, because their residential stays are likely to be 3 times longer than they would be if treated in day hospital. For men, residential care will be marginally more costly. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Residential treatment appears to represent a cost-effective alternative to day hospital for female and White clients with severe alcohol and drug problems who are not at environmental risk. The much shorter stays in day hospital than at residential among non-Whites highlight the need for research to better understand how to best meet the needs and preferences of non-White clients when considering both costs and outcomes.

Frontier battery development for hybrid vehicles

PubMed Central

2012-01-01

Background Interest in hybrid-electric vehicles (HEVs) has recently spiked, partly due to an increasingly negative view toward the U.S. foreign oil dependency and environmental concerns. Though HEVs are becoming more common, they have a significant price premium over gasoline-powered vehicles. One of the primary drivers of this “hybrid premium” is the cost of the vehicles’ batteries. This paper focuses on these batteries used in hybrid vehicles, examines the types of batteries used for transportation applications and addresses some of the technological, environmental and political drivers in battery development and the deployment of HEVs. Methods This paper examines the claim, often voiced by HEV proponents, that by taking into account savings on gasoline and vehicle maintenance, hybrid cars are cheaper than traditional gasoline cars. This is done by a quantitative benefit-cost analysis, in addition to qualitative benefit-cost analysis from political, technological and environmental perspectives. Results The quantitative benefit-cost analysis shows that, taking account of all costs for the life of the vehicle, hybrid cars are in fact more expensive than gasoline-powered vehicles; however, after five years, HEVs will break even with gasoline cars. Conclusions Our results show that it is likely that after 5 years, using hybrid vehicles should be cheaper in effect and yield a positive net benefit to society. There are a number of externalities that could significantly impact the total social cost of the car. These externalities can be divided into four categories: environmental, industrial, R&D and political. Despite short-term implications and hurdles, increased HEV usage forecasts a generally favorable long-term net benefit to society. Most notably, increasing HEV usage could decrease greenhouse gas emissions, while also decreasing U.S. dependence on foreign oil. PMID:22540987

Future European health care: cost containment, health care reform and scientific progress in drug research.

PubMed

Emilien, G

1997-01-01

The cost of the development of a new pharmaceutical product from its conception and synthesis through to the regulatory approval process has more than quadrupled in the last 20 years. Both clinical and total development times have increased substantially. To amortize the costs incurred, the pharmaceutical industry has taken an international dimension. The incentives for pharmaceutical firms to discover and develop new drugs depend on the length of the development and regulatory review process plus the potential market size. Recent regulatory, economic and political changes may have significant implications for the future of new drug developments in Europe. The European Union industrial policy felt that there is a need for convergence in the area of pricing. It is recommended that the policy should aim to contain growth in pharmaceutical expenses by means specific to reimbursement rather than direct price controls. By encouraging doctors to prescribe and customers to use generics, competition is enhanced to bring down drug prices. More emphasis is being laid by government in educating customers to cost-awareness and cost-benefit ratios with regard to pharmaceuticals. Concerning clinical trials, European harmonization has been achieved by significant developments: the rights and integrity of the trial subjects are protected; the credibility of the data is established; and the ethical, scientific and technical quality of the trials has improved. Future European health care forecasts a whole change in the pharmaceutical business. Important issues in cost and outcome measurement should be carefully planned and considered in drug development. Due to important mergers and acquisitions, the pharmaceutical sector will consist mainly of important multinational corporations. In this way, valuable new products may be brought to the market.

Delivery system characteristics and their association with quality and costs of care: implications for accountable care organizations.

PubMed

Chukmaitov, Askar; Harless, David W; Bazzoli, Gloria J; Carretta, Henry J; Siangphoe, Umaporn

2015-01-01

Implementation of accountable care organizations (ACOs) is currently underway, but there is limited empirical evidence on the merits of the ACO model. The aim was to study the associations between delivery system characteristics and ACO competencies, including centralization strategies to manage organizations, hospital integration with physicians and outpatient facilities, health information technology, infrastructure to monitor community health and report quality, and risk-adjusted 30-day all-cause mortality and case-mixed-adjusted inpatient costs for the Medicare population. Panel data (2006-2009) were assembled from Florida and multiple sources: inpatient hospital discharge, vital statistics, the American Hospital Association, the Healthcare Information and Management Systems Society, and other databases. We applied a panel study design, controlling for hospital and market characteristics. Hospitals that were in centralized health systems or became more centralized over the study period had significantly larger reductions in mortality compared with hospitals that remained freestanding. Surprisingly, tightly integrated hospital-physician arrangements were associated with increased mortality; as such, hospitals may wish to proceed cautiously when developing specific types of alignment with local physician organizations. We observed no statistically significant differences in the growth rate of costs across hospitals in any of the health systems studied relative to freestanding hospitals. Although we observed quality improvement in some organizational types, these outcome improvements were not coupled with the additional desired objective of lower cost growth. This implies that additional changes not present during our study period, potentially changes in provider payment approaches, are essential for achieving the ACO objectives of higher quality of care at lower costs. Provider organizations implementing ACOs should consider centralizing service delivery as a viable strategy to improve quality of care, although the strategy did not result in lower cost growth.

Frontier battery development for hybrid vehicles.

PubMed

Lewis, Heather; Park, Haram; Paolini, Maion

2012-04-23

Interest in hybrid-electric vehicles (HEVs) has recently spiked, partly due to an increasingly negative view toward the U.S. foreign oil dependency and environmental concerns. Though HEVs are becoming more common, they have a significant price premium over gasoline-powered vehicles. One of the primary drivers of this "hybrid premium" is the cost of the vehicles' batteries. This paper focuses on these batteries used in hybrid vehicles, examines the types of batteries used for transportation applications and addresses some of the technological, environmental and political drivers in battery development and the deployment of HEVs. This paper examines the claim, often voiced by HEV proponents, that by taking into account savings on gasoline and vehicle maintenance, hybrid cars are cheaper than traditional gasoline cars. This is done by a quantitative benefit-cost analysis, in addition to qualitative benefit-cost analysis from political, technological and environmental perspectives. The quantitative benefit-cost analysis shows that, taking account of all costs for the life of the vehicle, hybrid cars are in fact more expensive than gasoline-powered vehicles; however, after five years, HEVs will break even with gasoline cars. Our results show that it is likely that after 5 years, using hybrid vehicles should be cheaper in effect and yield a positive net benefit to society. There are a number of externalities that could significantly impact the total social cost of the car. These externalities can be divided into four categories: environmental, industrial, R&D and political. Despite short-term implications and hurdles, increased HEV usage forecasts a generally favorable long-term net benefit to society. Most notably, increasing HEV usage could decrease greenhouse gas emissions, while also decreasing U.S. dependence on foreign oil.

An improved synthesis of haloaceteamidine-based inactivators of protein arginine deiminase 4 (PAD4)

PubMed Central

Causey, Corey P.; Thompson, Paul R.

2008-01-01

Protein arginine deiminase 4 (PAD4) is an enzyme that hydrolyzes peptidyl arginine residues to form citrulline and ammonia. This enzyme has been implicated in several disease states, e.g. rheumatoid arthritis, and therefore represents a unique target for the development of a novel therapeutic. A solution-phase synthesis of Cl-amidine, the most potent PAD4 inactivator described to date, has been developed. This synthesis proceeds in 80% yield over 4 steps at a significantly (12-fold) lower cost. PMID:19587776

Managerial accounting applications in radiology.

PubMed

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

2005-03-01

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

Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance.

PubMed

Oppong, Raymond; Smith, Richard D; Little, Paul; Verheij, Theo; Butler, Christopher C; Goossens, Herman; Coenen, Samuel; Moore, Michael; Coast, Joanna

2016-09-01

Lower respiratory tract infections (LRTIs) are a major disease burden and are often treated with antibiotics. Typically, studies evaluating the use of antibiotics focus on immediate costs of care, and do not account for the wider implications of antimicrobial resistance. This study sought to establish whether antibiotics (principally amoxicillin) are cost effective in patients with LRTIs, and to explore the implications of taking into account costs associated with resistance. Multinational randomised double-blinded trial in 2060 patients with acute cough/LRTIs recruited in 12 European countries. A cost-utility analysis from a health system perspective with a time horizon of 28 days was conducted. The primary outcome measure was the quality-adjusted life year (QALY). Hierarchical modelling was used to estimate incremental cost-effectiveness ratios (ICERs). Amoxicillin was associated with an ICER of €8216 (£6540) per QALY gained when the cost of resistance was excluded. If the cost of resistance is greater than €11 (£9) per patient, then amoxicillin treatment is no longer cost effective. Including possible estimates of the cost of resistance resulted in ICERs ranging from €14 730 (£11 949) per QALY gained - when only multidrug resistance costs and health care costs are included - to €727 135 (£589 856) per QALY gained when broader societal costs are also included. Economic evaluation of antibiotic prescribing strategies that do not include the cost of resistance may provide misleading results that could be of questionable use to policymakers. However, further work is required to estimate robust costs of resistance. © British Journal of General Practice 2016.

Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance

PubMed Central

Oppong, Raymond; Smith, Richard D; Little, Paul; Verheij, Theo; Butler, Christopher C; Goossens, Herman; Coenen, Samuel; Moore, Michael; Coast, Joanna

2016-01-01

Background Lower respiratory tract infections (LRTIs) are a major disease burden and are often treated with antibiotics. Typically, studies evaluating the use of antibiotics focus on immediate costs of care, and do not account for the wider implications of antimicrobial resistance. Aim This study sought to establish whether antibiotics (principally amoxicillin) are cost effective in patients with LRTIs, and to explore the implications of taking into account costs associated with resistance. Design and setting Multinational randomised double-blinded trial in 2060 patients with acute cough/LRTIs recruited in 12 European countries. Method A cost-utility analysis from a health system perspective with a time horizon of 28 days was conducted. The primary outcome measure was the quality-adjusted life year (QALY). Hierarchical modelling was used to estimate incremental cost-effectiveness ratios (ICERs). Results Amoxicillin was associated with an ICER of €8216 (£6540) per QALY gained when the cost of resistance was excluded. If the cost of resistance is greater than €11 (£9) per patient, then amoxicillin treatment is no longer cost effective. Including possible estimates of the cost of resistance resulted in ICERs ranging from €14 730 (£11 949) per QALY gained — when only multidrug resistance costs and health care costs are included — to €727 135 (£589 856) per QALY gained when broader societal costs are also included. Conclusion Economic evaluation of antibiotic prescribing strategies that do not include the cost of resistance may provide misleading results that could be of questionable use to policymakers. However, further work is required to estimate robust costs of resistance. PMID:27402969

Cost-effectiveness analysis of trastuzumab in the adjuvant setting for treatment of HER2-positive breast cancer.

PubMed

Garrison, Louis P; Lubeck, Deborah; Lalla, Deepa; Paton, Virginia; Dueck, Amylou; Perez, Edith A

2007-08-01

Adding trastuzumab to adjuvant chemotherapy provides significant clinical benefit in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. A cost-effectiveness analysis was performed to assess clinical and economic implications of adding trastuzumab to adjuvant chemotherapy, based upon joint analysis of NSABP B-31 and NCCTG N9831 trials. A Markov model with 4 health states was used to estimate the cost utility for a 50-year-old woman on the basis of trial results through 4 years and estimates of long-term recurrence and death based on a meta-analysis of trials. From 6 years onward, rates of recurrence and death were assumed to be the same in both trastuzumab and chemotherapy-only arms. Incremental costs were estimated for diagnostic and treatment-related costs. Analyses were from payer and societal perspectives, and these analyses were projected to lifetime and 20-year horizons. Over a lifetime, the projected cost of trastuzumab per quality-adjusted life year (QALY; discount rate 3%) gained was 26,417 dollars (range 9,104 dollars-69,340 dollars under multiway sensitivity analysis). Discounted incremental lifetime cost was 44,923 dollars, and projected life expectancy was 3 years longer for patients who received trastuzumab (19.4 years vs 16.4 years). During a 20-year horizon, the projected cost of adding trastuzumab to chemotherapy was 34,201 dollars per QALY gained. Key cost-effectiveness drivers were discount rate, trastuzumab price, and probability of metastasis. The cost-effectiveness result was robust to sensitivity analysis. Trastuzumab for adjuvant treatment of early stage breast cancer was projected to be cost effective over a lifetime horizon, achieving a cost-effectiveness ratio below that of many widely accepted oncology treatments. (c) 2007 American Cancer Society.

Construction and Operation Costs of Wastewater Treatment and Implications for the Paper Industry in China.

PubMed

Niu, Kunyu; Wu, Jian; Yu, Fang; Guo, Jingli

2016-11-15

This paper aims to develop a construction and operation cost model of wastewater treatment for the paper industry in China and explores the main factors that determine these costs. Previous models mainly involved factors relating to the treatment scale and efficiency of treatment facilities for deriving the cost function. We considered the factors more comprehensively by adding a regional variable to represent the economic development level, a corporate ownership factor to represent the plant characteristics, a subsector variable to capture pollutant characteristics, and a detailed-classification technology variable. We applied a unique data set from a national pollution source census for the model simulation. The major findings include the following: (1) Wastewater treatment costs in the paper industry are determined by scale, technology, degree of treatment, ownership, and regional factors; (2) Wastewater treatment costs show a large decreasing scale effect; (3) The current level of pollutant discharge fees is far lower than the marginal treatment costs for meeting the wastewater discharge standard. Key implications are as follows: (1) Cost characteristics and impact factors should be fully recognized when planning or making policies relating to wastewater treatment projects or technology development; (2) There is potential to reduce treatment costs by centralizing wastewater treatment via industrial parks; (3) Wastewater discharge fee rates should be increased; (4) Energy efficient technology should become the future focus of wastewater treatment.

Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability.

PubMed

Daviaud, Emmanuelle; Besada, Donnela; Leon, Natalie; Rohde, Sarah; Sanders, David; Oliphant, Nicholas; Doherty, Tanya

2017-06-01

Sub-Saharan Africa still reports the highest rates of under-five mortality. Low cost, high impact interventions exist, however poor access remains a challenge. Integrated community case management (iCCM) was introduced to improve access to essential services for children 2-59 months through diagnosis, treatment and referral services by community health workers for malaria, pneumonia and diarrhea. This paper presents the results of an economic analysis of iCCM implementation in regions supported by UNICEF in six countries and assesses country-level scale-up implications. The paper focuses on costs to provider (health system and donors) to inform planning and budgeting, and does not cover cost-effectiveness. The analysis combines annualised set-up costs and 1 year implementation costs to calculate incremental economic and financial costs per treatment from a provider perspective. Affordability is assessed by calculating the per capita financial cost of the program as a percentage of the public health expenditure per capita. Time and financial implications of a 30% increase in utilization were modeled. Country scale-up is modeled for all children under 5 in rural areas. Utilization of iCCM services varied from 0.05 treatment/y/under-five in Ethiopia to over 1 in Niger. There were between 10 and 603 treatments/community health worker (CHW)/y. Consultation cost represented between 93% and 22% of economic costs per treatment influenced by the level of utilization. Weighted economic cost per treatment ranged from US$ 13 (2015 USD) in Ghana to US$ 2 in Malawi. CHWs spent from 1 to 9 hours a week on iCCM. A 30% increase in utilization would add up to 2 hours a week, but reduce cost per treatment (by 20% in countries with low utilization). Country scale up would amount to under US$ 0.8 per capita total population (US$ 0.06-US$0.74), between 0.5% and 2% of public health expenditure per capita but 8% in Niger. iCCM addresses unmet needs and impacts on under 5 mortality. An economic cost of under US$ 1/capita/y represents a sound investment. Utilization remains low however, and strategies must be developed as a priority to improve demand. Continued donor support is required to sustain iCCM services and strengthen its integration within national health systems.

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

NASA Astrophysics Data System (ADS)

Dall, Ernest P.; Hoffmann, Jaap E.

2017-06-01

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

Oxygen consumption, oxygen cost, heart rate, and perceived effort during split-belt treadmill walking in young healthy adults.

PubMed

Roper, Jaimie A; Stegemöller, Elizabeth L; Tillman, Mark D; Hass, Chris J

2013-03-01

During split-belt treadmill walking the speed of the treadmill under one limb is faster than the belt under the contralateral limb. This unique intervention has shown evidence of acutely improving gait impairments in individuals with neurologic impairment such as stroke and Parkinson's disease. However, oxygen use, heart rate and perceived effort associated with split-belt treadmill walking are unknown and may limit the utility of this locomotor intervention. To better understand the intensity of this new intervention, this study was undertaken to examine the oxygen consumption, oxygen cost, heart rate, and rating of perceived exertion associated with split-belt treadmill walking in young healthy adults. Fifteen participants completed three sessions of treadmill walking: slow speed with belts tied, fast speed with belts tied, and split-belt walking with one leg walking at the fast speed and one leg walking at the slow speed. Oxygen consumption, heart rate, and rating of perceived exertion were collected during each walking condition and oxygen cost was calculated. Results revealed that oxygen consumption, heart rate, and perceived effort associated with split-belt walking were higher than slow treadmill walking, but only oxygen consumption was significantly lower during both split-belt walking than fast treadmill walking. Oxygen cost associated with slow treadmill walking was significantly higher than fast treadmill walking. These findings have implications for using split-belt treadmill walking as a rehabilitation tool as the cost associated with split-belt treadmill walking may not be higher or potentially more detrimental than that associated with previously used treadmill training rehabilitation strategies.

Commercial agencies and surrogate motherhood: a transaction cost approach.

PubMed

Galbraith, Mhairi; McLachlan, Hugh V; Swales, J Kim

2005-03-01

In this paper we investigate the legal arrangements involved in UK surrogate motherhood from a transaction-cost perspective. We outline the specific forms the transaction costs take and critically comment on the way in which the UK institutional and organisational arrangements at present adversely influence transaction costs. We then focus specifically on the potential role of surrogacy agencies and look at UK and US evidence on commercial and voluntary agencies. Policy implications follow.

A survey of computer search service costs in the academic health sciences library.

PubMed Central

Shirley, S

1978-01-01

The Norris Medical Library, University of Southern California, has recently completed an extensive survey of costs involved in the provision of computer search services beyond vendor charges for connect time and printing. In this survey costs for such items as terminal depreciation, repair contract, personnel time, and supplies are analyzed. Implications of this cost survey are discussed in relation to planning and price setting for computer search services. PMID:708953

Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions

PubMed Central

Benkeser, David; Coe, Norma B.; Engelberg, Ruth A.; Teno, Joan M.; Curtis, J. Randall

2016-01-01

Abstract Background: Terminal intensive care unit (ICU) stays represent an important target to increase value of care. Objective: To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value. Design: Secondary analysis of an intervention study to improve quality of care for critically ill patients. Setting/Patients: 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center. Methods: Data were linked with hospital financial records. Costs were categorized into direct fixed, direct variable, and indirect costs. Patterns of daily costs were explored using generalized estimating equations stratified by length of stay, cause of death, ICU type, and insurance status. Estimates from the literature of effects of palliative care interventions on ICU utilization were used to simulate potential cost savings under different time horizons and reimbursement models. Main Results: Mean cost for a terminal ICU stay was 39.3K ± 45.1K. Direct fixed costs represented 45% of total hospital costs, direct variable costs 20%, and indirect costs 34%. Day of admission was most expensive (mean 9.6K ± 7.6K); average cost for subsequent days was 4.8K ± 3.4K and stable over time and patient characteristics. Conclusions: Terminal ICU stays display consistent cost patterns across patient characteristics. Savings can be realized with interventions that align care with patient preferences, helping to prevent unwanted ICU utilization at end of life. Cost modeling suggests that implications vary depending on time horizon and reimbursement models. PMID:27813724

Assessment of the financial implications for laparoscopic liver surgery: a single-centre UK cost analysis for minor and major hepatectomy.

PubMed

Abu Hilal, Mohammed; Di Fabio, Francesco; Syed, Shareef; Wiltshire, Robert; Dimovska, Eleonora; Turner, David; Primrose, John N; Pearce, Neil W

2013-07-01

Laparoscopic hepatectomy is progressively gaining popularity. However, it is still unclear whether the laparoscopic approach offers cost advantages compared with the open approach, especially when major hepatectomies are required. Data providing useful insights into the costs of the laparoscopic approach for clinicians and hospitals are needed. The aim of this study is to assess the financial implications of the laparoscopic approach for two standardized minor and major hepatectomies: left lateral sectionectomy and right hepatectomy. A cost comparison analysis of patients undergoing laparoscopic right hepatectomy (LRH) and laparoscopic left lateral sectionectomy (LLLS) versus the open counterparts was performed. Data considered for the comparison analysis were operative costs (theatre cost, consumables and surgeon/anaesthetic labour cost), postoperative costs (hospital stay, complication management and readmissions) and overall costs. A total of 149 patients were included: 38 patients underwent LRH and 46 open right hepatectomy (ORH); 46 patients underwent LLLS and 19 open left lateral sectionectomy (OLLS). For LRH the mean operative, postoperative and overall costs were £10,181, £4,037 and £14,218; for ORH the mean operative, postoperative and overall costs were £6,483 (p < 0.0001), £10,304 (p < 0.0001) and £16,787 (p = 0.886). Regarding LLLS, the mean operative, postoperative and overall costs were £5,460, £2,599 and £8,059; for OLLS the mean operative, postoperative and overall costs were £5,841 (p = 0.874), £5,796 (p < 0.0001) and £11,637 (p = 0.0001). Our data support the cost advantage of the laparoscopic approach for left lateral sectionectomy and the cost neutrality for right hepatectomy.

Fast production of methane by anaerobic digestion. Annual progress report, May 24, 1976--May 23, 1977

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

Finney, C.D.; Evans II, R.S.; Finney, K.A.

1977-06-01

Since the productional cost of methane generated by anaerobic digestion of cellulose is on the economic borderline and the cost could be reduced by increasing the rate of the digestion process, a research program was undertaken to delineate the most promising areas of development. The concept that the step involving transfer of products from solution is rate-limiting and inhibiting in anaerobic digestion was supported by all evidence available. The most significant design implication of this concept is that faster gas production can be achieved in a two-stage digestion system in which unreactive solids are eliminated after the hydrolysis step somore » that the effluent to the gas-producing stage possesses a low viscosity. The advantages and disadvantages of three hydrolysis methods (enzymatic, anaerobic, and acid) are reviewed.« less

Pediatric Specialty Care Model for Management of Chronic Respiratory Failure: Cost and Savings Implications and Misalignment With Payment Models.

PubMed

Graham, Robert J; McManus, Michael L; Rodday, Angie Mae; Weidner, Ruth Ann; Parsons, Susan K

2018-05-01

To describe program design, costs, and savings implications of a critical care-based care coordination model for medically complex children with chronic respiratory failure. All program activities and resultant clinical outcomes were tracked over 4 years using an adapted version of the Care Coordination Measurement Tool. Patient characteristics, program activity, and acute care resource utilization were prospectively documented in the adapted version of the Care Coordination Measurement Tool and retrospectively cross-validated with hospital billing data. Impact on total costs of care was then estimated based on program outcomes and nationally representative administrative data. Tertiary children's hospital. Critical Care, Anesthesia, Perioperative Extension and Home Ventilation Program enrollees. None. The program provided care for 346 patients and families over the study period. Median age at enrollment was 6 years with more than half deriving secondary respiratory failure from a primary neuromuscular disease. There were 11,960 encounters over the study period, including 1,202 home visits, 673 clinic visits, and 4,970 telephone or telemedicine encounters. Half (n = 5,853) of all encounters involved a physician and 45% included at least one care coordination activity. Overall, we estimated that program interventions were responsible for averting 556 emergency department visits and 107 hospitalizations. Conservative monetization of these alone accounted for annual savings of $1.2-2 million or $407/pt/mo net of program costs. Innovative models, such as extension of critical care services, for high-risk, high-cost patients can result in immediate cost savings. Evaluation of financial implications of comprehensive care for high-risk patients is necessary to complement clinical and patient-centered outcomes for alternative care models. When year-to-year cost variability is high and cost persistence is low, these savings can be estimated from documentation within care coordination management tools. Means of financial sustainability, scalability, and equal access of such care models need to be established.

Recreational drugs. Societal and professional issues.

PubMed

Solari-Twadell, P A

1991-06-01

Recreational drug use presents a challenge to society and, in particular, the profession of nursing. Recreational drug use must be appreciated for the implications it presents for the episodes of abuse and development of chronic health problems. The effects and recreational use of volatile substances, cannabis, opioids, barbiturates, benzodiazepines, amphetamines, cocaine, psychedelics, and designer drugs as well as alcohol, caffeine, and nicotine must be acknowledged and understood if options for change are to be considered. The resultant cost of recreational drug use as well as health care implications, public safety, and prevention are significant issues society is faced with today. These issues will continue to be significant unless the current posture toward recreational drug use and abuse is addressed. The profession of nursing continues to be faced with the problems associated with recreational drug use not only through caring for clients, but immediately by the effects of recreational drug use on individual professional nurses. To respond effectively, nursing education and nursing research must be challenged to create an emphasis on this focus. Only through this type of multifocal approach will long-term substantial change be affected for the betterment of future generations.

Economic implications of cardiovascular disease management programs: moving beyond one-off experiments.

PubMed

Maru, Shoko; Byrnes, Joshua; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

2015-01-01

Substantial variation in economic analyses of cardiovascular disease management programs hinders not only the proper assessment of cost-effectiveness but also the identification of heterogeneity of interest such as patient characteristics. The authors discuss the impact of reporting and methodological variation on the cost-effectiveness of cardiovascular disease management programs by introducing issues that could lead to different policy or clinical decisions, followed by the challenges associated with net intervention effects and generalizability. The authors conclude with practical suggestions to mitigate the identified issues. Improved transparency through standardized reporting practice is the first step to advance beyond one-off experiments (limited applicability outside the study itself). Transparent reporting is a prerequisite for rigorous cost-effectiveness analyses that provide unambiguous implications for practice: what type of program works for whom and how.

Investigating Cost Implications of Incorporating Level III At-Home Testing into a Polysomnography Based Sleep Medicine Program Using Administrative Data.

PubMed

Stewart, Samuel Alan; Penz, Erika; Fenton, Mark; Skomro, Robert

2017-01-01

Obstructive sleep apnea is a common problem, requiring expensive in-lab polysomnography for proper diagnosis. Home monitoring can provide an alternative to in-lab testing for a subset of OSA patients. The objective of this project was to investigate the effect of incorporating home testing into an OSA program at a large, tertiary sleep disorders centre. The Sleep Disorders Centre in Saskatoon, Canada, has been incorporating at-home testing into their diagnostic pathways since 2006. Administrative data from 2007 to 2013 were extracted (10030 patients) and the flow of patients through the program was followed from diagnosis to treatment. Costs were estimated using 2014 pricing and were stratified by disease attributes and sensitivity analysis was applied. The overall costs per patient were $627.40, with $419.20 for at-home testing and $746.20 for in-lab testing. The cost of home management would rise to $515 if all negative tests were required to be confirmed by an in-lab PSG. Our review suggests that at-home testing can be cost-effective alternative to in-lab testing when applied to the correct population, specifically, those with a high pretest probability of obstructive sleep apnea and an absence of significant comorbidities.

Does the average cost of home health care vary with case mix?

PubMed

Nyman, J A; Svetlik, M A

1989-01-01

The relationship between the average cost of home health care and the case mix of patients served by the home health agency is investigated using 1983 data from Wisconsin's home health care agencies. In contrast to previous work, case mix is shown to have a significant effect on the home health agency's average costs. The methods used in the previous work are evaluated, and differences between the earlier study and the present study are discussed to explain the divergent results. Also, average costs are shown to decrease with output, to increase with the proportion of private patients served by the agency, and to be higher if the home health agency is located in an urban area or if it has a proprietary charter. The implications of this research for the design of an appropriate home health reimbursement policy are discussed. Primarily, it is argued that, although future research might confirm the relationship between average costs and case mix for home health agencies, we cannot necessarily conclude that reimbursement rates must be adjusted to account for differences in case mix as many States are now doing for nursing home reimbursement. Policies must take into account the fundamental differences between home health agencies and nursing homes, and their respective markets, in order to be effective.

Does the average cost of home health care vary with case mix?

PubMed Central

Nyman, J A; Svetlik, M A

1989-01-01

The relationship between the average cost of home health care and the case mix of patients served by the home health agency is investigated using 1983 data from Wisconsin's home health care agencies. In contrast to previous work, case mix is shown to have a significant effect on the home health agency's average costs. The methods used in the previous work are evaluated, and differences between the earlier study and the present study are discussed to explain the divergent results. Also, average costs are shown to decrease with output, to increase with the proportion of private patients served by the agency, and to be higher if the home health agency is located in an urban area or if it has a proprietary charter. The implications of this research for the design of an appropriate home health reimbursement policy are discussed. Primarily, it is argued that, although future research might confirm the relationship between average costs and case mix for home health agencies, we cannot necessarily conclude that reimbursement rates must be adjusted to account for differences in case mix as many States are now doing for nursing home reimbursement. Policies must take into account the fundamental differences between home health agencies and nursing homes, and their respective markets, in order to be effective. PMID:2502804

Impacts of the type of social health insurance on health service utilisation and expenditures: implications for a unified system in China.

PubMed

Tan, Si Ying; Wu, Xun; Yang, Wei

2018-05-08

While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model. Our results show that Urban Employee Medical Insurance, which offers the most generous benefits, incurs the highest total costs prior to reimbursement when compared to other SHI schemes. Our analysis also shows that utilisation of SHI did not show significant reduction in out-of-pocket payments for outpatients. We argue that, unless effective measures are introduced to deal with perverse provider payment incentives, the move towards a unified system with more generous benefits may usher in a new wave of cost escalation for health care systems in China.

Daily variation in natural disaster casualties: information flows, safety, and opportunity costs in tornado versus hurricane strikes.

PubMed

Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

2013-07-01

Casualties from natural disasters may depend on the day of the week they strike. With data from the Spatial Hazard Events and Losses Database for the United States (SHELDUS), daily variation in hurricane and tornado casualties from 5,043 tornado and 2,455 hurricane time/place events is analyzed. Hurricane forecasts provide at-risk populations with considerable lead time. Such lead time allows strategic behavior in choosing protective measures under hurricane threat; opportunity costs in terms of lost income are higher during weekdays than during weekends. On the other hand, the lead time provided by tornadoes is near zero; hence tornados generate no opportunity costs. Tornado casualties are related to risk information flows, which are higher during workdays than during leisure periods, and are related to sheltering-in-place opportunities, which are better in permanent buildings like businesses and schools. Consistent with theoretical expectations, random effects negative binomial regression results indicate that tornado events occurring on the workdays of Monday through Thursday are significantly less lethal than tornados that occur on weekends. In direct contrast, and also consistent with theory, the expected count of hurricane casualties increases significantly with weekday occurrences. The policy implications of observed daily variation in tornado and hurricane events are considered. © 2012 Society for Risk Analysis.

Socioeconomic differences in the cost, availability and quality of healthy food in Sydney.

PubMed

Crawford, Belinda; Byun, Roy; Mitchell, Emily; Thompson, Susan; Jalaludin, Bin; Torvaldsen, Siranda

2017-12-01

To compare the cost of a basket of staple foods, together with the availability and quality of fresh fruit and vegetables, by supermarket store type in high and low socioeconomic suburbs of Sydney. A food basket survey was undertaken in 100 supermarkets in the 20 highest and 20 lowest socioeconomic suburbs of Sydney. We assessed the cost of 46 foods, the range of 30 fresh fruit and vegetables and the quality of ten fresh fruit and vegetables. Two major supermarket retailers, a discount supermarket chain and independent grocery stores were surveyed. The food basket was significantly cheaper in low compared to high socioeconomic suburbs ($177 vs $189, p<0.01). Discount supermarkets were at least 30% cheaper than other supermarket stores. There were fewer varieties and poorer quality fruit and vegetables in stores in low socioeconomic suburbs. Food basket prices and the availability and quality of fruit and vegetables varied significantly by store type and socioeconomic status of suburb. Implications for public health: A nationwide food and nutrition surveillance system is required to inform public health policy and practice initiatives. In addition to the food retail environment, these initiatives must address the underlying contributors to inequity and food insecurity for disadvantaged groups. © 2017 The Authors.

Cognitive Constraints and Island Effects

PubMed Central

Hofmeister, Philip; Sag, Ivan A.

2012-01-01

Competence-based theories of island effects play a central role in generative grammar, yet the graded nature of many syntactic islands has never been properly accounted for. Categorical syntactic accounts of island effects have persisted in spite of a wealth of data suggesting that island effects are not categorical in nature and that non-structural manipulations that leave island structures intact can radically alter judgments of island violations. We argue here, building on work by Deane, Kluender, and others, that processing factors have the potential to account for this otherwise unexplained variation in acceptability judgments. We report the results of self-paced reading experiments and controlled acceptability studies which explore the relationship between processing costs and judgments of acceptability. In each of the three self-paced reading studies, the data indicate that the processing cost of different types of island violations can be significantly reduced to a degree comparable to that of non-island filler-gap constructions by manipulating a single non-structural factor. Moreover, this reduction in processing cost is accompanied by significant improvements in acceptability. This evidence favors the hypothesis that island-violating constructions involve numerous processing pressures that aggregate to drive processing difficulty above a threshold so that a perception of unacceptability ensues. We examine the implications of these findings for the grammar of filler-gap dependencies.* PMID:22661792

Indirect Costs SEA-LEA Workshop. Report of Workshop Conducted by Upper Midwest Regional Interstate Project. (Chicago, Illinois, January 17-18, 1973).

ERIC Educational Resources Information Center

Shanks, Robb L., Comp.

The Policy Committee of the Upper Midwest Regional Interstate Project saw a need to inform the State Education Agencies (SEAs) concerning the implications of federal program indirect costs. The Indirect Cost Workshop was established to develop communication concerning the problems between the United States Office of Education (USOE), SEAs, and…

The Cost-Effectiveness of Undergraduate Education at Private Nondoctoral Colleges and Universities: Implications for Students and Public Policy

ERIC Educational Resources Information Center

Zumeta, William; Huntington-Klein, Nick

2015-01-01

This study examines key aspects of the cost-effectiveness of private nondoctoral (PND) colleges as providers of baccalaureate degrees and explores how states might feasibly make better use of these colleges to produce more degrees efficiently. The study looks at degree production and cost in the PND sector relative to other higher education…

Care and Feeding of the Money Tree: Pricing and Financial Aid Strategies and Their Market Implications at Private Colleges and Universities.

ERIC Educational Resources Information Center

Zuker, Fred

2000-01-01

Considers the dilemma of higher priced college attendance from the viewpoint of private institutions. Identifies and discusses factors currently driving increase in tuition costs and also factors likely to influence relative cost in the next ten years. This discussion includes both increasing and decreasing cost factors. (VWC)

Cost-effectiveness and resource implications of aggressive action on TB in China, India and South Africa: a combined analysis of nine models

PubMed Central

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein MGJ; Kimerling, Michael E; White, Richard G; Vassall, Anna

2017-01-01

BACKGROUND The End TB Strategy sets global goals of reducing TB incidence and mortality by 50% and 75% respectively by 2025. We assessed resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. METHODS We examined intervention scenarios developed in consultation with country stakeholders, which scaled-up existing interventions to high but feasible coverage by 2025. Nine independent TB modelling groups collaborated to estimate policy outcomes, and we costed each scenario by synthesizing service utilization estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health impact and resource implications for 2016–2035, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios to a base case representing continued current practice. FINDINGS Incremental TB service costs differed by scenario and country, and in some cases more than doubled current funding needs. In general, expanding TB services substantially reduced patient-incurred costs; and in India and China this produced net cost-savings for most interventions under a societal perspective. In all countries, expanding TB care access produced substantial health gains. Compared to current practice, most intervention approaches appeared highly cost-effective when compared to conventional cost-effectiveness thresholds. INTERPRETATION Expanding TB services appears cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, though funding needs challenge affordability. Further work is required to determine the optimal intervention mix for each country. PMID:27720689

Cost-effectiveness of preoperative biliary drainage for obstructive jaundice in pancreatic and periampullary cancer

PubMed Central

Morris, Stephen; Gurusamy, Kurinchi S.; Sheringham, Jessica; Davidson, Brian R.

2015-01-01

Background A recent Cochrane Review found that preoperative biliary drainage (PBD) in patients with resectable pancreatic and periampullary cancer undergoing surgery for obstructive jaundice is associated with similar mortality but increased serious morbidity compared with no PBD. Despite this clinical evidence of its lack of effectiveness, PBD is still in use. We considered the economic implications of PBD versus direct surgery for obstructive jaundice in patients with pancreatic and periampullary cancer. Materials and methods Model-based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service over a 6-month time horizon. A decision tree model was constructed and populated with probabilities, outcomes, and cost data from published sources. One-way and probabilistic sensitivity analyses were undertaken. Results PBD was more costly than direct surgery (mean cost per patient £10,775 [$15,616] versus £8221 [$11,914]) and produced fewer QALYs (mean QALYs per patient 0.337 versus 0.343). Not performing PBD would result in cost savings of approximately £2500 ($3623) per patient to the National Health Service. PBD had <10% probability of being cost-effective at a maximum willingness to pay for a QALY of £20,000 ($28,986) to £30,000 ($43,478). Conclusions There are significant cost savings to be gained by avoiding routine PBD in patients with resectable pancreatic and periampullary cancer where PBD is still routinely used in this context; this economic evidence should be used to support the clinical argument for a change in practice. PMID:25172090

Value analysis of postoperative staging imaging for asymptomatic, early-stage breast cancer: implications of clinical variation on utility and cost.

PubMed

Pellet, Andrew C; Erten, Mujde Z; James, Ted A

2016-06-01

Routine staging imaging for early-stage breast cancer is not recommended. Despite this, there is clinical practice variation with imaging studies obtained for asymptomatic patients with a positive sentinel node (SN+). We characterize the utility, cost, and clinical implications of imaging studies obtained in asymptomatic SN+ patients. A retrospective review was performed of asymptomatic, clinically node-negative patients who were found to have a positive sentinel node after surgery. The type of imaging, subsequent tests/interventions, frequency of additional malignancy detected, and costs were recorded. From April 2009 to April 2013, a total of 50 of 113 (44%) asymptomatic patients underwent staging imaging for a positive sentinel node; 11 (22%) patients had at least 1 subsequent imaging study or diagnostic intervention. No instance of metastatic breast cancer was identified, with a total cost of imaging calculated at $116,905. Staging imaging for asymptomatic SN+ breast cancer demonstrates clinical variation. These tests were associated with low utility, increased costs, and frequent false positives leading to subsequent testing/intervention. Evidence-based standardization may help increase quality by decreasing unnecessary variation and cost. Copyright © 2015 Elsevier Inc. All rights reserved.

Exploring the market for third-party-owned residential photovoltaic systems: insights from lease and power-purchase agreement contract structures and costs in California

DOE PAGES

Davidson, Carolyn; Steinberg, Daniel; Margolis, Robert

2015-02-04

We report that over the past several years, third-party-ownership (TPO) structures for residential photovoltaic (PV) systems have become the predominant ownership model in the US residential market. Under a TPO contract, the PV system host typically makes payments to the third-party owner of the system. Anecdotal evidence suggests that the total TPO contract payments made by the customer can differ significantly from payments in which the system host directly purchases the system. Furthermore, payments can vary depending on TPO contract structure. To date, a paucity of data on TPO contracts has precluded studies evaluating trends in TPO contract cost. Thismore » study relies on a sample of 1113 contracts for residential PV systems installed in 2010–2012 under the California Solar Initiative to evaluate how the timing of payments under a TPO contract impacts the ultimate cost of the system to the customer. Furthermore, we evaluate how the total cost of TPO systems to customers has changed through time, and the degree to which contract costs have tracked trends in the installed costs of a PV system. We find that the structure of the contract and the timing of the payments have financial implications for the customer: (1) power-purchase contracts, on average, cost more than leases, (2) no-money-down contracts are more costly than prepaid contracts, assuming a customer's discount rate is lower than 17% and (3) contracts that include escalator clauses cost more, for both power-purchase agreements and leases, at most plausible discount rates. Additionally, all contract costs exhibit a wide range, and do not parallel trends in installed costs over time.« less

Exploring the market for third-party-owned residential photovoltaic systems: insights from lease and power-purchase agreement contract structures and costs in California

NASA Astrophysics Data System (ADS)

Davidson, Carolyn; Steinberg, Daniel; Margolis, Robert

2015-02-01

Over the past several years, third-party-ownership (TPO) structures for residential photovoltaic (PV) systems have become the predominant ownership model in the US residential market. Under a TPO contract, the PV system host typically makes payments to the third-party owner of the system. Anecdotal evidence suggests that the total TPO contract payments made by the customer can differ significantly from payments in which the system host directly purchases the system. Furthermore, payments can vary depending on TPO contract structure. To date, a paucity of data on TPO contracts has precluded studies evaluating trends in TPO contract cost. This study relies on a sample of 1113 contracts for residential PV systems installed in 2010-2012 under the California Solar Initiative to evaluate how the timing of payments under a TPO contract impacts the ultimate cost of the system to the customer. Furthermore, we evaluate how the total cost of TPO systems to customers has changed through time, and the degree to which contract costs have tracked trends in the installed costs of a PV system. We find that the structure of the contract and the timing of the payments have financial implications for the customer: (1) power-purchase contracts, on average, cost more than leases, (2) no-money-down contracts are more costly than prepaid contracts, assuming a customer’s discount rate is lower than 17% and (3) contracts that include escalator clauses cost more, for both power-purchase agreements and leases, at most plausible discount rates. In addition, all contract costs exhibit a wide range, and do not parallel trends in installed costs over time.

Exploring the market for third-party-owned residential photovoltaic systems: insights from lease and power-purchase agreement contract structures and costs in California

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

Davidson, Carolyn; Steinberg, Daniel; Margolis, Robert

We report that over the past several years, third-party-ownership (TPO) structures for residential photovoltaic (PV) systems have become the predominant ownership model in the US residential market. Under a TPO contract, the PV system host typically makes payments to the third-party owner of the system. Anecdotal evidence suggests that the total TPO contract payments made by the customer can differ significantly from payments in which the system host directly purchases the system. Furthermore, payments can vary depending on TPO contract structure. To date, a paucity of data on TPO contracts has precluded studies evaluating trends in TPO contract cost. Thismore » study relies on a sample of 1113 contracts for residential PV systems installed in 2010–2012 under the California Solar Initiative to evaluate how the timing of payments under a TPO contract impacts the ultimate cost of the system to the customer. Furthermore, we evaluate how the total cost of TPO systems to customers has changed through time, and the degree to which contract costs have tracked trends in the installed costs of a PV system. We find that the structure of the contract and the timing of the payments have financial implications for the customer: (1) power-purchase contracts, on average, cost more than leases, (2) no-money-down contracts are more costly than prepaid contracts, assuming a customer's discount rate is lower than 17% and (3) contracts that include escalator clauses cost more, for both power-purchase agreements and leases, at most plausible discount rates. Additionally, all contract costs exhibit a wide range, and do not parallel trends in installed costs over time.« less

The real world cost and health resource utilization associated to manic episodes: The MANACOR study.

PubMed

Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnín, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduard

2015-01-01

Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables. Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations. One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost. Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Cost analysis of cetuximab (Erbitux) plus radiotherapy (ERT) versus concomitant cisplatin plus radiotherapy (CRT) within an NHS oncology unit (single institution): a pilot study

PubMed Central

Sundus, Yahya; Dawn, Dawson; Carol, Glaister; Susan, Merrick

2016-01-01

Objective: The aim of this feasibility study is to define the resource effectiveness of cetuximab vs cisplatin given concomitantly with radiotherapy for squamous cell carcinoma within a National Health Service clinical oncology unit. Methods: 20 patients with Stage 3 or 4 head and neck squamous cell cancers were randomized to receive either cetuximab with radiotherapy (ERT) or cisplatin with radiotherapy concurrent with external beam radiotherapy 70 Gy in 35 fractions on a 1 : 1 basis over a 12-month duration. The study compared the resource utilization of ERT vs cisplatin with radiotherapy taking into account drug costs, clinical management and the costs of managing treatment-related toxicity from first fraction of radiotherapy to 6 months after the completion of therapy. Outcome measures were quality of life (recorded at the entry, end of radiotherapy, 6 weeks post treatment and 6 months post treatment), admissions to hospital, delays to radiotherapy, locoregional control and survival. Results: Total drug costs including cost of nutritional supplements for patients treated with cetuximab were £7407.45 compared with £3959.07 for patients treated with cisplatin. Unscheduled admissions for toxicity management were significantly more common in the ERT arm. Healthcare personnel spent significantly more time delivering unscheduled outpatient care for patients receiving cisplatin than for those receiving cetuximab (p = 0.01). No significant difference in the quality of life was suggested at baseline, 6 weeks and 6 months. The mean time to removal of percutaneous gastrostomy (PEG) after completion of radiotherapy was 49.7 weeks in the cisplatin arm and 18.5 weeks in the cetuximab arm (p = 0.04). There was a statistically significant difference in patient-reported use of PEG between the cisplatin and cetuximab arms at 6 months following completion of treatment (p = 0.04). At 21 months, overall survival was 80% in the cisplatin arm vs 50% in the cetuximab (p = 0.332), with disease-free survival being 80% in the cisplatin arm vs 40% in the cetuximab (p = 0.097). Conclusion: Cetuximab is still more expensive in simple drug cost terms than cisplatin when delivered with radiotherapy taking into account costs of drugs for toxicity management and nutritional supplements but other resource implications such as inpatient admission, time spent delivering unscheduled care and cost of additional investigations to manage toxicity for patients treated with cisplatin significantly reduce differential. The study suggested significant differences in patient-reported PEG use at 6 months and in time to PEG removal in favour of the cetuximab arm. Advances in knowledge: There is paucity of randomized data on cost analysis for cisplatin vs cetuximab radiotherapy; this trial informs on the cost analysis between the two approaches. PMID:27734748

Estimating The Cost of Work Rule Changes in Transit

DOT National Transportation Integrated Search

1984-06-01

In many transit labor negotiations, management and labor want to explore a variety of changes in work rules. A dozen or more changes may be desired in a typical negotiation. To assess the cost implications of these proposals, a complete schedule runc...

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

PubMed

Hillman, Lynne; Foster, Rhonda R

2011-01-01

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

Reforming the wastewater treatment sector in Italy: Implications of plant size, structure, and scale economies

NASA Astrophysics Data System (ADS)

Fraquelli, Giovanni; Giandrone, Roberto

2003-10-01

In the context of the restructuring of the water industry, this work examines the treatment processes of urban wastewaters in Italy, with reference to costs, size, and technology. The operating cost function of 103 plants confirms scope economies from vertical integration and strong economies of scale for the smaller structure, confirming the benefits coming from the aggregation of the existing little firms. A minimum efficient size at about 100,000 inhabitants, however, inhibits the creation of large monopolies at a local level and enables the maintenance of indirect competition. Among the explanatory variables of running costs, the pollution load of the input wastewater takes on a high statistical significance and suggests environmental prevention, while the strong impact of sludge concentration means it should be considered in the new tariff systems. The recent introduction of advanced treatments is expensive, but the costs are balanced by a notable improvement in the pureness of the effluent waters. As for general environmental policies, it is necessary to find a good compromise between the need to improve the effectiveness of the existing plants and the investments in areas where the water treatment service is still inexistent.

Process measures to improve perioperative prophylactic antibiotic compliance: quality and financial implications.

PubMed

Sutherland, Tori; Beloff, Jennifer; Lightowler, Marie; Liu, Xiaoxia; Nascimben, Luigino; Urman, Richard D

2014-01-01

The Surgical Care Improvement Project (SCIP) was launched in 2005. The core prophylactic perioperative antibiotic guidelines were created because of recognition of the impact of proper perioperative prophylaxis on an estimated annual 1 million inpatient days and $1.6 billion in excess health care costs that are secondary to preventable surgical site infections. There is a need to create low-cost, standardized processes on an institutional level to improve compliance with prophylactic antibiotic administration. The impact of interventions on provider compliance with SCIP inpatient antibiotic guidelines and net financial gain or loss to a large tertiary center were assessed. A single hospital was able to significantly improve their SCIP compliance and emphasis on patient safety within a year of intervention implementation. The hospital earned an additional $290,612 in 2011 and $209,096 in 2012 for reinvestment in patient safety initiatives. Low-cost interventions aimed at educating providers that utilize existing infrastructure result in improved SCIP compliance and patient safety. As a secondary gain, there were hundreds of thousands of dollars in annual cost savings. The impact of compliance on infection rates is inferred but requires further study.

Software forecasting as it is really done: A study of JPL software engineers

NASA Technical Reports Server (NTRS)

Griesel, Martha Ann; Hihn, Jairus M.; Bruno, Kristin J.; Fouser, Thomas J.; Tausworthe, Robert C.

1993-01-01

This paper presents a summary of the results to date of a Jet Propulsion Laboratory internally funded research task to study the costing process and parameters used by internally recognized software cost estimating experts. Protocol Analysis and Markov process modeling were used to capture software engineer's forecasting mental models. While there is significant variation between the mental models that were studied, it was nevertheless possible to identify a core set of cost forecasting activities, and it was also found that the mental models cluster around three forecasting techniques. Further partitioning of the mental models revealed clustering of activities, that is very suggestive of a forecasting lifecycle. The different forecasting methods identified were based on the use of multiple-decomposition steps or multiple forecasting steps. The multiple forecasting steps involved either forecasting software size or an additional effort forecast. Virtually no subject used risk reduction steps in combination. The results of the analysis include: the identification of a core set of well defined costing activities, a proposed software forecasting life cycle, and the identification of several basic software forecasting mental models. The paper concludes with a discussion of the implications of the results for current individual and institutional practices.

Neck hematoma after major head and neck surgery: Risk factors, costs, and resource utilization.

PubMed

Shah-Becker, Shivani; Greenleaf, Erin K; Boltz, Melissa M; Hollenbeak, Christopher S; Goyal, Neerav

2018-06-01

Postoperative cervical hematoma after major head and neck surgery is a feared complication. However, risk factors for developing this complication and attributable costs are not well-established. The Nationwide Inpatient Sample database was utilized compare patients with and without postoperative cervical hematoma. Logistic regression was used to analyze risk factors for hematoma formation and 30-day mortality. Total inpatient length of stay (LOS) and costs were fit to generalized linear models. Of 32 071 patients, 1098 (3.4%) experienced a postoperative cervical hematoma. Male sex (odds ratio [OR] 1.38; P < .0001), black race (OR 1.35; P = .010), 4 or more comorbidities (OR 1.66; P < .0001), or presence of a preoperative coagulopathy (OR 6.76; P < .0001) were associated. Postoperative cervical hematoma was associated with 540% increased odds of death (P < .0001). The LOS and total excess costs were 5.14 days (P < .0001) and $17 887.40 (P < .0001), respectively. Although uncommon, postoperative cervical hematoma is a life-threatening complication of head and neck surgery with significant implications for outcomes and resource utilization. © 2018 Wiley Periodicals, Inc.

Risk assessment in mental health care: values and costs.

PubMed

Szmukler, George; Rose, Nikolas

2013-01-01

Risk assessment has assumed increasing salience in mental health care in a number of countries. The frequency of serious violent incidents perpetrated by people with a mental illness is an insufficient explanation. Understandings of mental illness and of the role of those charged with their care (or control) play a key role. "Moral outrage", associated with an implied culpability when certain types of tragedy occur, is very significant. This leads to tensions concerning the role of post-incident inquiries, and contributes to a flawed conception of what such inquiries can offer. At the same time, understanding of probability and prediction is generally very poor, among both professionals and the public. Unrealistic expectations for risk assessment and management in general psychiatric practice carry a variety of significant costs, taking a number forms, to those with a mental illness, to mental health professionals and to services. Especially important are changes in professional practice and accountabilities that are significantly divorced from traditional practice, implications for trust in patient-clinician relationships and the organisations in which mental health professionals work, and practices that often breach the ethical principle of justice (or fairness) and heighten discrimination against people with mental illness. Copyright © 2013 John Wiley & Sons, Ltd.

Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability

PubMed Central

Daviaud, Emmanuelle; Besada, Donnela; Leon, Natalie; Rohde, Sarah; Sanders, David; Oliphant, Nicholas; Doherty, Tanya

2017-01-01

Background Sub–Saharan Africa still reports the highest rates of under–five mortality. Low cost, high impact interventions exist, however poor access remains a challenge. Integrated community case management (iCCM) was introduced to improve access to essential services for children 2–59 months through diagnosis, treatment and referral services by community health workers for malaria, pneumonia and diarrhea. This paper presents the results of an economic analysis of iCCM implementation in regions supported by UNICEF in six countries and assesses country–level scale–up implications. The paper focuses on costs to provider (health system and donors) to inform planning and budgeting, and does not cover cost–effectiveness. Methods The analysis combines annualised set–up costs and 1 year implementation costs to calculate incremental economic and financial costs per treatment from a provider perspective. Affordability is assessed by calculating the per capita financial cost of the program as a percentage of the public health expenditure per capita. Time and financial implications of a 30% increase in utilization were modeled. Country scale–up is modeled for all children under 5 in rural areas. Results Utilization of iCCM services varied from 0.05 treatment/y/under–five in Ethiopia to over 1 in Niger. There were between 10 and 603 treatments/community health worker (CHW)/y. Consultation cost represented between 93% and 22% of economic costs per treatment influenced by the level of utilization. Weighted economic cost per treatment ranged from US$ 13 (2015 USD) in Ghana to US$ 2 in Malawi. CHWs spent from 1 to 9 hours a week on iCCM. A 30% increase in utilization would add up to 2 hours a week, but reduce cost per treatment (by 20% in countries with low utilization). Country scale up would amount to under US$ 0.8 per capita total population (US$ 0.06–US$0.74), between 0.5% and 2% of public health expenditure per capita but 8% in Niger. Conclusions iCCM addresses unmet needs and impacts on under 5 mortality. An economic cost of under US$ 1/capita/y represents a sound investment. Utilization remains low however, and strategies must be developed as a priority to improve demand. Continued donor support is required to sustain iCCM services and strengthen its integration within national health systems. PMID:28702174

Cost-Reduction Roadmap for Residential Solar Photovoltaics (PV), 2017-2030

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

Cook, Jeffrey J.; Ardani, Kristen B.; Margolis, Robert M.

The installed cost of solar photovoltaics (PV) has fallen rapidly in recent years and is expected to continue declining in the future. In this report, we focus on the potential for continued PV cost reductions in the residential market. From 2010 to 2017, the levelized cost of energy (LCOE) for residential PV declined from 52 cents per kilowatt-hour (cents/kWh) to 16 cents/kWh (Fu et al. 2017). The U.S. Department of Energy's (DOE's) Solar Energy Technologies Office (SETO) recently set new LCOE targets for 2030, including a target of 5 cents/kWh for residential PV. We present a roadmap for achieving themore » SETO 2030 residential PV target. Because the 2030 target likely will not be achieved under business-as-usual trends (NREL 2017), we examine two key market segments that demonstrate significant opportunities for cost savings and market growth: installing PV at the time of roof replacement and installing PV as part of the new home construction process. Within both market segments, we identify four key cost-reduction opportunities: market maturation, business model integration, product innovation, and economies of scale. To assess the potential impact of these cost reductions, we compare modeled residential PV system prices in 2030 to the National Renewable Energy Laboratory's (NREL's) quarter one 2017 (Q1 2017) residential PV system price benchmark (Fu et al. 2017). We use a bottom-up accounting framework to model all component and project-development costs incurred when installing a PV system. The result is a granular accounting for 11 direct and indirect costs associated with installing a residential PV system in 2030. All four modeled pathways demonstrate significant installed-system price savings over the Q1 2017 benchmark, with the visionary pathways yielding the greatest price benefits. The largest modeled cost savings are in the supply chain, sales and marketing, overhead, and installation labor cost categories. When we translate these installed-system costs into LCOE, we find that the less-aggressive pathways achieve significant cost reductions, but may not achieve the 2030 LCOE target. On the other hand, both visionary pathways could get very close to (for roof replacement) or achieve (for new construction) the 2030 target. Our analysis has two key implications. First, because installed-system soft cost reductions account for about 65 percent of the LCOE reductions in 2030 for both visionary pathways, residential PV stakeholders may need to emphasize these soft cost reductions to achieve the 2030 target. Second, capturing these savings will likely require considerable innovation in the technologies and business practices employed by the PV industry.« less

Modal shifts in short-haul passenger travel and the consequent energy impacts. [Intercity travel under 500 miles

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

Not Available

1980-03-01

A study was performed to evaluate the impacts of strategies to effect modal shifts in short-haul passenger travel (defined herein as intercity travel under 500 miles) from energy-intensive modes to those modes that are less energy-intensive. A series of individual strategies, ranging from incentives to the less energy-intensive modes (bus, rail) to penalties to the more energy-intensive modes (auto, air) was examined to determine energy saved and policy implications relative to strategy implementation. The most effective of the individual strategies were then combined in all permutations, and the analysis was repeated. As part of the analytical process, effects of factorsmore » other than energy (user cost and time, emissions, government subsidy, and travel fatailities) were examined in a benefit/cost analysis. Finally, energy savings, benefit/cost impacts, implementation considerations, and policy implications were evaluated to arrive at conclusions as to the effectiveness of the more-influential strategies and to the overall effectiveness of induced modal shifts. The principal conclusion of the study is that the maximum 1980 energy saving that might be realized by modal shifts, discounting the concurrent effects of demand suppression and improvement of mode efficiency, is approximately 83 x 10/sup 12/ Btu (46,500 bbl gasoline per day), 3.8% of the total projected 1980 energy consumption in the short-haul transportation sector and 0.23% of the total US petroleum use. It was also concluded that strategies to achieve these small savings by modal shifts would result in significant economic, social, and business disruptions.« less

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:24810593

Diagnostic accuracy and cost-effectiveness of alternative methods for detection of soil-transmitted helminths in a post-treatment setting in western Kenya.

PubMed

Assefa, Liya M; Crellen, Thomas; Kepha, Stella; Kihara, Jimmy H; Njenga, Sammy M; Pullan, Rachel L; Brooker, Simon J

2014-05-01

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. 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. 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. 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.

Dual Task of Fine Motor Skill and Problem Solving in Individuals With Multiple Sclerosis: A Pilot Study.

PubMed

Goverover, Y; Sandroff, B M; DeLuca, J

2018-04-01

To (1) examine and compare dual-task performance in patients with multiple sclerosis (MS) and healthy controls (HCs) using mathematical problem-solving questions that included an everyday competence component while performing an upper extremity fine motor task; and (2) examine whether difficulties in dual-task performance are associated with problems in performing an everyday internet task. Pilot study, mixed-design with both a within and between subjects' factor. A nonprofit rehabilitation research institution and the community. Participants (N=38) included persons with MS (n=19) and HCs (n=19) who were recruited from a nonprofit rehabilitation research institution and from the community. Not applicable. Participant were presented with 2 testing conditions: (1) solving mathematical everyday problems or placing bolts into divots (single-task condition); and (2) solving problems while putting bolts into divots (dual-task condition). Additionally, participants were required to perform a test of everyday internet competence. As expected, dual-task performance was significantly worse than either of the single-task tasks (ie, number of bolts into divots or correct answers, and time to answer the questions). Cognitive but not motor dual-task cost was associated with worse performance in activities of everyday internet tasks. Cognitive dual-task cost is significantly associated with worse performance of everyday technology. This was not observed in the motor dual-task cost. The implications of dual-task costs on everyday activity are discussed. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Photosynthesis in reproductive structures: costs and benefits

PubMed Central

Raven, John A.; Griffiths, Howard

2015-01-01

The role of photosynthesis by reproductive structures during grain-filling has important implications for cereal breeding, but the methods for assessing the contribution by reproductive structures to grain-filling are invasive and prone to compensatory changes elsewhere in the plant. A technique analysing the natural abundance of stable carbon isotopes in soluble carbohydrates has significant promise. However, it depends crucially on there being no more than two sources of organic carbon (leaf and ear/awn), with significantly different 13C:12C ratios and no secondary fractionation during grain-filling. The role of additional peduncle carbohydrate reserves represents a potential means for N remobilization, as well as for hydraulic continuity during grain-filling. The natural abundance of the stable isotopes of carbon and oxygen are also useful for exploring the influence of reproduction on whole plant carbon and water relations and have been used to examine the resource costs of reproduction in females and males of dioecious plants. Photosynthesis in reproductive structures is widespread among oxygenic photosynthetic organisms, including many clades of algae and embryophytes of different levels of complexity. The possible evolutionary benefits of photosynthesis in reproductive structures include decreasing the carbon cost of reproduction and ‘use’ of transpiratory loss of water to deliver phloem-immobile calcium Ca2+ and silicon [Si(OH)4] via the xylem. The possible costs of photosynthesis in reproductive structures are increasing damage to DNA from photosynthetically active, and hence UV-B, radiation and the production of reactive oxygen species. PMID:25871648

The cost and effectiveness of surfactant replacement therapy at Johannesburg Hospital, November 1991-December 1992.

PubMed

Davies, V A; Ballot, D E; Rothberg, A D

1995-07-01

To assess the impact of surfactant replacement therapy (SRT) on the outcome of hyaline membrane disease (HMD) and to assess the cost implications of a policy of selective administration of artificial surfactant. The short-term outcome of 103 newborns ventilated for HMD (61 selected for SRT according to initial and/or ongoing oxygen requirements) was compared with that of a historical control group of 173 infants ventilated for HMD before the introduction of SRT. Mortality and morbidity of HMD including death, bronchopulmonary dysplasia, pneumothorax, pulmonary haemorrhage, patent ductus arteriosus and intraventricular haemorrhage. There were significant demographic differences between the treatment and control groups (black patients 74% v. 28%, P < 0.0001; unbooked mothers 72% v. 15%, P < 0.0001) as well as evidence of more severe lung disease in the treatment group (pressor support 44% v. 27%, P < 0.005; and paralysis during ventilation 38% v. 25%, P < 0.005). Pneumothorax was reduced in the SRT group (7% v. 17%, P < 0.01). There were no significant differences between the two groups in the incidence of BPD or mortality. The use of SRT added to the total cost of treating a patient ventilated for HMD. The selective use of SRT had the effect of converting severe disease into moderate disease rather than achieving maximal benefit in all cases of HMD through routine use of the product. A policy of restricting use may result in cost savings where resources are limited.

Financial Impact of Liver Sharing and Organ Procurement Organizations' Experience With Share 35: Implications for National Broader Sharing.

PubMed

Fernandez, H; Weber, J; Barnes, K; Wright, L; Levy, M

2016-01-01

The Share 35 policy for organ allocation, which was adopted in June 2013, allocates livers regionally for candidates with Model for End-Stage Liver Disease scores of 35 or greater. The authors analyzed the costs resulting from the increased movement of allografts related to this new policy. Using a sample of nine organ procurement organizations, representing 17% of the US population and 19% of the deceased donors in 2013, data were obtained on import and export costs before Share 35 implementation (June 15, 2012, to June 14, 2013) and after Share 35 implementation (June 15, 2013, to June 14, 2014). Results showed that liver import rates increased 42%, with an increased cost of 51%, while export rates increased 112%, with an increased cost of 127%. When the costs of importing and exporting allografts were combined, the total change in costs for all nine organ procurement organizations was $11 011 321 after Share 35 implementation. Extrapolating these costs nationally resulted in an increased yearly cost of $68 820 756 by population or $55 056 605 by number of organ donors. Any alternative allocation proposal needs to account for the financial implications to the transplant infrastructure. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Commercialisation and entrepreneurialism in maternity.

PubMed

Mander, Rosemary

2011-08-01

against an international background, to examine the implications of private sector activity for maternity care in the United Kingdom National Health Service (UK NHS). the private sector and commercial or entrepreneurial activity in maternity services have attracted limited attention in the UK compared with, for e.g., Greece and the Irish Republic. discursive paper. despite rhetoric to the contrary, financial costs have always featured in the UK NHS. Financial payments in maternity have increased gradually. Commercial and entrepreneurial activity in maternity now includes 'entertainment ultrasound', reflecting a greater hegemonic imbalance. The commercialisation of maternity raises organisational, professional, quality-related and systematic issues, which all carry implications for the childbearing woman. the childbearing woman shoulders financial costs, whose origins and implications matter to both midwife and woman. The mixed benefits of medical investigations deserve closer attention. Copyright © 2011 Elsevier Ltd. All rights reserved.

Surgeon volume for percutaneous nephrolithotomy is associated with medical costs and length of hospital stay: a nationwide population-based study in Taiwan.

PubMed

Huang, Wei-Yi; Wu, Shiao-Chi; Chen, Yu-Fen; Lan, Chung-Fu; Hsieh, Ju-Ton; Huang, Kuo-How

2014-08-01

To investigate the factors associated with outcomes and medical costs for percutaneous nephrolithotomy (PCNL). The present study uses a subset of the National Health Insurance Research Database (NHIRD), known as the Longitudinal Health Insurance Database 2005 (LHID 2005), which contains the data of all medical benefit claims from 1997 to 2010 for a subset of 1 million enrollees randomly drawn from the population of 22.72 million persons who were enrolled in 2005. The claims data for all subjects with a diagnosis of urolithiasis who underwent PCNL were analyzed. Hospital and surgeon case volume were classified by quartile. The correlations of all patient, surgeon, and hospital variables with the outcomes and medical costs of PCNL were analyzed by generalized estimating equations. A total of 995 subjects received PCNL. In univariate analysis, PCNL performed by high-volume surgeons (≥12) cost 26% less ($2684 vs $1986) and resulted in a 34.3% shorter hospital stay (6.5 vs 9.9 days) compared with low-volume surgeons (≤3). In multivariate analysis, surgeon volume was a significant predictor for medical cost, length of stay, and intensive care unit transfer but not complications and mortality. Surgeon volume was associated with lower medical costs and shorter length of stay after PCNL. Surgeon volume, however, was not an independent predictor of complications and mortality. Our findings have important implications for urologists and policymakers with regard to the cost and effectiveness of PCNL.

Medical technology as a key driver of rising health expenditure: disentangling the relationship

PubMed Central

Sorenson, Corinna; Drummond, Michael; Bhuiyan Khan, Beena

2013-01-01

Health care spending has risen steadily in most countries, becoming a concern for decision-makers worldwide. Commentators often point to new medical technology as the key driver for burgeoning expenditures. This paper critically appraises this conjecture, based on an analysis of the existing literature, with the aim of offering a more detailed and considered analysis of this relationship. Several databases were searched to identify relevant literature. Various categories of studies (eg, multivariate and cost-effectiveness analyses) were included to cover different perspectives, methodological approaches, and issues regarding the link between medical technology and costs. Selected articles were reviewed and relevant information was extracted into a standardized template and analyzed for key cross-cutting themes, ie, impact of technology on costs, factors influencing this relationship, and methodological challenges in measuring such linkages. A total of 86 studies were reviewed. The analysis suggests that the relationship between medical technology and spending is complex and often conflicting. Findings were frequently contingent on varying factors, such as the availability of other interventions, patient population, and the methodological approach employed. Moreover, the impact of technology on costs differed across technologies, in that some (eg, cancer drugs, invasive medical devices) had significant financial implications, while others were cost-neutral or cost-saving. In light of these issues, we argue that decision-makers and other commentators should extend their focus beyond costs solely to include consideration of whether medical technology results in better value in health care and broader socioeconomic benefits. PMID:23807855

The cost implications of an early versus delayed invasive strategy in Acute Coronary Syndromes: the TIMACS study.

PubMed

Bainey, Kevin R; Gafni, Amiram; Rao-Melacini, Purnima; Tong, Wesley; Steg, Philippe G; Faxon, David P; Lamy, Andre; Granger, Christopher B; Yusuf, Salim; Mehta, Shamir R

2014-06-01

The Timing of Intervention in Acute Coronary Syndromes (TIMACS) trial demonstrated that early invasive intervention (within 24 hours) was similar to a delayed approach (after 36 hours) overall but improved outcomes were seen in patients at high risk. However, the cost implications of an early versus delayed invasive strategy are unknown. A third-party perspective of direct cost was chosen and United States Medicare costs were calculated using average diagnosis related grouping (DRG) units. Direct medical costs included those of the index hospitalization (including clinical, procedural and hospital stay costs) as well as major adverse cardiac events during 6 months of follow-up. Sensitivity and sub-group analyses were performed. The average total cost per patient in the early intervention group was lower compared with the delayed intervention group (-$1170; 95% CI -$2542 to $202). From the bootstrap analysis (5000 replications), the early invasive approach was associated with both lower costs and better clinical outcomes regarding death/myocardial infarction (MI)/stroke in 95.1% of the cases (dominant strategy). In high-risk patients (GRACE score ≥141), the net reduction in cost was greatest (-$3720; 95% CI -$6270 to -$1170). Bootstrap analysis revealed 99.8% of cases were associated with both lower costs and better clinical outcomes (death/MI/stroke). We were unable to evaluate the effect of community care and investigations without hospitalization (office visits, non-invasive testing, etc). Medication costs were not captured. Indirect costs such as loss of productivity and family care were not included. An early invasive management strategy is as effective as a delayed approach and is likely to be less costly in most patients with acute coronary syndromes.

Cost Accounting Standards: An Overview of Compliance with These Complex Standards.

ERIC Educational Resources Information Center

Bruce, Janet D.

1993-01-01

A discussion of federal cost accounting standards (CAS) chronicles briefly the history of CAS, notes other pertinent regulations applicable to higher education, summarizes the initial standards drafted for colleges and universities, and examines disclosure statement requirements and implications of noncompliance. (MSE)

Government regulation and public opposition create high additional costs for field trials with GM crops in Switzerland.

PubMed

Bernauer, Thomas; Tribaldos, Theresa; Luginbühl, Carolin; Winzeler, Michael

2011-12-01

Field trials with GM crops are not only plant science experiments. They are also social experiments concerning the implications of government imposed regulatory constraints and public opposition for scientific activity. We assess these implications by estimating additional costs due to government regulation and public opposition in a recent set of field trials in Switzerland. We find that for every Euro spent on research, an additional 78 cents were spent on security, an additional 31 cents on biosafety, and an additional 17 cents on government regulatory supervision. Hence the total additional spending due to government regulation and public opposition was around 1.26 Euros for every Euro spent on the research per se. These estimates are conservative; they do not include additional costs that are hard to monetize (e.g. stakeholder information and dialogue activities, involvement of various government agencies). We conclude that further field experiments with GM crops in Switzerland are unlikely unless protected sites are set up to reduce these additional costs.

LANDSAT D user data processing study

NASA Technical Reports Server (NTRS)

1976-01-01

The major expected users of the LANDSAT D system and a preliminary system design of their required facilities are investigated. This system design will then be costed in order to provide an estimate of the incremental user costs necessitated by LANDSAT D. One major use of these cost estimates is as part of an overall economic cost/benefit argument being developed for the LANDSAT D system. The implication of this motive is key; the system design (and corresponding cost estimates) must be a credible one, but not necessarily an optimum one.

Mental Illness in Offender Populations: Prevalence, Duty and Implications

ERIC Educational Resources Information Center

Soderstrom, Irina R.

2007-01-01

Prisons are increasingly being filled with inmates who suffer from mental illness. This paper examines the prevalence of mental illness in American jails and prisons, the duty government and society has to provide appropriate mental health treatment, and the implications for inmate safety, costs, recidivism, and community reintegration if…

Tax Reform Implications for Rural Communities and Farmers.

ERIC Educational Resources Information Center

Durst, Ron L.; Reeder, Richard J.

1987-01-01

Discusses indirect and long-term rural implications of tax reform: elimination of local sales tax deduction, limits on local bond issues. Summarizes major tax changes affecting agriculture: individual income taxes, corporate tax rates, tax treatment of capital, capital gains, land deductions, cash accounting, development costs, passive losses and…

Financial Implications of Implementing an E-Learning Project

ERIC Educational Resources Information Center

Sharma, Kunal

2011-01-01

Purpose: This paper aims to outline the financial implications, while deploying information and communication technologies for implementing e-learning, and to elucidate them, while implementing an e-learning project in a conventional university environment. Design/methodology/approach: The paper is a descriptive account of the various cost factors…

Economic costs of Oxford House inpatient treatment and incarceration: a preliminary report.

PubMed

Olson, Bradley D; Viola, Judah; Jason, Leonard A; Davis, Margaret I; Ferrari, Joseph R; Rabin-Belyaev, Olga

2006-01-01

The Oxford House model for substance abuse recovery has potential economic advantages associated with the low cost of opening up and maintaining the settings. In the present study, annual program costs per person were estimated for Oxford House based on federal loan information and data collected from Oxford House Inc. In addition, annual treatment and incarceration costs were approximated based on participant data prior to Oxford House residence in conjunction with normative costs for these settings. Societal costs associated with the Oxford House program were relatively low, whereas estimated costs associated with inpatient and incarceration history were high. The implications of these findings are discussed.

Cost Comparison Model: Blended eLearning versus traditional training of community health workers

PubMed Central

Sissine, Mysha; Segan, Robert; Taylor, Mathew; Jefferson, Bobby; Borrelli, Alice; Koehler, Mohandas; Chelvayohan, Meena

2014-01-01

Objectives: Another one million community healthcare workers are needed to address the growing global population and increasing demand of health care services. This paper describes a cost comparison between two training approaches to better understand costs implications of training community health workers (CHWs) in Sub-Saharan Africa. Methods: Our team created a prospective model to forecast and compare the costs of two training methods as described in the Dalburge Report - (1) a traditional didactic training approach (“baseline”) and (2) a blended eLearning training approach (“blended”). After running the model for training 100,000 CHWs, we compared the results and scaled up those results to one million CHWs. Results: A substantial difference exists in total costs between the baseline and blended training programs. Results indicate that using a blended eLearning approach for training community health care workers could provide a total cost savings of 42%. Scaling the model to one million CHWs, the blended eLearning training approach reduces total costs by 25%. Discussion: The blended eLearning savings are a result of decreased classroom time, thereby reducing the costs associated with travel, trainers and classroom costs; and using a tablet with WiFi plus a feature phone rather than a smartphone with data plan. Conclusion: The results of this cost analysis indicate significant savings through using a blended eLearning approach in comparison to a traditional didactic method for CHW training by as much as 67%. These results correspond to the Dalberg publication which indicates that using a blended eLearning approach is an opportunity for closing the gap in training community health care workers. PMID:25598868

Comparison of seating, powered characteristics and functions and costs of electrically powered wheelchairs in a general population of users.

PubMed

Dolan, Michael John; Bolton, Megan Jennifer; Henderson, Graham Iain

2017-10-26

To profile and compare the seating and powered characteristics and functions of electrically powered wheelchairs (EPWs) in a general user population including equipment costs. Case notes of adult EPW users of a regional NHS service were reviewed retrospectively. Seating equipment complexity and type were categorized using the Edinburgh classification. Powered characteristics and functions, including control device type, were recorded. 482 cases were included; 53.9% female; mean duration EPW use 8.1 years (SD 7.4); rear wheel drive 88.0%; hand joystick 94.8%. Seating complexity: low 73.2%, medium 18.0%, high 8.7%. Most prevalent diagnoses: multiple sclerosis (MS) 25.3%, cerebral palsy (CP) 18.7%, muscular dystrophy (8.5%). Compared to CP users, MS users were significantly older at first use, less experienced, more likely to have mid-wheel drive and less complex seating. Additional costs for muscular dystrophy and spinal cord injury users were 3-4 times stroke users. This is the first large study of a general EPW user population using a seating classification. Significant differences were found between diagnostic groups; nevertheless, there was also high diversity within each group. The differences in provision and the equipment costs across diagnostic groups can be used to improve service planning. Implications for Rehabilitation At a service planning level, knowledge of a population's diagnostic group and age distribution can be used to inform decisions about the number of required EPWs and equipment costs. At a user level, purchasing decisions about powered characteristics and functions of EPWs and specialised seating equipment need to be taken on a case by case basis because of the diversity of users' needs within diagnostic groups. The additional equipment costs for SCI and MD users are several times those of stroke users and add between 60 and 70% of the cost of basic provision.

Implications of global budget payment system on nursing home costs.

PubMed

Di Giorgio, Laura; Filippini, Massimo; Masiero, Giuliano

2014-04-01

Pressure on health care systems due to the increasing expenditures of the elderly population is pushing policy makers to adopt new regulation and payment schemes for nursing home services. We consider the behavior of nonprofit nursing homes under different payment schemes and empirically investigate the implications of prospective payments on nursing home costs under tightly regulated quality aspects. To evaluate the impact of the policy change introduced in 2006 in Southern Switzerland - from retrospective to prospective payment - we use a panel of 41 homes observed over a 10-years period (2001-2010). We employ a fixed effects model with a time trend that is allowed to change after the policy reform. There is evidence that the new payment system slightly reduces costs without impacting quality. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

"Cost creep due to age creep" phenomenon: pattern analyses of in-patient hospitalization costs for various age brackets in the United States.

PubMed

Chinta, Ravi; Burns, David J; Manolis, Chris; Nighswander, Tristan

2013-01-01

The expectation that aging leads to a progressive deterioration of biological functions leading to higher healthcare costs is known as the healthcare cost creep due to age creep phenomenon. The authors empirically test the validity of this phenomenon in the context of hospitalization costs based on more than 8 million hospital inpatient records from 1,056 hospitals in the United States. The results question the existence of cost creep due to age creep after the age of 65 years as far as average hospitalization costs are concerned. The authors discuss implications for potential knowledge transfer for cost minimization and medical tourism.

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association.

PubMed

Dunbar, Sandra B; Khavjou, Olga A; Bakas, Tamilyn; Hunt, Gail; Kirch, Rebecca A; Leib, Alyssa R; Morrison, R Sean; Poehler, Diana C; Roger, Veronique L; Whitsel, Laurie P

2018-05-08

In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers. © 2018 American Heart Association, Inc.

Is there a business case for magnet hospitals? Estimates of the cost and revenue implications of becoming a magnet.

PubMed

Jayawardhana, Jayani; Welton, John M; Lindrooth, Richard C

2014-05-01

Although Magnet hospitals (MHs) are known for their better nursing care environments, little is known about whether MHs achieve this at a higher (lower) cost of health care or whether a superior nursing environment yields higher net patient revenue versus non-MHs over an extended period of time. To examine how achieving Magnet status is related to subsequent inpatient costs and revenues controlling for other hospital characteristics. Data from the American Hospital Association Annual Survey, Hospital Cost Reporting Information System reports collected by Centers for Medicare & Medicaid Services, and Magnet status of hospitals from American Nurses Credentialing Center from 1998 to 2006 were combined and used for the analysis. Descriptive statistics, propensity score matching, fixed-effect, and instrumental variable methods were used to analyze the data. Regression analyses revealed that MH status is positively and significantly associated with both inpatient costs and net inpatient revenues for both urban hospitals and all hospitals. MH status was associated with an increase of 2.46% in the inpatient costs and 3.89% in net inpatient revenue for all hospitals, and 2.1% and 3.2% for urban hospitals. Although it is costly for hospitals to attain Magnet status, the cost of becoming a MH may be offset by higher net inpatient income. On average, MHs receive an adjusted net increase in inpatient income of $104.22-$127.05 per discharge after becoming a Magnet which translates to an additional $1,229,770-$1,263,926 in income per year.

Evaluation of international recruitment of health professionals in England.

PubMed

Young, Ruth; Noble, Jenny; Mahon, Ann; Maxted, Mairead; Grant, Janet; Sibbald, Bonnie

2010-10-01

To explore whether a period of intensive international recruitment by the English National Health Service (NHS) achieved its objectives of boosting workforce numbers and to set this against the wider costs, longer-term challenges and questions arising. A postal survey of all pre-2006 NHS providers, Strategic Health Authorities and Deans of Postgraduate Medical Education obtained information on 284 (45%) organizations (142 completed questionnaires). Eight subsequent case studies (74 interviews) covered medical consultant, general practitioner, nurse, midwife and allied health professional recruitment. Most respondents had undertaken or facilitated international recruitment between 2001 and 2006 and believed that it had enabled them to address immediate staff shortages. Views on longer-term implications, such as recruit retention, were more equivocal. Most organizations had made only a limited value-for-money assessment, balancing direct expenditure on overseas recruitment against savings on temporary staff. Other short and long-term transaction and opportunity costs arose from pressures on existing staff, time spent on induction/pastoral support, and human resource management and workforce planning challenges. Though recognized, these extensive 'hidden costs' for NHS organizations were harder to assess as were the implications for source countries and migrant staff. The main achievement of the intensive international recruitment period from a UK viewpoint was that such a major undertaking was seen through without major disruption to NHS services. The wider costs and challenges meant, however, that large-scale international recruitment was not sustainable as a solution to workforce shortages. Should such approaches be attempted in future, a clearer upfront appraisal of all the potential costs and implications will be vital.

Cost Accounting Standards: Determining an Institution's Disclosure Requirements.

ERIC Educational Resources Information Center

Bruce, Janet D.

1995-01-01

This article discusses the implications of recently adopted U.S. Cost Accounting Standards (CAS) that apply to educational institutions that contract with or receive grants from the federal government. It focuses on the disclosure requirements that colleges and universities must follow to comply with CAS. (MDM)

Controlling Urban Air Pollution: A Benefit-Cost Assessment.

ERIC Educational Resources Information Center

Krupnick, Alan J.; Portney, Paul R.

1991-01-01

The pros and cons of air pollution control efforts are discussed. Both national and regional air pollution control plans are described. Topics of discussion include benefit-cost analysis, air quality regulation, reducing ozone in the urban areas, the Los Angeles plan, uncertainties, and policy implications. (KR)

Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.

PubMed

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-Chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein M G J; Kimerling, Michael E; White, Richard G; Vassall, Anna

2016-11-01

The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations.

PubMed

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2016-05-01

While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. © The Author(s) 2015.

Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya.

PubMed

Shretta, Rima; Johnson, Brittany; Smith, Lisa; Doumbia, Seydou; de Savigny, Don; Anupindi, Ravi; Yadav, Prashant

2015-02-05

Studies have shown that supply chain costs are a significant proportion of total programme costs. Nevertheless, the costs of delivering specific products are poorly understood and ballpark estimates are often used to inadequately plan for the budgetary implications of supply chain expenses. The purpose of this research was to estimate the country level costs of the public sector supply chain for artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) from the central to the peripheral levels in Benin and Kenya. A micro-costing approach was used and primary data on the various cost components of the supply chain was collected at the central, intermediate, and facility levels between September and November 2013. Information sources included central warehouse databases, health facility records, transport schedules, and expenditure reports. Data from document reviews and semi-structured interviews were used to identify cost inputs and estimate actual costs. Sampling was purposive to isolate key variables of interest. Survey guides were developed and administered electronically. Data were extracted into Microsoft Excel, and the supply chain cost per unit of ACT and RDT distributed by function and level of system was calculated. In Benin, supply chain costs added USD 0.2011 to the initial acquisition cost of ACT and USD 0.3375 to RDTs (normalized to USD 1). In Kenya, they added USD 0.2443 to the acquisition cost of ACT and USD 0.1895 to RDTs (normalized to USD 1). Total supply chain costs accounted for more than 30% of the initial acquisition cost of the products in some cases and these costs were highly sensitive to product volumes. The major cost drivers were found to be labour, transport, and utilities with health facilities carrying the majority of the cost per unit of product. Accurate cost estimates are needed to ensure adequate resources are available for supply chain activities. Product volumes should be considered when costing supply chain functions rather than dollar value. Further work is needed to develop extrapolative costing models that can be applied at country level without extensive micro-costing exercises. This will allow other countries to generate more accurate estimates in the future.

South Asia in the Space Age: Security Implications of Private-Sector Military Innovation on the Subcontinent

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

Luber, Steven M.

On 15 February 2017, India achieved the impressive feat of launching 104 commercial satellites into space from a single delivery vehicle. This launch was being closely watched by international firms, as India was asking for significantly less than the price of their American or European counterparts. Prime Minister Modi remarked that the launch cost less than the Hollywood move “Gravity.” C. Uday Bhaskar, Director of the Society for Policy Studies in New Delhi, commented that “by charging significantly less to launch satellites into space, India could carve out a niche in the $3 billion to $4 billion market for detailedmore » information about climate, topography and defense.”« less

Comparison of extracorporeal shock wave lithotripsy running models between outsourcing cooperation and rental cooperation conducted in Taiwan.

PubMed

Liu, Chih-Kuang; Ko, Ming-Chung; Chen, Shiou-Sheng; Lee, Wen-Kai; Shia, Ben-Chang; Chiang, Han-Sun

2015-02-01

We conducted a retrospective study to compare the cost and effectiveness between two different running models for extracorporeal shock wave lithotripsy (SWL), including the outsourcing cooperation model (OC) and the rental cooperation model (RC). Between January 1999 and December 2005, we implemented OC for the SWL, and from January 2006 to October 2011, RC was utilized. With OC, the cooperative company provided a machine and shared a variable payment with the hospital, according to treatment sessions. With RC, the cooperative company provided a machine and received a fixed rent from the hospital. We calculated the cost of each treatment session, and evaluated the break-even point to estimate the lowest number of treatment sessions to make the balance between revenue and cost every month. Effectiveness parameters, including the stone-free rate, the retreatment rate, the rate of additional procedures and complications, were evaluated. Compared with OC there were significantly less treatment sessions for RC every month (42.6±7.8 vs. 36.8±6.5, p=0.01). The cost of each treatment session was significantly higher for OC than for RC (751.6±20.0 USD vs. 684.7±16.7 USD, p=0.01). The break-even point for the hospital was 27.5 treatment sessions/month for OC, when the hospital obtained 40% of the payment, and it could be reduced if the hospital got a greater percentage. The break-even point for the hospital was 27.3 treatment sessions/month for RC. No significant differences were noticed for the stone-free rate, the retreatment rate, the rate of additional procedures and complications. Our study revealed that RC had a lower cost for every treatment session, and fewer treatment sessions of SWL/month than OC. The study might provide a managerial implication for healthcare organization managers, when they face a situation of high price equipment investment. Copyright © 2012. Published by Elsevier B.V.

The metabolic costs of sexual signalling in the chirping katydid Plangia graminea (Serville) (Orthoptera: Tettigoniidae) are context dependent: cumulative costs add up fast.

PubMed

Doubell, Marcé; Grant, Paul B C; Esterhuizen, Nanike; Bazelet, Corinna S; Addison, Pia; Terblanche, John S

2017-12-01

Katydids produce acoustic signals via stridulation, which they use to attract conspecific females for mating. However, direct estimates of the metabolic costs of calling to date have produced diverse cost estimates and are limited to only a handful of insect species. Therefore, in this study, we investigated the metabolic cost of calling in an unstudied sub-Saharan katydid, Plangia graminea Using wild-caught animals, we measured katydid metabolic rate using standard flow-through respirometry while simultaneously recording the number of calls produced. Overall, the metabolic rate during calling in P. graminea males was 60% higher than the resting metabolic rate (0.443±0.056 versus 0.279±0.028 ml CO 2  h -1 g -1 ), although this was highly variable among individuals. Although individual call costs were relatively inexpensive (ranging from 0.02 to 5.4% increase in metabolic rate per call), the individuals with cheaper calls called more often and for longer than those with expensive calls, resulting in the former group having significantly greater cumulative costs over a standard amount of time (9.5 h). However, the metabolic costs of calling are context dependent because the amount of time spent calling greatly influenced these costs in our trials. A power law function described this relationship between cumulative cost ( y ) and percentage increase per call ( x ) ( y =130.21 x -1.068 , R 2 =0.858). The choice of metric employed for estimating energy costs (i.e. how costs are expressed) also affects the outcome and any interpretation of costs of sexual signalling. For example, the absolute, relative and cumulative metabolic costs of calling yielded strongly divergent estimates, and any fitness implications depend on the organism's energy budget and the potential trade-offs in allocation of resources that are made as a direct consequence of increased calling effort. © 2017. Published by The Company of Biologists Ltd.

Is minimal access spine surgery more cost-effective than conventional spine surgery?

PubMed

Lubelski, Daniel; Mihalovich, Kathryn E; Skelly, Andrea C; Fehlings, Michael G; Harrop, James S; Mummaneni, Praveen V; Wang, Michael Y; Steinmetz, Michael P

2014-10-15

Systematic review. To summarize and critically review the economic literature evaluating the cost-effectiveness of minimal access surgery (MAS) compared with conventional open procedures for the cervical and lumbar spine. MAS techniques may improve perioperative parameters (length of hospital stay and extent of blood loss) compared with conventional open approaches. However, some have questioned the clinical efficacy of these differences and the associated cost-effectiveness implications. When considering the long-term outcomes, there seem to be no significant differences between MAS and open surgery. PubMed, EMBASE, the Cochrane Collaboration database, University of York, Centre for Reviews and Dissemination (NHS-EED and HTA), and the Tufts CEA Registry were reviewed to identify full economic studies comparing MAS with open techniques prior to December 24, 2013, based on the key questions established a priori. Only economic studies that evaluated and synthesized the costs and consequences of MAS compared with conventional open procedures (i.e., cost-minimization, cost-benefit, cost-effectiveness, or cost-utility) were considered for inclusion. Full text of the articles meeting inclusion criteria were reviewed by 2 independent investigators to obtain the final collection of included studies. The Quality of Health Economic Studies instrument was scored by 2 independent reviewers to provide an initial basis for critical appraisal of included economic studies. The search strategy yielded 198 potentially relevant citations, and 6 studies met the inclusion criteria, evaluating the costs and consequences of MAS versus conventional open procedures performed for the lumbar spine; no studies for the cervical spine met the inclusion criteria. Studies compared MAS tubular discectomy with conventional microdiscectomy, minimal access transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion, and multilevel hemilaminectomy via MAS versus open approach. Overall, the included cost-effectiveness studies generally supported no significant differences between open surgery and MAS lumbar approaches. However, these conclusions are preliminary because there was a paucity of high-quality evidence. Much of the evidence lacked details on methodology for modeling, related assumptions, justification of economic model chosen, and sources and types of included costs and consequences. The follow-up periods were highly variable, indirect costs were not frequently analyzed or reported, and many of the studies were conducted by a single group, thereby limiting generalizability. Prospective studies are needed to define differences and optimal treatment algorithms. 3.

User needs as a basis for advanced technology. [U.S. civil space program

NASA Technical Reports Server (NTRS)

Mankins, John C.; Reck, Gregory M.

1992-01-01

The NASA Integrated Technology Plan (ITP) is described with treatment given to the identification of U.S. technology needs, space research and technology programs, and some ITP implementations. The ITP is based on the development and transfer of technologies relevant to the space program that also have significant implications for general technological research. Among the areas of technological research identified are: astrophysics, earth sciences, microgravity, and space physics. The Office of Space Science and Applications prioritizes the technology needs in three classes; the highest priority is given to submm and microwave technologies for earth sciences and astrophysics study. Other government and commercial needs are outlined that include cryogenic technologies, low-cost engines, advanced data/signal processing, and low-cost ELVs. It is demonstrated that by identifying and addressing these areas of user technology needs NASA's research and technology program can enhance U.S. trade and industrial competitiveness.

In situ remediation technologies for mercury-contaminated soil

DOE PAGES

He, Feng; Gao, Jie; Pierce, Eric; ...

2015-04-09

A pollutant that poses significant risks to humans and the environment is mercury from anthropogenic activities. In soils, mercury remediation can be technically challenging and costly, depending on the subsurface mercury distribution, the types of mercury species, and the regulatory requirements. Our paper introduces the chemistry of mercury and its implications for in situ mercury remediation, which is followed by a detailed discussion of several in situ Hg remediation technologies in terms of applicability, cost, advantages, and disadvantages. The effect of Hg speciation on remediation performance, as well as Hg transformation during different remediation processes, was detailed. Thermal desorption, electrokinetic,more » and soil flushing/washing treatments are removal technologies that mobilize and capture insoluble Hg species, while containment, solidification/stabilization, and vitrification immobilize Hg by converting it to less soluble forms. We also discussed two emerging technologies, phytoremediation and nanotechnology, in this review.« less

Rising to the challenge of health care reform with entrepreneurial and intrapreneurial nursing initiatives.

PubMed

Wilson, Anne; Whitaker, Nancy; Whitford, Deirdre

2012-05-31

Health reform worldwide is required due to the largely aging population, increase in chronic diseases, and rising costs. To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. This can involve entrepreneurial or intrapreneurial roles. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost effective way, but to do so, they must be seen as equal partners in health service provision. This article provides a global perspective on evolving nursing roles for innovation in health care. A historical overview of entrepreneurship and intrapreneurship is offered. Included also is discussion of a social entrepreneurship approach for nursing, settings for nurse entre/intrapreneurship, and implications for research and practice.

Smallpox virus destruction and the implications of a new vaccine.

PubMed

Henderson, D A

2011-06-01

The World Health Assembly is scheduled to decide in May 2011 whether the 2 known remaining stockpiles of smallpox virus are to be destroyed or retained. In preparation for this, a WHO-appointed committee undertook a comprehensive review of the status of smallpox virus research from 1999 to 2010. It concluded that, considering the nature of the studies already completed with respect to vaccine, drugs, and diagnostics, there was no reason to retain live smallpox virus except to satisfy restrictive regulatory requirements. The committee advised that researchers and regulators define alternative models for testing the vaccines and drugs. Apart from other considerations, the costs of new products are significant and important. These include prospective expenditures required for the development, manufacture, testing, and storage of new products. This commentary provides approximations of these costs and the incremental contribution that a newly developed vaccine might make in terms of public health security.

Technology-based interventions for weight management: current randomized controlled trial evidence and future directions

PubMed Central

Buscemi, Joanna; Hawkins, Misty A. W.; Wang, Monica L.; Breland, Jessica Y.; Ross, Kathryn M.; Kommu, Anupama

2018-01-01

Obesity is a prevalent health care issue associated with disability, premature morality, and high costs. Behavioral weight management interventions lead to clinically significant weight losses in overweight and obese individuals; however, many individuals are not able to participate in these face-to-face treatments due to limited access, cost, and/or time constraints. Technological advances such as widespread access to the Internet, increased use of smartphones, and newer behavioral self-monitoring tools have resulted in the development of a variety of eHealth weight management programs. In the present paper, a summary of the most current literature is provided along with potential solutions to methodological challenges (e.g., high attrition, minimal participant racial/ethnic diversity, heterogeneity of technology delivery modes). Dissemination and policy implications will be highlighted as future directions for the field of eHealth weight management. PMID:27783259

In situ remediation technologies for mercury-contaminated soil

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

He, Feng; Gao, Jie; Pierce, Eric

A pollutant that poses significant risks to humans and the environment is mercury from anthropogenic activities. In soils, mercury remediation can be technically challenging and costly, depending on the subsurface mercury distribution, the types of mercury species, and the regulatory requirements. Our paper introduces the chemistry of mercury and its implications for in situ mercury remediation, which is followed by a detailed discussion of several in situ Hg remediation technologies in terms of applicability, cost, advantages, and disadvantages. The effect of Hg speciation on remediation performance, as well as Hg transformation during different remediation processes, was detailed. Thermal desorption, electrokinetic,more » and soil flushing/washing treatments are removal technologies that mobilize and capture insoluble Hg species, while containment, solidification/stabilization, and vitrification immobilize Hg by converting it to less soluble forms. We also discussed two emerging technologies, phytoremediation and nanotechnology, in this review.« less

2008 Alzheimer's disease facts and figures.

PubMed

2008-03-01

Alzheimer's disease is the seventh leading cause of all deaths in the United States and the fifth leading cause of death in Americans older than the age of 65 years. More than 5 million Americans are estimated to have Alzheimer's disease. Every 71 seconds someone in America develops Alzheimer's disease; by 2050 it is expected to occur every 33 seconds. During the coming decades, baby boomers are projected to add 10 million people to these numbers. By 2050, the incidence of Alzheimer's disease is expected to approach nearly a million people per year, with a total estimated prevalence of 11 to 16 million persons. Significant cost implications related to Alzheimer's disease and other dementias include an estimated $148 billion annually in direct (Medicare/Medicaid) and indirect (eg, caregiver lost wages and out-of-pocket expenses, decreased business productivity) costs. Not included in these figures are the estimated 10 million caregivers who annually provide $89 billion in unpaid services to individuals with Alzheimer's disease. This report provides information to increase understanding of the public health impact of Alzheimer's disease, including incidence and prevalence, mortality, lifetime risks, costs, and impact on family caregivers.

Concurrent validity of Physiological Cost Index in walking over ground and during robotic training in subacute stroke patients.

PubMed

Delussu, Anna Sofia; Morone, Giovanni; Iosa, Marco; Bragoni, Maura; Paolucci, Stefano; Traballesi, Marco

2014-01-01

Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p < 0.001); in CG Pearson correlation was 0.852 (p < 0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients.

The price of placements in residential and nursing home care: the effects of contracts and competition.

PubMed

Forder, J; Netten, A

2000-10-01

A variety of contract types are used in the placement of elderly people in residential and nursing care homes in the UK. Contracts vary according to how and when providers are paid. Among other things, prices can be made contingent on the total quantity of service to be purchased and on production cost characteristics. They can be determined at the time of placement or in advance. The primary objective of this paper is to assess the impact of contract choices on the price of placements. Regression analysis was conducted on a final sample of 1780 publicly funded placements made in 18 local authorities in the UK over a 6-month period ending in early 1996. Controlling factors included in the price analysis were production cost indicators and those measuring market competitiveness. Choices of both quantity and cost contingent contracts were found to be significantly associated with placement prices. The findings support the hypothesis that contract payment arrangements have different risk, insurance and information properties, and so have implications for the performance of residential care providers.

Compliance by Design: Influence of Acceleration Trade-offs on CO2 Emissions and Costs of Fuel Economy and Greenhouse Gas Regulations.

PubMed

Whitefoot, Kate S; Fowlie, Meredith L; Skerlos, Steven J

2017-09-19

The ability of automakers to improve the fuel economy of vehicles using engineering design modifications that compromise other performance attributes, such as acceleration, is not currently considered when setting fuel economy and greenhouse-gas emission standards for passenger cars and light trucks. We examine the role of these design trade-offs by simulating automaker responses to recently reformed vehicle standards with and without the ability to adjust acceleration performance. Results indicate that acceleration trade-offs can be important in two respects: (1) they can reduce the compliance costs of the standards, and (2) they can significantly reduce emissions associated with a particular level of the standards by mitigating incentives to shift sales toward larger vehicles and light trucks relative to passenger cars. We contrast simulation-based results with observed changes in vehicle attributes under the reformed standards. We find evidence that is consistent with firms using acceleration trade-offs to achieve compliance. Taken together, our analysis suggests that acceleration trade-offs play a role in automaker compliance strategies with potentially large implications for both compliance costs and emissions.

Implementation of occupational health service improvements through application of total quality management processes.

PubMed

Thomas, Elizabeth Anne

2011-06-01

The occupational health services department for a manufacturing division of a high-technology firm was redesigned from an outsourced model, in which most services were provided by an outside clinic vendor, to an in-house service model, in which services were provided by an on-site nurse practitioner. The redesign and implementation, accomplished by a cross-functional team using Total Quality Management processes, resulted in a comprehensive occupational health services department that realized significant cost reduction, increased compliance with regulatory and company requirements, and improved employee satisfaction. Implications of this project for occupational health nurses are discussed.

Instruction set commutivity

NASA Technical Reports Server (NTRS)

Windley, P.

1992-01-01

We present a state property called congruence and show how it can be used to demonstrate commutivity of instructions in a modern load-store architecture. Our analysis is particularly important in pipelined microprocessors where instructions are frequently reordered to avoid costly delays in execution caused by hazards. Our work has significant implications to safety and security critical applications since reordering can easily change the meaning and an instruction sequence and current techniques are largely ad hoc. Our work is done in a mechanical theorem prover and results in a set of trustworthy rules for instruction reordering. The mechanization makes it practical to analyze the entire instruction set.

Global implications of China's healthcare reform.

PubMed

Yan, Fei; Tang, Shenglan; Zhang, Jian

2016-01-01

The ongoing healthcare reform in China has a powerful spillover effect beyond the health sector and the borders of China. A successful completion of the Chinese reform will offer a new model for social justice development, shift the global economy toward sustainability and create a new hub for science and technology in medical and health science. However, reforming the healthcare system in the most populated country is a daunting task. China will not live up to its promise, and all the potentials may end with hype not hope if coherent national strategies are not constructed and state-of-the-art navigation is not achieved with staggering domestic and global challenges. The cost of failure will be immensely high, socioeconomic costs for Chinese and an opportunity cost for the world as a whole. A full appreciation of the global implications of China's healthcare reform is crucial in keeping China receptive toward good practices evidence-approved elsewhere and open minded to fulfill its international obligations. More critically, the appreciation yields constructive engagements from global community toward a joint development and global prosperity. The current report provides a multiple disciplinary assessment on the global implications of the healthcare reform in China. Copyright © 2014 John Wiley & Sons, Ltd.

Policy implications of startup utilization by enrollees in prepaid group plans.

PubMed

Baloff, N; Griffith, M J

1984-04-01

This article discusses several policy implications of the so-called startup effect, in which high initial health services utilization by new enrollees in prepaid group plans ( PGPs ) becomes reduced with the increasing duration of membership. Results of research in a developing PGP are analyzed as they relate to a mathematical model of startups for two measures of enrollee use. After estimating the total costs of startups in this setting, the motivating effects of such costs on PGPs are examined in relation to several policy issues--including the rate of PGP development in the United States, the use of financial incentives to enroll the elderly and medically disadvantaged, potential inequities of premium determination, the large impact of startups on disenrollment , and the federally mandated process of annual announcement of benefits and open enrollment. Ideas and mechanisms for future study on the startup effect and its policy implications are discussed.

Policy implications of startup utilization by enrollees in prepaid group plans.

PubMed Central

Baloff, N; Griffith, M J

1984-01-01

This article discusses several policy implications of the so-called startup effect, in which high initial health services utilization by new enrollees in prepaid group plans ( PGPs ) becomes reduced with the increasing duration of membership. Results of research in a developing PGP are analyzed as they relate to a mathematical model of startups for two measures of enrollee use. After estimating the total costs of startups in this setting, the motivating effects of such costs on PGPs are examined in relation to several policy issues--including the rate of PGP development in the United States, the use of financial incentives to enroll the elderly and medically disadvantaged, potential inequities of premium determination, the large impact of startups on disenrollment , and the federally mandated process of annual announcement of benefits and open enrollment. Ideas and mechanisms for future study on the startup effect and its policy implications are discussed. PMID:6724954

Why Block Grants Should Increase Administrative Costs.

ERIC Educational Resources Information Center

Baker, Keith

1983-01-01

Federal education programs increase costs because they attach fewer strings to funds than state or local grants, and this is likely to lead to administrative empire-building. Bureaucracy tends pathologically as it grows to generate more work for itself independent of true administrative needs. Some policy implications are drawn. (MJL)

Closing the Education Gap: Benefits and Costs.

ERIC Educational Resources Information Center

Vernez, Georges; Krop, Richard A.; Rydell, C. Peter

This study explored the implications of demographic trends on the quality of the future labor force and on public social expenditures. It also focused on the educational costs and social benefits of educational and immigration policy alternatives designed to close the gap in educational attainment between non-Hispanic whites and Hispanics and…

Impact of Agile Software Development Model on Software Maintainability

ERIC Educational Resources Information Center

Gawali, Ajay R.

2012-01-01

Software maintenance and support costs account for up to 60% of the overall software life cycle cost and often burdens tightly budgeted information technology (IT) organizations. Agile software development approach delivers business value early, but implications on software maintainability are still unknown. The purpose of this quantitative study…

Structuring Program Analysis for Educational Research.

ERIC Educational Resources Information Center

Levine, Donald M.

Education is too complex, multidimensional, and poorly understood to lend itself to a single cost/effectiveness criterion. Rather, analysts in the educational field seek to rank alternatives by their effectiveness, report separately on the cost implications, and leave the tradeoffs to the decisionmaker's judgment. In this context, a program is any…

Consumer Cost Differences for Traditional and Internet Markets.

ERIC Educational Resources Information Center

Shaw, Michael J.; Strader, Troy J.

1999-01-01

Addresses research issues related to the economics of electronic, Internet-based markets. Discusses consumer cost-based differences for traditional and electronic markets; revenue implications for sellers and transaction intermediaries; and results of an empirical, survey-based study of an electronic market in the sports trading-card industry.…

Health Care Analysis for the MCRMC Insurance Cost Model

DTIC Science & Technology

2015-06-01

demographically matched beneficiaries in civilian health care plans today in a PPO style plan 522 May 2015 FEHB  Largest employer-sponsored health benefit...Cost of treating Active Duty personnel  Implications of family earnings for plan choice  Availability of regional PPOs  Treatment of pharmacy

Long-Range Planning: Finding Fiscal Certainty in a Time of Uncertainty

ERIC Educational Resources Information Center

Malinowski, Matthew J.

2012-01-01

To navigate today's fiscal challenges successfully, school districts must constantly examine the long-term fiscal implications of policy, programmatic, and human resource decisions on their organization. They must look at the effect of such items as bargaining agreements, contracted services, placement costs, transportation costs, benefits,…

Fosphenytoin. Pharmacoeconomic implications of therapy.

PubMed

Holliday, S M; Benfield, P; Plosker, G L

1998-12-01

Advantages and disadvantages of Fosphenytoin. Advantages. More rapid intravenous administration than phenytoin and no need for an in-line filter. May be administered by intramuscular injection. Lower potential for local tissue and cardiac toxicity than phenytoin. Associated with less pain and phlebitis at the injection site, fewer reductions in infusion rate and fewer changes of administration site because of injection site complications than phenytoin. Benefits in terms of ease of administration and improved tolerability vs phenytoin have pharmacoeconomic implications which may translate into an overall cost advantage. Disadvantages. Approximately 10-fold higher acquisition cost vs phenytoin. Fosphenytoin is a parenterally administered prodrug of phenytoin, used in the treatment of patients with seizures. Advantages of fosphenytoin over phenytoin include more rapid intravenous administration, no need for an intravenous filter, and a lower potential for local tissue and cardiac toxicity. Unlike phenytoin, fosphenytoin may also be administered by intramuscular injection. Pharmacoeconomic data from a small study of patients with acute seizures in a US emergency department showed an overall cost advantage of fosphenytoin over phenytoin, despite a considerably greater acquisition cost of fosphenytoin. The main cost drivers for phenytoin therapy were treatment costs associated with adverse events. In view of the limited pharmacoeconomic data currently available, it is in the interests of individual institutions to conduct their own formal pharmacoeconomic studies applying local cost data and patterns of clinical practise to determine whether fosphenytoin should replace phenytoin on their formularly list.

The Training Implications of Manpower Productivity Agreements. Information Paper Number 4.

ERIC Educational Resources Information Center

Chemical and Allied Products Industry Training Board, Staines (England).

This paper is concerned with the training implications of productivity agreements which seek the achievement of high stable earnings through the improved use of manpower leading to efficient low cost production, by making changes which could not be achieved by traditional wage negotiations. Consideration is given to the training problems arising…

Persistent and transient cost efficiency—an application to the Swiss hydropower sector

DOE PAGES

Filippini, Massimo; Geissmann, Thomas; Greene, William H.

2017-11-27

Electricity prices on the European market have decreased significantly over the past few years, resulting in a deterioration of Swiss hydropower firms’ competitiveness and profitability. One option to improve the sector’s competitiveness is to increase cost efficiency. The goal of this study is to quantify the level of persistent and transient cost efficiency of individual firms by applying the generalized true random effects (GTRE) model introduced by Colombi et al. (Journal of Productivity Analysis 42(2): 123–136, 2014) and Filippini and Greene (Journal of Productivity Analysis 45(2): 187–196, 2016). Applying this newly developed GTRE model to a total cost function, themore » level of cost efficiency of 65 Swiss hydropower firms is analyzed for the period between 2000 and 2013. A true random effects specification is estimated as a benchmark for the transient level of cost efficiency. The results show the presence of both transient as well as persistent cost inefficiencies. The GTREM predicts the aggregate level of cost inefficiency to amount to 21.8% (8.0% transient, 13.8% persistent) on average between 2000 and 2013. These two components differ in interpretation and implication. From an individual firm’s perspective, the two types of cost inefficiencies might require a firm’s management to respond with different improvement strategies. The existing level of persistent inefficiency could prevent the hydropower firms from adjusting their production processes to new market environments. From a regulatory point of view, the results of this study could be used in the scope and determination of the amount of financial support given to struggling firms.« less

Drivers of costs associated with reperfusion therapy in acute stroke: the Interventional Management of Stroke III Trial.

PubMed

Simpson, Kit N; Simpson, Annie N; Mauldin, Patrick D; Hill, Michael D; Yeatts, Sharon D; Spilker, Judith A; Foster, Lydia D; Khatri, Pooja; Martin, Renee; Jauch, Edward C; Kleindorfer, Dawn; Palesch, Yuko Y; Broderick, Joseph P

2014-06-01

The Interventional Management of Stroke (IMS) III study tested the effect of intravenous tissue-type plasminogen activator (tPA) alone when compared with intravenous tPA followed by endovascular therapy and collected cost data to assess the economic implications of the 2 therapies. This report describes the factors affecting the costs of the initial hospitalization for acute stroke subjects from the United States. Prospective cost analysis of the US subjects was treated with intravenous tPA alone or with intravenous tPA followed by endovascular therapy in the IMS III trial. Results were compared with expected Medicare payments. The adjusted cost of a stroke admission in the study was $35 130 for subjects treated with endovascular therapy after intravenous tPA treatment and $25 630 for subjects treated with intravenous tPA alone (P<0.0001). Significant factors related to costs included treatment group, baseline National Institutes of Health Stroke Scale, time from stroke onset to intravenous tPA, age, stroke location, and comorbid diabetes mellitus. The mean cost for subjects who had routine use of general anesthesia as part of endovascular therapy was $46 444 when compared with $30 350 for those who did not have general anesthesia. The costs of embolectomy for IMS III subjects and patients from the National Inpatient Sample cohort exceeded the Medicare diagnosis-related group payment in ≥75% of patients. Minimizing the time to start of intravenous tPA and decreasing the use of routine general anesthesia may improve the cost-effectiveness of medical and endovascular therapy for acute stroke. http://www.clinicaltrials.gov. Unique identifier: NCT00359424. © 2014 American Heart Association, Inc.

Cost Implications of Primary Versus Revision Surgery in Adult Spinal Deformity.

PubMed

Qureshi, Rabia; Puvanesarajah, Varun; Jain, Amit; Kebaish, Khaled; Shimer, Adam; Shen, Francis; Hassanzadeh, Hamid

2017-08-01

Adult spinal deformity (ASD) is an important problem to consider in the elderly. Although studies have examined the complications of ASD surgery and have compared functional and radiographic results of primary surgery versus revision, no studies have compared the costs of primary procedures with revisions. We assessed the in-hospital costs of these 2 surgery types in patients with ASD. The PearlDiver Database, a database of Medicare records, was used in this study. Mutually exclusive groups of patients undergoing primary or revision surgery were identified. Patients in each group were queried for age, sex, and comorbidities. Thirty-day readmission rates, 30-day and 90-day complication rates, and postoperative costs of care were assessed with multivariate analysis. For analyses, significance was set at P < 0.001. The average reimbursement of the primary surgery cohort was $57,078 ± $30,767. Reimbursement of revision surgery cohort was $52,999 ± $27,658. The adjusted difference in average costs between the 2 groups is $4773 ± $1069 (P < 0.001). The 30-day and 90-day adjusted difference in cost of care when sustaining any of the major medical complications in primary surgery versus revision surgery was insignificant. Patients undergoing primary and revision corrective procedures for ASD have similar readmission rates, lengths of stays, and complication rates. Our data showed a higher cost of primary surgery compared with revision surgery, although costs of sustaining postoperative complications were similar. This finding supports the decision to perform revision procedures in patients with ASD when indicated because neither outcomes nor costs are a hindrance to correction. Copyright © 2017 Elsevier Inc. All rights reserved.

Persistent and transient cost efficiency—an application to the Swiss hydropower sector

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

Filippini, Massimo; Geissmann, Thomas; Greene, William H.

Electricity prices on the European market have decreased significantly over the past few years, resulting in a deterioration of Swiss hydropower firms’ competitiveness and profitability. One option to improve the sector’s competitiveness is to increase cost efficiency. The goal of this study is to quantify the level of persistent and transient cost efficiency of individual firms by applying the generalized true random effects (GTRE) model introduced by Colombi et al. (Journal of Productivity Analysis 42(2): 123–136, 2014) and Filippini and Greene (Journal of Productivity Analysis 45(2): 187–196, 2016). Applying this newly developed GTRE model to a total cost function, themore » level of cost efficiency of 65 Swiss hydropower firms is analyzed for the period between 2000 and 2013. A true random effects specification is estimated as a benchmark for the transient level of cost efficiency. The results show the presence of both transient as well as persistent cost inefficiencies. The GTREM predicts the aggregate level of cost inefficiency to amount to 21.8% (8.0% transient, 13.8% persistent) on average between 2000 and 2013. These two components differ in interpretation and implication. From an individual firm’s perspective, the two types of cost inefficiencies might require a firm’s management to respond with different improvement strategies. The existing level of persistent inefficiency could prevent the hydropower firms from adjusting their production processes to new market environments. From a regulatory point of view, the results of this study could be used in the scope and determination of the amount of financial support given to struggling firms.« less

The Cost-Effectiveness of Antibiotic Prophylaxis for Patients at Risk of Infective Endocarditis.

PubMed

Franklin, Matthew; Wailoo, Allan; Dayer, Mark J; Jones, Simon; Prendergast, Bernard; Baddour, Larry M; Lockhart, Peter B; Thornhill, Martin H

2016-11-15

In March 2008, the National Institute for Health and Care Excellence recommended stopping antibiotic prophylaxis (AP) for those at risk of infective endocarditis (IE) undergoing dental procedures in the United Kingdom, citing a lack of evidence of efficacy and cost-effectiveness. We have performed a new economic evaluation of AP on the basis of contemporary estimates of efficacy, adverse events, and resource implications. A decision analytic cost-effectiveness model was used. Health service costs and benefits (measured as quality-adjusted life-years) were estimated. Rates of IE before and after the National Institute for Health and Care Excellence guidance were available to estimate prophylactic efficacy. AP adverse event rates were derived from recent UK data, and resource implications were based on English Hospital Episode Statistics. AP was less costly and more effective than no AP for all patients at risk of IE. The results are sensitive to AP efficacy, but efficacy would have to be substantially lower for AP not to be cost-effective. AP was even more cost-effective in patients at high risk of IE. Only a marginal reduction in annual IE rates (1.44 cases in high-risk and 33 cases in all at-risk patients) would be required for AP to be considered cost-effective at £20 000 ($26 600) per quality-adjusted life-year. Annual cost savings of £5.5 to £8.2 million ($7.3-$10.9 million) and health gains >2600 quality-adjusted life-years could be achieved from reinstating AP in England. AP is cost-effective for preventing IE, particularly in those at high risk. These findings support the cost-effectiveness of guidelines recommending AP use in high-risk individuals. © 2016 The Authors.

On global energy scenario, dye-sensitized solar cells and the promise of nanotechnology.

PubMed

Reddy, K Govardhan; Deepak, T G; Anjusree, G S; Thomas, Sara; Vadukumpully, Sajini; Subramanian, K R V; Nair, Shantikumar V; Nair, A Sreekumaran

2014-04-21

One of the major problems that humanity has to face in the next 50 years is the energy crisis. The rising population, rapidly changing life styles of people, heavy industrialization and changing landscape of cities have increased energy demands, enormously. The present annual worldwide electricity consumption is 12 TW and is expected to become 24 TW by 2050, leaving a challenging deficit of 12 TW. The present energy scenario of using fossil fuels to meet the energy demand is unable to meet the increase in demand effectively, as these fossil fuel resources are non-renewable and limited. Also, they cause significant environmental hazards, like global warming and the associated climatic issues. Hence, there is an urgent necessity to adopt renewable sources of energy, which are eco-friendly and not extinguishable. Of the various renewable sources available, such as wind, tidal, geothermal, biomass, solar, etc., solar serves as the most dependable option. Solar energy is freely and abundantly available. Once installed, the maintenance cost is very low. It is eco-friendly, safely fitting into our society without any disturbance. Producing electricity from the Sun requires the installation of solar panels, which incurs a huge initial cost and requires large areas of lands for installation. This is where nanotechnology comes into the picture and serves the purpose of increasing the efficiency to higher levels, thus bringing down the overall cost for energy production. Also, emerging low-cost solar cell technologies, e.g. thin film technologies and dye-sensitized solar cells (DSCs) help to replace the use of silicon, which is expensive. Again, nanotechnological implications can be applied in these solar cells, to achieve higher efficiencies. This paper vividly deals with the various available solar cells, choosing DSCs as the most appropriate ones. The nanotechnological implications which help to improve their performance are dealt with, in detail. Additionally, the economic and ecological aspects of using nanotechnology are briefly introduced.

Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria

PubMed Central

Abimbola, Seye; Ukwaja, Kingsley N.; Onyedum, Cajetan C.; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra L.C.

2015-01-01

Health care costs incurred prior to the appropriate patient–provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers. PMID:25652349

Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.

PubMed

Abimbola, Seye; Ukwaja, Kingsley N; Onyedum, Cajetan C; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra L C

2015-10-01

Health care costs incurred prior to the appropriate patient-provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

Clinical and economic impact of the introduction of a nucleic acid amplification assay for Clostridium difficile.

PubMed

Guinta, Margaret M; Bunnell, Kristen; Harrington, Amanda; Bleasdale, Susan; Danziger, Larry; Wenzler, Eric

2017-12-04

The clinical outcomes and cost implications of a diagnostic shift from an EIA- to PCR-based assay for Clostridium difficile infection (CDI) have not been completely described in the literature. The impact of the PCR-based assay on the incidence and duration of CDI therapy was compared to the EIA assay for patients with a negative CDI diagnostic result. Secondary clinical and economic outcomes were also evaluated. Independent predictors of receipt of antibiotic therapy were assessed via logistic regression. 141 EIA and 140 PCR patients were included. Significantly more patients were started or continued on anti-CDI antibiotic therapy after a known negative assay result in the EIA group (26 patients vs. 8 patients, P = 0.002). Duration of antibiotic therapy after a known negative result was significantly shorter in the PCR group (1 vs. 4 days, P = 0.029) and a 23% reduction in the number of tests obtained per patient was observed (1.41 ± 0.86 vs. 1.82 ± 1.35, P = 0.007). The over fourfold difference in per-test cost of the EIA assay ($8.33 vs. $42.86, P < 0.0001) was offset by the overall medication costs required for the increased treatment in the EIA group ($546.60 vs. $188.96, P = 0.191). Utilization of the EIA-based CDI assay was associated with increased odds of CDI treatment after a negative test (aOR 4.71, 95% CI 1.93-11.46, P = 0.001). The transition from an EIA to PCR-based assay for diagnosing CDI resulted in a significant decrease in the number of patients treated and the duration of treatment in response to a negative test result. This significant decrease in treatment resulted in decreased costs offsetting the utilization of a more expensive molecular test for patients with a negative CDI diagnostic result.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care

PubMed Central

Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J.

2018-01-01

Background The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. Key issues for economic evaluation The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter’s value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. Implications The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented. PMID:29293611

Addressing the burden of epilepsy: Many unmet needs.

PubMed

Beghi, Ettore

2016-05-01

Epilepsy is a heterogeneous clinical condition characterized by recurrent unprovoked seizures, their causes and complications. The incidence, prevalence and mortality of epilepsy vary with age, place and time contributing to a variable extent to the burden of the disease. Diagnostic misclassification may have strong impact on personal and societal reflections of the disease in light of its clinical manifestations and the need for chronic treatment. Epilepsy accounts for a significant proportion of the world's disease burden ranking fourth after tension-type headache, migraine and Alzheimer disease. Among neurological diseases, it accounts for the highest disability-adjusted life year rates both in men and in women. Although epilepsy is self-remitting in up to 50% of cases, variable long-term prognostic patterns can be identified based on the response to the available treatments. Epilepsy carries an overall increased risk of premature mortality with variable estimates across countries. Premature mortality predominates in patients aged less than 50 years, with epilepsies due to structural/metabolic conditions, with generalized tonic-clonic seizures, and seizures not remitting under treatment. Among deaths directly attributable to epilepsy or seizures, included are sudden unexpected death in epilepsy (SUDEP), status epilepticus, accidents, drowning, unintentional injuries, and suicide. Somatic and psychiatric disorders prevail in patients with epilepsy than in people without epilepsy. Asthma, migraine and cerebral tumors tend to occur more frequently in younger adults while cardiovascular disorders, stroke, dementia and meningioma predominate in the elderly. As being a fairly common clinical condition affecting all ages and requiring long-term (sometimes lifelong) treatment, epilepsy carries high health care costs for the society. Direct costs peak in the first year after diagnosis and then vary according to the severity of the disease, the response to treatment, and the presence of comorbidity. Although in several countries the costs of epilepsy are met by the national health systems, out-of-pocket costs may be a relevant fraction of the overall costs, especially in countries where the public management of health care is suboptimal or non-existent. Epilepsy strongly affects patients' independence, psychological health and emotional adjustment. Epilepsy impairs all aspects of health-related quality of life. Awareness and attitudes of the public about epilepsy may significantly affect the burden of the disease. All these factors add to the burden of the disease. However, many of the factors implicated in the onset of epilepsy, its course and treatment can be favorably addressed with appropriate strategic plans. More research is needed to investigate and manage the medical and psychosocial implications of epilepsy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cost implication of irrational prescribing of chloroquine in Lagos State general hospitals.

PubMed

Aina, Bolajoko A; Tayo, Fola; Taylor, Ogori

2008-02-01

A major share of the hospital budget is spent on drugs. Irrational use of these drugs is a waste of financial and human resources that could have been deployed for another use within the hospital setting especially in cases where such drugs are provided free to patients. Also there is increased morbidity and progression of severity with irrational use. The objective of this study was to determine the irrational use of chloroquine and the subsequent cost implications in Lagos State general hospitals. A retrospective study period of one year (January to December, 2000) was selected. A total of 18,781 prescription forms of "Free Eko Malaria" were sampled for children and adults from all the Lagos State general hospitals. Drug costs in each prescription form were identified. Cost effectiveness analysis of chloroquine tablet and intramuscular injection was undertaken. The average cost of medicine per prescription was 132.071 ($1.03) which should have been 94.22 ($0.73) if prescribed rationally. The total cost of prescriptions for malaria under study was 2,480,425.00 ($19,348.09). About 68% {(1,679,444.00) ($13,100.19)} of the total cost was lost to irrational prescribing. This is a waste of scarce resources. When the prescriptions were differentiated into the different dosage forms prescribed, the prescriptions containing intramuscular injections only had over 90% of the cost lost to irrational prescribing. Cost effectiveness analysis showed that chloroquine tablet was 17 times more cost effective than chloroquine injection (intramuscular) from a health care system perspective while it was 14 times more cost effective from a patient perspective. There is waste of scarce resources with irrational dispensing of drugs and these resources could have been deployed to other uses or areas within the hospitals. The tablet chloroquine was more cost effective than injection chloroquine (intramuscular). Increasing the cost of tablets, decreasing effectiveness of tablets, decreasing the cost of injections and increasing the effectiveness of injections did not change the cost effectiveness conclusion.

Emetogenicity-risk procedures in same day surgery center of an academic university hospital in United States: a retrospective cost-audit of postoperative nausea vomiting management.

PubMed

Gupta, Deepak; Haber, Halim

2014-06-01

Despite the variable results of published studies, it is imperative for ambulatory surgery centers to self-audit local cost-implications for post-operative nausea and vomiting (PONV) management. Our retrospective cost-audit assessed if there were comparative peri-anesthesia care cost-trends among patients who had undergone Low-Emetogenicity-Risk Procedures (LERP), Moderate-Emetogenicity-Risk Procedures (MERP) and Severe-Emetogenicity-Risk Procedures (SERP). This study was a review of Same Day Surgery Center practices in an academic university hospital setting during a three-year period (2010-2012). The patient lists were accessed from CIS and CITRIX App Bar for time audit and OR (operating room) schedule reports. Subsequently, OR pharmacy department ran a search for peri-operative anti-emetics and opioids that were billed for the patients at Same Day Surgery Center for the review period. The primary outcomes were the comparative costs/charges of these medications and comparative durations/ charges for these patients' stay in the post-anesthesia care unit (PACU). Secondary outcomes analyzed in the study included peri-anesthesia durations. A total of 8,657 patient records were analyzed. Almost all analyzed variables revealed statistically significant inter-variable positive correlations. The patients' age was significantly (P < 0.001) different among LERP/MERP/SERP patients (LERP: 48.8 +/- 14.7 years; MERP: 61.8 +/- 14.6 years; SERP: 51.3 +/- 14.5 years). In regards to primary and secondary outcomes, the statistical significant differences among LERP/MERP/SERP patients (after correcting for both patients' age as well as patients' sex) were only achieved for preoperative times (P = 0.002; Power = 0.9), operating room recovery times (P = 0.003; Power = 0.9), PACU stay times (P < 0.001; Power = 1.0), and PACU charges (P < 0.001; Power = 1.0). PACU stay times and PACU charges were significantly higher in patients who had undergone SERP as compared to patients who had undergone LERP or MERP at our Same Day Surgery Center.

Case study - Dynamic pressure-limited capacity and costs of CO2 storage in the Mount Simon sandstone

USGS Publications Warehouse

Anderson, Steven T.; Jahediesfanjani, Hossein

2017-01-01

Widespread deployment of carbon capture and storage (CCS) is likely necessary to be able to satisfy baseload electricity demand, to maintain diversity in the energy mix, and to achieve climate and other objectives at the lowest cost. If all of the carbon dioxide (CO2) emissions from stationary sources (such as fossil-fuel burning power plants, and other industrial plants) in the United States needed to be captured and stored, it could be possible to store only a small fraction of this CO2 in oil and natural gas reservoirs, including as a result of CO2 utilization for enhanced oil recovery. The vast majority would have to be stored in saline-filled reservoirs (Dahowski et al., 2005). Given a lack of long-term commercial-scale CCS projects, there is considerable uncertainty in the risks, dynamic capacity, and their cost implications for geologic storage of CO2. Pressure buildup in the storage reservoir is expected to be a primary source of risk associated with CO2 storage, and could severely limit CO2 injection rates (dynamic storage capacities). Most cost estimates for commercial-scale deployment of CCS estimate CO2 storage costs under assumed availability of a theoretical capacity to store tens, hundreds, or even thousands of gigatons of CO2, without considering geologic heterogeneities, pressure limitations, or the time dimension. This could lead to underestimation of the costs of CO2 storage (Anderson, 2017). This paper considers the impacts of pressure limitations and geologic heterogeneity on the dynamic CO2 storage capacity and storage (injection) costs. In the U.S. Geological Survey (USGS)’s National Assessment of Geologic CO2 Storage Resources (USGS, 2013), the mean estimate of the theoretical storage capacity in the Mount Simon Sandstone was about 94 billion metric tons of CO2. However, our results suggest that the pressure-limited capacity after 50 years of injection could be only about 4% of the theoretical geologic storage capacity in this formation. Because this is far less than emissions of CO2 from stationary sources in the region around the Mount Simon Sandstone, the costs to accommodate the potential annual demand for CO2 storage in this formation could be significantly greater than current estimates. Our results could have implications for how long and to what extent decision makers can expect to be able to deploy CCS before transitioning to other low- or zero-carbon energy technologies.

Multiple Chronic Conditions and Healthcare Costs among Adults

PubMed Central

Sambamoorthi, Usha; Tan, Xi; Deb, Arijita

2015-01-01

The prevalence of multiple chronic conditions (MCC) is increasing among individuals of all ages. MCC are associated with poor health outcomes. The presence of MCC has profound healthcare utilization and cost implications for public and private insurance payers, individuals, and families. Investigators have used a variety of definitions for MCC to evaluate costs associated with MCC. The objective of this article is to examine the current literature in estimating excess costs associated with MCC among adults. The discussion highlights some of the theoretical and technical merits of various MCC definitions and models used to estimate the excess costs associated with MCC. PMID:26400220

Estimates and implications of the costs of compliance with biosafety regulations in developing countries.

PubMed

Falck-Zepeda, Jose; Yorobe, Jose; Husin, Bahagiawati Amir; Manalo, Abraham; Lokollo, Erna; Ramon, Godfrey; Zambrano, Patricia; Sutrisno

2012-01-01

Estimating the cost of compliance with biosafety regulations is important as it helps developers focus their investments in producer development. We provide estimates for the cost of compliance for a set of technologies in Indonesia, the Philippines and other countries. These costs vary from US $100,000 to 1.7 million. These are estimates of regulatory costs and do not include product development or deployment costs. Cost estimates need to be compared with potential gains when the technology is introduced in these countries and the gains in knowledge accumulate during the biosafety assessment process. Although the cost of compliance is important, time delays and uncertainty are even more important and may have an adverse impact on innovations reaching farmers.

The Impact of Hospital Pay-for-Performance on Hospital and Medicare Costs

PubMed Central

Kruse, Gregory B; Polsky, Daniel; Stuart, Elizabeth A; Werner, Rachel M

2012-01-01

Objective To evaluate the effects of Medicare's hospital pay-for-performance demonstration project on hospital revenues, costs, and margins and on Medicare costs. Data Sources/Study Setting All health care utilization for Medicare beneficiaries hospitalized for acute myocardial infarction (AMI; ICD-9-CM code 410.x1) in fiscal years 2002–2005 from Medicare claims, containing 420,211 admissions with AMI. Study Design We test for changes in hospital costs and revenues and Medicare payments among 260 hospitals participating in the Medicare hospital pay-for-performance demonstration project and a group of 780 propensity-score-matched comparison hospitals. Effects were estimated using a difference-in-difference model with hospital fixed effects, testing for changes in costs among pay-for-performance hospitals above and beyond changes in comparison hospitals. Principal Findings We found no significant effect of pay-for-performance on hospital financials (revenues, costs, and margins) or Medicare payments (index hospitalization and 1 year after admission) for AMI patients. Conclusions Pay-for-performance in the CMS hospital demonstration project had minimal impact on hospital financials and Medicare payments to providers. As P4P extends to all hospitals under the Affordable Care Act, these results provide some estimates of the impact of P4P and emphasize our need for a better understanding of the financial implications of P4P on providers and payers if we want to create sustainable and effective programs to improve health care value. PMID:23088391

Answering the big questions about differential response in Colorado: safety and cost outcomes from a randomized controlled trial.

PubMed

Winokur, Marc; Ellis, Raquel; Drury, Ida; Rogers, John

2015-01-01

Over the past 20 years, jurisdictions across the United States have implemented differential response (DR), which provides child protective services with the flexibility to tailor their response to reports of child abuse or neglect based on the level of risk. Given the widespread adoption of DR, there has been an increasing demand from policymakers, practitioners, and community stakeholders to build the evidence base for this innovative child welfare approach. This study was designed to answer the big questions regarding the effect of differential response on child welfare outcomes and costs using a randomized controlled trial in five Colorado counties. Specifically, the study examined the safety outcomes and costs of families who were randomly assigned to either a family assessment response (FAR) or an investigation response (IR). According to the regression results, there were no differences between the tracks on measures of system re-involvement. However, survival analysis findings indicate that FAR families were 18% less likely, over time, to have a high risk assessment after their initial accepted referral than were IR families. The cost study revealed no differences between the tracks on initial costs for caseworker contacts, services, and out-of-home placements. However, the results suggest that follow-up costs for IR cases were significantly higher (p<0.001) than for FAR cases. The authors discuss policy and practice implications for jurisdictions considering DR. Copyright © 2014 Elsevier Ltd. All rights reserved.

The impact of hospital pay-for-performance on hospital and Medicare costs.

PubMed

Kruse, Gregory B; Polsky, Daniel; Stuart, Elizabeth A; Werner, Rachel M

2012-12-01

To evaluate the effects of Medicare's hospital pay-for-performance demonstration project on hospital revenues, costs, and margins and on Medicare costs. All health care utilization for Medicare beneficiaries hospitalized for acute myocardial infarction (AMI; ICD-9-CM code 410.x1) in fiscal years 2002-2005 from Medicare claims, containing 420,211 admissions with AMI. We test for changes in hospital costs and revenues and Medicare payments among 260 hospitals participating in the Medicare hospital pay-for-performance demonstration project and a group of 780 propensity-score-matched comparison hospitals. Effects were estimated using a difference-in-difference model with hospital fixed effects, testing for changes in costs among pay-for-performance hospitals above and beyond changes in comparison hospitals. We found no significant effect of pay-for-performance on hospital financials (revenues, costs, and margins) or Medicare payments (index hospitalization and 1 year after admission) for AMI patients. Pay-for-performance in the CMS hospital demonstration project had minimal impact on hospital financials and Medicare payments to providers. As P4P extends to all hospitals under the Affordable Care Act, these results provide some estimates of the impact of P4P and emphasize our need for a better understanding of the financial implications of P4P on providers and payers if we want to create sustainable and effective programs to improve health care value. © Health Research and Educational Trust.

Economic assessment of different mulches in conventional and water-saving rice production systems.

PubMed

Jabran, Khawar; Hussain, Mubshar; Fahad, Shah; Farooq, Muhammad; Bajwa, Ali Ahsan; Alharrby, Hesham; Nasim, Wajid

2016-05-01

Water-saving rice production systems including alternate wetting and drying (AWD) and aerobic rice (AR) are being increasingly adopted by growers due to global water crises. Application of natural and artificial mulches may further improve water economy of water-saving rice production systems. Conventionally flooded rice (CFR) system has been rarely compared with AWD and AR in terms of economic returns. In this 2-year field study, we compared CFR with AWD and AR (with and without straw and plastic mulches) for the cost of production and economic benefits. Results indicated that CFR had a higher production cost than AWD and AR. However, application of mulches increased the cost of production of AWD and AR production systems where plastic mulch was expensive than straw mulch. Although the mulching increased the cost of production for AWD and AR, the gross income of these systems was also improved significantly. The gross income from mulched plots of AWD and AR was higher than non-mulched plots of the same systems. In conclusion, AWD and AR effectively reduce cost of production by economizing the water use. However, the use of natural and artificial mulches in such water-saving environments further increased the economic returns. The maximized economic returns by using straw mulch in water-saving rice production systems definitely have pragmatic implications for sustainable agriculture.

Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility.

PubMed

Manca, Andrea; Hawkins, Neil; Sculpher, Mark J

2005-05-01

In trial-based cost-effectiveness analysis baseline mean utility values are invariably imbalanced between treatment arms. A patient's baseline utility is likely to be highly correlated with their quality-adjusted life-years (QALYs) over the follow-up period, not least because it typically contributes to the QALY calculation. Therefore, imbalance in baseline utility needs to be accounted for in the estimation of mean differential QALYs, and failure to control for this imbalance can result in a misleading incremental cost-effectiveness ratio. This paper discusses the approaches that have been used in the cost-effectiveness literature to estimate absolute and differential mean QALYs alongside randomised trials, and illustrates the implications of baseline mean utility imbalance for QALY calculation. Using data from a recently conducted trial-based cost-effectiveness study and a micro-simulation exercise, the relative performance of alternative estimators is compared, showing that widely used methods to calculate differential QALYs provide incorrect results in the presence of baseline mean utility imbalance regardless of whether these differences are formally statistically significant. It is demonstrated that multiple regression methods can be usefully applied to generate appropriate estimates of differential mean QALYs and an associated measure of sampling variability, while controlling for differences in baseline mean utility between treatment arms in the trial. Copyright 2004 John Wiley & Sons, Ltd

Combustible cigarettes cost less to use than e-cigarettes: global evidence and tax policy implications.

PubMed

Liber, Alex C; Drope, Jeffrey M; Stoklosa, Michal

2017-03-01

Some scholars suggest that price differences between combustible cigarettes and e-cigarettes could be effective in moving current combustible smokers to e-cigarettes, which could reduce tobacco-related death and disease. Currently, in most jurisdictions, e-cigarettes are not subject to the same excise taxes as combustible cigarettes, potentially providing the category with a price advantage over combustible cigarettes. This paper tests whether e-cigarettes tax advantage has translated into a price advantage. In a sample of 45 countries, the price of combustible cigarettes, disposable e-cigarettes and rechargeable cigarettes were compared. Comparable units of combustible cigarettes cost less than disposable e-cigarettes in almost every country in the sample. While the e-liquids consumed in rechargeable e-cigarettes might cost less per comparable unit than combustible cigarettes, the initial cost to purchase a rechargeable e-cigarette presents a significant cost barrier to switching from smoking to vaping. Existing prices of e-cigarettes are generally much higher than of combustible cigarettes. If policymakers wish to tax e-cigarettes less than combustibles, forceful policy action-almost certainly through excise taxation-must raise the price of combustible cigarettes beyond the price of using e-cigarettes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

PubMed Central

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

2017-01-01

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

Pathogen and Particle Associations in Wastewater: Significance and Implications for Treatment and Disinfection Processes.

PubMed

Chahal, C; van den Akker, B; Young, F; Franco, C; Blackbeard, J; Monis, P

2016-01-01

Disinfection guidelines exist for pathogen inactivation in potable water and recycled water, but wastewater with high numbers of particles can be more difficult to disinfect, making compliance with the guidelines problematic. Disinfection guidelines specify that drinking water with turbidity ≥1 Nephelometric Turbidity Units (NTU) is not suitable for disinfection and therefore not fit for purpose. Treated wastewater typically has higher concentrations of particles (1-10NTU for secondary treated effluent). Two processes widely used for disinfecting wastewater are chlorination and ultraviolet radiation. In both cases, particles in wastewater can interfere with disinfection and can significantly increase treatment costs by increasing operational expenditure (chemical demand, power consumption) or infrastructure costs by requiring additional treatment processes to achieve the required levels of pathogen inactivation. Many microorganisms (viruses, bacteria, protozoans) associate with particles, which can allow them to survive disinfection processes and cause a health hazard. Improved understanding of this association will enable development of cost-effective treatment, which will become increasingly important as indirect and direct potable reuse of wastewater becomes more widespread in both developed and developing countries. This review provides an overview of wastewater and associated treatment processes, the pathogens in wastewater, the nature of particles in wastewater and how they interact with pathogens, and how particles can impact disinfection processes. Copyright © 2016 Elsevier Inc. All rights reserved.

Environmental and Economic Implications of Distributed Additive Manufacturing: The Case of Injection Mold Tooling: Environmental Implications of Additive Manufacturing

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

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

Additive manufacturing (AM) holds great potentials in enabling superior engineering functionality, streamlining supply chains, and reducing life cycle impacts compared to conventional manufacturing (CM). This study estimates the net changes in supply-chain lead time, life cycle primary energy consumption, greenhouse gas (GHG) emissions, and life cycle costs (LCC) associated with AM technologies for the case of injection molding, to shed light on the environmental and economic advantages of a shift from international or onshore CM to AM in the United States. A systems modeling framework is developed, with integrations of lead-time analysis, life cycle inventory analysis, LCC model, and scenariosmore » considering design differences, supply-chain options, productions, maintenance, and AM technological developments. AM yields a reduction potential of 3% to 5% primary energy, 4% to 7% GHG emissions, 12% to 60% lead time, and 15% to 35% cost over 1 million cycles of the injection molding production depending on the AM technology advancement in future. The economic advantages indicate the significant role of AM technology in raising global manufacturing competitiveness of local producers, while the relatively small environmental benefits highlight the necessity of considering trade-offs and balance techniques between environmental and economic performances when AM is adopted in the tooling industry. The results also help pinpoint the technological innovations in AM that could lead to broader benefits in future.« less

Environmental and Economic Implications of Distributed Additive Manufacturing: The Case of Injection Mold Tooling: Environmental Implications of Additive Manufacturing

DOE PAGES

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

2017-08-26

Additive manufacturing (AM) holds great potentials in enabling superior engineering functionality, streamlining supply chains, and reducing life cycle impacts compared to conventional manufacturing (CM). This study estimates the net changes in supply-chain lead time, life cycle primary energy consumption, greenhouse gas (GHG) emissions, and life cycle costs (LCC) associated with AM technologies for the case of injection molding, to shed light on the environmental and economic advantages of a shift from international or onshore CM to AM in the United States. A systems modeling framework is developed, with integrations of lead-time analysis, life cycle inventory analysis, LCC model, and scenariosmore » considering design differences, supply-chain options, productions, maintenance, and AM technological developments. AM yields a reduction potential of 3% to 5% primary energy, 4% to 7% GHG emissions, 12% to 60% lead time, and 15% to 35% cost over 1 million cycles of the injection molding production depending on the AM technology advancement in future. The economic advantages indicate the significant role of AM technology in raising global manufacturing competitiveness of local producers, while the relatively small environmental benefits highlight the necessity of considering trade-offs and balance techniques between environmental and economic performances when AM is adopted in the tooling industry. The results also help pinpoint the technological innovations in AM that could lead to broader benefits in future.« less

Range of cell-wall alterations enhance saccharification in Brachypodium distachyon mutants

PubMed Central

Marriott, Poppy E.; Sibout, Richard; Lapierre, Catherine; Fangel, Jonatan U.; Willats, William G. T.; Hofte, Herman; Gómez, Leonardo D.; McQueen-Mason, Simon J.

2014-01-01

Lignocellulosic plant biomass is an attractive feedstock for the production of sustainable biofuels, but the commercialization of such products is hampered by the high costs of processing this material into fermentable sugars (saccharification). One approach to lowering these costs is to produce crops with cell walls that are more susceptible to hydrolysis to reduce preprocessing and enzyme inputs. To deepen our understanding of the molecular genetic basis of lignocellulose recalcitrance, we have screened a mutagenized population of the model grass Brachypodium distachyon for improved saccharification with an industrial polysaccharide-degrading enzyme mixture. From an initial screen of 2,400 M2 plants, we selected 12 lines that showed heritable improvements in saccharification, mostly with no significant reduction in plant size or stem strength. Characterization of these putative mutants revealed a variety of alterations in cell-wall components. We have mapped the underlying genetic lesions responsible for increased saccharification using a deep sequencing approach, and here we report the mapping of one of the causal mutations to a narrow region in chromosome 2. The most likely candidate gene in this region encodes a GT61 glycosyltransferase, which has been implicated in arabinoxylan substitution. Our work shows that forward genetic screening provides a powerful route to identify factors that impact on lignocellulose digestibility, with implications for improving feedstock for cellulosic biofuel production. PMID:25246540

CVX: Propulsion System Decision. Industrial Base Implications of Nuclear and Non-Nuclear Options

DTIC Science & Technology

1998-01-01

industrial base may be affected by the demand for either a nuclear or non-nuclear CVX. If CVX were conventional, the cost of components for other...air- craft carrier, designated CVX. Because of the high cost of designing a new carrier and because of competing demands within its budget, the Navy...reactor re- fuelings. The organizations also supplied workforce requirements associated with different nuclear workload demands and the costs of

Ireland and the Defense of Western Europe. Issues and Implications.

DTIC Science & Technology

1988-05-01

domestic or external pressure to do so. In fact, neutrality is widely supported and could be abandoned only at a prohibitive political cost . Many...makes the costs of Irish membership outweigh any benefits? Her geographic location, as well as certain of her physical characteristics, would make her...peacetime must be weighed against the considerable costs involved. The obvious question then is, what would Ireland do in wartime? This is a question other

Next Generation Cloud-based Science Data Systems and Their Implications on Data and Software Stewardship, Preservation, and Provenance

NASA Astrophysics Data System (ADS)

Hua, H.; Manipon, G.; Starch, M.

2017-12-01

NASA's upcoming missions are expected to be generating data volumes at least an order of magnitude larger than current missions. A significant increase in data processing, data rates, data volumes, and long-term data archive capabilities are needed. Consequently, new challenges are emerging that impact traditional data and software management approaches. At large-scales, next generation science data systems are exploring the move onto cloud computing paradigms to support these increased needs. New implications such as costs, data movement, collocation of data systems & archives, and moving processing closer to the data, may result in changes to the stewardship, preservation, and provenance of science data and software. With more science data systems being on-boarding onto cloud computing facilities, we can expect more Earth science data records to be both generated and kept in the cloud. But at large scales, the cost of processing and storing global data may impact architectural and system designs. Data systems will trade the cost of keeping data in the cloud with the data life-cycle approaches of moving "colder" data back to traditional on-premise facilities. How will this impact data citation and processing software stewardship? What are the impacts of cloud-based on-demand processing and its affect on reproducibility and provenance. Similarly, with more science processing software being moved onto cloud, virtual machines, and container based approaches, more opportunities arise for improved stewardship and preservation. But will the science community trust data reprocessed years or decades later? We will also explore emerging questions of the stewardship of the science data system software that is generating the science data records both during and after the life of mission.

Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12 months.

PubMed

Batehup, L; Porter, K; Gage, H; Williams, P; Simmonds, P; Lowson, E; Dodson, L; Davies, N J; Wagland, R; Winter, J D; Richardson, A; Turner, A; Corner, J L

2017-07-01

To compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU). Questionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared. Patients in Cohort B1 were significantly more likely to have received chemotherapy (p < 0.001), radiotherapy (p < 0.05), and reported poorer QoL (p = 0.001). Having a longstanding co-morbid condition was the most important determinant of QoL (p < 0.001); model of care was not significant. Patients were satisfied with their follow-up care regardless of model. Health service costs were higher in PTFU over the first year CONCLUSIONS: PTFU is acceptable to patients with colorectal cancer and can be considered to be a realistic alternative to OPFU for clinically suitable patients. The initial costs are higher due to provision of a self-management (SM) programme and remote surveillance. Further research is needed to establish long-term outcomes and costs.

The humanistic and economic burden of Dravet syndrome on caregivers and families: Implications for future research.

PubMed

Jensen, Mark P; Brunklaus, Andreas; Dorris, Liam; Zuberi, Sameer M; Knupp, Kelly G; Galer, Bradley S; Gammaitoni, Arnold R

2017-05-01

We reviewed the current literature with respect to the humanistic and financial burdens of Dravet Syndrome (DS) on the caregivers of children with DS, in order to (1) identify key unanswered questions or gaps in knowledge that need to be addressed and then, based on these knowledge gaps, (2) propose a research agenda for the scientific community to address in the coming decade. The findings support the conclusion that caring for a child with DS is associated with significant humanistic burden and direct costs. However, due in part to the paucity of studies, as well as the lack of measures of specific burden domains, there remains much that is not known regarding the burden of caregiving for children with DS. To address the significant knowledge gaps in this area, research is needed that will: (1) identify the specific domains of caregivers' lives that are impacted by caring for a child with DS; (2) identify or, if needed, develop measures of caregiving impact in this area; (3) identify the factors that influence DS caregiving burden; (4) develop and evaluate the efficacy of treatments for reducing the negative impact of DS and its comorbidities on DS caregivers; (5) quantify the direct medical costs associated with DS and DS comorbidities and identify the factors that influence these costs; and (6) quantify and fully explore the indirect costs of DS. Research that addresses these goals will provide the empirical foundation needed for improving the quality of life of children with DS and their families. Copyright © 2017 Elsevier Inc. All rights reserved.

The neuroeconomics of alcohol demand: an initial investigation of the neural correlates of alcohol cost-benefit decision making in heavy drinking men.

PubMed

MacKillop, James; Amlung, Michael T; Acker, John; Gray, Joshua C; Brown, Courtney L; Murphy, James G; Ray, Lara A; Sweet, Lawrence H

2014-07-01

Neuroeconomics integrates concepts and methods from psychology, economics, and cognitive neuroscience to understand how the brain makes decisions. In economics, demand refers to the relationship between a commodity's consumption and its cost, and, in behavioral studies, high alcohol demand has been consistently associated with greater alcohol misuse. Relatively little is known about how the brain processes demand decision making, and the current study is an initial investigation of the neural correlates of alcohol demand among heavy drinkers. Using an event-related functional magnetic resonance imaging (fMRI) paradigm, participants (N=24) selected how much they would drink under varying levels of price. These choices determined access to alcohol during a subsequent bar laboratory self-administration period. During decisions to drink in general, greater activity was present in multiple distinct subunits of the prefrontal and parietal cortices. In contrast, during decisions to drink that were demonstrably affected by the cost of alcohol, significantly greater activation was evident in frontostriatal regions, suggesting an active interplay between cognitive deliberation and subjective reward value. These choices were also characterized by significant deactivation in default mode network regions, suggesting suppression resulting from greater cognitive load. Across choice types, the anterior insula was notably recruited in diverse roles, further implicating the importance of interoceptive processing in decision-making behavior. These findings reveal the neural signatures subserving alcohol cost-benefit decision making, providing a foundation for future clinical applications of this paradigm and extending this approach to understanding the neural correlates of demand for other addictive commodities.

The Impact of Different Nursing Skill Mix Models on Patient Outcomes in a Respiratory Care Center

PubMed Central

Yang, Pei-Hsuan; Hung, Chich-Hsiu; Chen, Yao-Mei; Hu, Chuan-Yu; Shieh, Sheng-Lan

2012-01-01

Background Many hospitals have reformed hospital policies and changed nursing models to cope with shortages in nursing staff and control medical costs. However, the nursing skill mix model that most successfully achieves both cost effectiveness and quality care has yet to be determined. Aim The aim of this study was to explore the impact of different nurse staffing models on patient outcomes in a respiratory care center (RCC). Methods Retrospective data from 2006 to 2008 were obtained from records monitoring nursing care quality, as well as patient records and nursing personnel costs in an RCC as a medical center, in southern Taiwan. A total of 487 patients were categorized into two groups according to the RCC's mix of nursing staff. The “RN/Aide” group comprised 247 patients who received RN and aide care, with a 0.7–0.8 proportion of RNs, from July 2006 to June 2007. The other 240 patients (“All-RN”) received 100% RN care from January 2008 to December 2008. Results The results of this study indicated no significant differences in occurrence of pressure ulcer or respiratory tract infections, days of hospitalization, mortality, or nursing costs. However, significant differences were observed in ventilator weaning and occurrence of urinary tract and bloodstream infections. Conclusions A higher proportion of RNs was associated not only with a lower rate of urinary tract infection but also with more patients being weaned successfully from ventilators. The findings of this study have implications for how managers and administrators manage nurse staffing in respiratory care. PMID:22489996

Predicting Cost/Reliability/Maintainability of Advanced General Aviation Avionics Equipment

NASA Technical Reports Server (NTRS)

Davis, M. R.; Kamins, M.; Mooz, W. E.

1978-01-01

A methodology is provided for assisting NASA in estimating the cost, reliability, and maintenance (CRM) requirements for general avionics equipment operating in the 1980's. Practical problems of predicting these factors are examined. The usefulness and short comings of different approaches for modeling coast and reliability estimates are discussed together with special problems caused by the lack of historical data on the cost of maintaining general aviation avionics. Suggestions are offered on how NASA might proceed in assessing cost reliability CRM implications in the absence of reliable generalized predictive models.

Bundled payments in orthopedic surgery.

PubMed

Bushnell, Brandon D

2015-02-01

As a result of reading this article, physicians should be able to: 1. Describe the concept of bundled payments and the potential applications of bundled payments in orthopedic surgery. 2. For specific situations, outline a clinical episode of care, determine the participants in a bundling situation, and define care protocols and pathways. 3. Recognize the importance of resource utilization management, quality outcome measurement, and combined economic-clinical value in determining the value of bundled payment arrangements. 4. Identify the implications of bundled payments for practicing orthopedists, as well as the legal issues and potential future directions of this increasingly popular alternative payment method. Bundled payments, the idea of paying a single price for a bundle of goods and services, is a financial concept familiar to most American consumers because examples appear in many industries. The idea of bundled payments has recently gained significant momentum as a financial model with the potential to decrease the significant current costs of health care. Orthopedic surgery as a field of medicine is uniquely positioned for success in an environment of bundled payments. This article reviews the history, logistics, and implications of the bundled payment model relative to orthopedic surgery. Copyright 2015, SLACK Incorporated.

Efficiency assessment of wastewater treatment plants: A data envelopment analysis approach integrating technical, economic, and environmental issues.

PubMed

Castellet, Lledó; Molinos-Senante, María

2016-02-01

The assessment of the efficiency of wastewater treatment plants (WWTPs) is essential to compare their performance and consequently to identify the best operational practices that can contribute to the reduction of operational costs. Previous studies have evaluated the efficiency of WWTPs using conventional data envelopment analysis (DEA) models. Most of these studies have considered the operational costs of the WWTPs as inputs, while the pollutants removed from wastewater are treated as outputs. However, they have ignored the fact that each pollutant removed by a WWTP involves a different environmental impact. To overcome this limitation, this paper evaluates for the first time the efficiency of a sample of WWTPs by applying the weighted slacks-based measure model. It is a non-radial DEA model which allows assigning weights to the inputs and outputs according their importance. Thus, the assessment carried out integrates environmental issues with the traditional "techno-economic" efficiency assessment of WWTPs. Moreover, the potential economic savings for each cost item have been quantified at a plant level. It is illustrated that the WWTPs analyzed have significant room to save staff and energy costs. Several managerial implications to help WWTPs' operators make informed decisions were drawn from the methodology and empirical application carried out. Copyright © 2015 Elsevier Ltd. All rights reserved.

A clinical utility study of exome sequencing versus conventional genetic testing in pediatric neurology.

PubMed

Vissers, Lisenka E L M; van Nimwegen, Kirsten J M; Schieving, Jolanda H; Kamsteeg, Erik-Jan; Kleefstra, Tjitske; Yntema, Helger G; Pfundt, Rolph; van der Wilt, Gert Jan; Krabbenborg, Lotte; Brunner, Han G; van der Burg, Simone; Grutters, Janneke; Veltman, Joris A; Willemsen, Michèl A A P

2017-09-01

Implementation of novel genetic diagnostic tests is generally driven by technological advances because they promise shorter turnaround times and/or higher diagnostic yields. Other aspects, including impact on clinical management or cost-effectiveness, are often not assessed in detail prior to implementation. We studied the clinical utility of whole-exome sequencing (WES) in complex pediatric neurology in terms of diagnostic yield and costs. We analyzed 150 patients (and their parents) presenting with complex neurological disorders of suspected genetic origin. In a parallel study, all patients received both the standard diagnostic workup (e.g., cerebral imaging, muscle biopsies or lumbar punctures, and sequential gene-by-gene-based testing) and WES simultaneously. Our unique study design allowed direct comparison of diagnostic yield of both trajectories and provided insight into the economic implications of implementing WES in this diagnostic trajectory. We showed that WES identified significantly more conclusive diagnoses (29.3%) than the standard care pathway (7.3%) without incurring higher costs. Exploratory analysis of WES as a first-tier diagnostic test indicates that WES may even be cost-saving, depending on the extent of other tests being omitted. Our data support such a use of WES in pediatric neurology for disorders of presumed genetic origin.Genet Med advance online publication 23 March 2017.

A clinical utility study of exome sequencing versus conventional genetic testing in pediatric neurology

PubMed Central

Vissers, Lisenka E.L.M.; van Nimwegen, Kirsten J.M.; Schieving, Jolanda H.; Kamsteeg, Erik-Jan; Kleefstra, Tjitske; Yntema, Helger G.; Pfundt, Rolph; van der Wilt, Gert Jan; Krabbenborg, Lotte; Brunner, Han G.; van der Burg, Simone; Grutters, Janneke; Veltman, Joris A.; Willemsen, Michèl A.A.P.

2017-01-01

Purpose: Implementation of novel genetic diagnostic tests is generally driven by technological advances because they promise shorter turnaround times and/or higher diagnostic yields. Other aspects, including impact on clinical management or cost-effectiveness, are often not assessed in detail prior to implementation. Methods: We studied the clinical utility of whole-exome sequencing (WES) in complex pediatric neurology in terms of diagnostic yield and costs. We analyzed 150 patients (and their parents) presenting with complex neurological disorders of suspected genetic origin. In a parallel study, all patients received both the standard diagnostic workup (e.g., cerebral imaging, muscle biopsies or lumbar punctures, and sequential gene-by-gene–based testing) and WES simultaneously. Results: Our unique study design allowed direct comparison of diagnostic yield of both trajectories and provided insight into the economic implications of implementing WES in this diagnostic trajectory. We showed that WES identified significantly more conclusive diagnoses (29.3%) than the standard care pathway (7.3%) without incurring higher costs. Exploratory analysis of WES as a first-tier diagnostic test indicates that WES may even be cost-saving, depending on the extent of other tests being omitted. Conclusion: Our data support such a use of WES in pediatric neurology for disorders of presumed genetic origin. Genet Med advance online publication 23 March 2017 PMID:28333917

Economic implications of current systems

NASA Technical Reports Server (NTRS)

Daniel, R. E.; Aster, R. W.

1983-01-01

The primary goals of this study are to estimate the value of R&D to photovoltaic (PV) metallization systems cost, and to provide a method for selecting an optimal metallization method for any given PV system. The value-added cost and relative electrical performance of 25 state-of-the-art (SOA) and advanced metallization system techniques are compared.

The Cost Structure of Higher Education: Implications for Governmental Policy in Steady State.

ERIC Educational Resources Information Center

Lyell, Edward H.

The historical pattern of resource allocation in American higher education as exemplified by public colleges in Colorado was examined. The reliance upon average cost information in making resource allocation decisions was critiqued for the special problems that arise from student enrollment decline or steady state. A model of resource allocation…

Juvenile Delinquency among African-American Males: Implications for Special Education

ERIC Educational Resources Information Center

Bowman, Lisa J.

2000-01-01

Juvenile delinquency is a pervasive and costly problem. As a society, we are losing too many youth to substance abuse, gang involvement, and criminal activity. The toll delinquency places on families, educational systems, and social welfare systems costs monetarily and socially. In this article, I review the research literature on juvenile…

First Permanent Molar Restoration Differences between Those with or without Dental Sealants.

ERIC Educational Resources Information Center

Kuthy, Raymond A.; And Others

1990-01-01

The study examined differences in the number of restorations in permanent, posterior teeth for those children receiving dental sealants with cost sharing when compared to children who do not receive sealants. Results indicated a 51 percent reduction in restoration rates for each quadrant sealed. Findings have implications for cost savings and…

Update on the Costs of Depakote and Depakene.

ERIC Educational Resources Information Center

Feldstein, Jerome H.; Curtis, Judy L.

1995-01-01

This update on the costs of two anticonvulsant drugs points out that a substantial price increase for Depakene makes it nearly twice as expensive as Depakote and, thus, now makes Depakote the preferred drug over Depakene. Implications of price increases for treatment of individuals with mental retardation who exhibit behavior or mental disorders…

The Implications of the Net Fiscal Benefits Criterion for Cost Sharing in Flood Control Projects.

DTIC Science & Technology

controversial areas. First, it is concluded that the net fiscal benefits criterion has important advantages in the determination of what local governments...would be willing to contribute to the cost of flood control projects, but somewhat less applicability to the analysis of economic efficiency benefits and

Productivity and cost implications of implementing electronic medical records into an ambulatory surgical subspecialty clinic.

PubMed

Patil, Mukul; Puri, Lalit; Gonzalez, Chris M

2008-02-01

Electronic medical records (EMRs) have been proposed as technology through which the quality of healthcare could be improved. We present an analysis of the cost and productivity implications associated with the transition from transcription to an EMR system in an ambulatory setting. Data were collected from eight consecutive fiscal years from 1998 to 2005. Transcription was used in the first 4-year period, and EMR was implemented and used in the later 4-year period. Productivity was defined as ambulatory revenue and the number of patient encounters. All costs related to transcription and EMR implementation were calculated. All data were adjusted for inflation. Within the transcription era, the transcription costs were $395,404, total revenue was $18,137,945, and patient encounters numbered 52,027. The average transcription cost per encounter was $7.60, average revenue per encounter was $348.63, and average revenue per provider was $505,615. Within the EMR era, the EMR-related costs were $293,406, total revenue was $30,370,647 and patient encounters numbered 65,102. The average documentation cost per encounter was $4.51, average revenue per encounter was $466.51, and average revenue per provider was $690,242. The startup costs of initial EMR implementation were $10,329 per physician provider. The results of our study have shown that the implementation of an EMR system when an economy of scale exists coincides with an increase in the revenue per encounter and per provider compared with transcription. The advantage of the fixed costs of an EMR system compared with the variable costs of a transcription-based system is the allowance of cash savings in an ambulatory surgical subspecialty practice.

Preliminary estimates of the economic implications of addiction in the United Arab Emirates.

PubMed

Doran, C M

2017-01-23

This study aimed to provide preliminary estimates of the economic implications of addiction in the United Arab Emirates (UAE). Local and international data sources were used to derive estimates of substancerelated healthcare costs, lost productivity and criminal behaviour. From an estimated population of 8.26 million: ~1.47 million used tobacco (20.5% of adults); 380 085 used cannabis (> 5%); 14 077 used alcohol in a harmful manner (0.2%); and 1408 used opiates (0.02%). The cost of addiction was estimated at US$ 5.47 billion in 2012, equivalent to 1.4% of gross domestic product. Productivity costs were the largest contributor at US$ 4.79 billion (88%) followed by criminal behaviour at US$ 0.65 billion (12%). There were no data to estimate cost of: treating tobacco-related diseases, community education and prevention efforts, or social disharmony. Current data collection efforts are limited in their capacity to fully inform an appropriate response to addiction in the UAE. Resources are required to improve indicators of drug use, monitor harm and evaluate treatment.

Helicopter Emergency Medical Services (HEMS) over-triage and the financial implications for major trauma centres in NSW, Australia

PubMed Central

2013-01-01

Background In NSW Australia, a formal trauma system including the use of helicopter emergency medical services (HEMS) has existed for over 20 years. Despite providing many advantages in NSW, HEMS patients are frequently over-triaged; leading to financial implications for major trauma centres that receive HEMS patients. The aim of this study was to investigate the financial implications of HEMS over-triage from the perspective of major trauma centres in NSW. Methods The study sample included all trauma patients transported via HEMS to 12 major trauma centres in NSW during the period: 1 July 2008 to 30 June 2009. Clinical data were gathered from individual hospital trauma registries and merged with financial information obtained from casemix units at respective hospitals. HEMS over-triage was estimated based on the local definition of minor to moderate trauma (ISS≤12) and hospital length of stay of less than 24 hrs. The actual treatment costs were determined and compared to state-wide peer group averages to obtain estimates of potential funding discrepancies. Results A total of 707 patients transported by HEMS were identified, including 72% pre-hospital (PH; n=507) and 28% inter-hospital (IH; n=200) transports. Over-triage was estimated at 51% for PH patients and 29% for IH patients. Compared to PH patients, IH patients were more costly to treat on average (IH: $42,604; PH: $25,162), however PH patients were more costly overall ($12,329,618 [PH]; $8,265,152 [IH]). When comparing actual treatment costs to peer group averages we found potential funding discrepancies ranging between 4% and 32% across patient groups. Using a sensitivity analysis, the potential funding discrepancy increased with increasing levels of over-triage. Conclusions HEMS patients are frequently over-triaged in NSW, leading to funding implications for major trauma centres. In general, HEMS patient treatment costs are higher than the peer group average and the potential funding discrepancy varies by injury severity and the type of transport performed. Although severely injured HEMS patients are more costly to treat, HEMS patients with minor injuries make up the majority of HEMS transports and have larger relative potential funding discrepancies. Future episode funding models need to account for the variability of trauma patients and the proportion of patients transported via HEMS. PMID:23815080

Helicopter emergency medical services (HEMS) over-triage and the financial implications for major trauma centres in NSW, Australia.

PubMed

Taylor, Colman B; Curtis, Kate; Jan, Stephen; Newcombe, Mark

2013-07-01

In NSW Australia, a formal trauma system including the use of helicopter emergency medical services (HEMS) has existed for over 20 years. Despite providing many advantages in NSW, HEMS patients are frequently over-triaged; leading to financial implications for major trauma centres that receive HEMS patients. The aim of this study was to investigate the financial implications of HEMS over-triage from the perspective of major trauma centres in NSW. The study sample included all trauma patients transported via HEMS to 12 major trauma centres in NSW during the period: 1 July 2008 to 30 June 2009. Clinical data were gathered from individual hospital trauma registries and merged with financial information obtained from casemix units at respective hospitals. HEMS over-triage was estimated based on the local definition of minor to moderate trauma (ISS≤12) and hospital length of stay of less than 24 hrs. The actual treatment costs were determined and compared to state-wide peer group averages to obtain estimates of potential funding discrepancies. A total of 707 patients transported by HEMS were identified, including 72% pre-hospital (PH; n=507) and 28% inter-hospital (IH; n=200) transports. Over-triage was estimated at 51% for PH patients and 29% for IH patients. Compared to PH patients, IH patients were more costly to treat on average (IH: $42,604; PH: $25,162), however PH patients were more costly overall ($12,329,618 [PH]; $8,265,152 [IH]). When comparing actual treatment costs to peer group averages we found potential funding discrepancies ranging between 4% and 32% across patient groups. Using a sensitivity analysis, the potential funding discrepancy increased with increasing levels of over-triage. HEMS patients are frequently over-triaged in NSW, leading to funding implications for major trauma centres. In general, HEMS patient treatment costs are higher than the peer group average and the potential funding discrepancy varies by injury severity and the type of transport performed. Although severely injured HEMS patients are more costly to treat, HEMS patients with minor injuries make up the majority of HEMS transports and have larger relative potential funding discrepancies. Future episode funding models need to account for the variability of trauma patients and the proportion of patients transported via HEMS.

Neuropsychological screening as a standard of care during discharge from psychiatric hospitalization: the preliminary psychometrics of the CNS Screen.

PubMed

Levy, Boaz; Celen-Demirtas, Selda; Surguladze, Tinatin; Eranio, Sara; Ellison, James

2014-03-30

Cost-prohibitive factors currently prevent a warranted integration of neuropsychological screenings into routine psychiatric evaluations, as a standard of care. To overcome this challenge, the current study examined the psychometric properties of a new computerized measure-the CNS Screen. One hundred and twenty six psychiatric inpatients completed the CNS Screen, the Montreal Cognitive Assessment (MoCA), and the Quick Inventory of Depressive Symptomatology-Self Rated (QIDS-SR₁₆) on the day of hospital discharge. Statistical analysis established convergent validity with a moderate correlation between the self-administered CNS Screen and the clinician-administered MoCA (r=0.64). Discriminant validity was implicated by a non-significant correlation with the QIDS-SR₁₆. Concurrent validity was supported by a moderate, negative correlation with patients' age (r=-0.62). In addition, consistent with previous findings, patients with psychotic disorders exhibited significantly poorer performance on the CNS Screen than patients with a mood disorder. Similarly, patients with a formal disability status scored significantly lower than other patients. The CNS Screen was well tolerated by all patients. With further development, this type of measure may provide a cost-effective approach to expanding neuropsychological screenings on inpatient psychiatric units. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Allocation of healthcare dollars: analysis of nonneonatal circumcisions in Florida.

PubMed

Gutwein, Luke G; Alvarez, Juan F; Gutwein, Jenny L; Kays, David W; Islam, Saleem

2013-09-01

Circumcision remains a controversial operation. Most procedures are performed in the neonatal period and avoid general anesthesia. Legislation driven by policy statements from the American Academy of Pediatrics led to significant changes in circumcisions in Florida with a shift to nonneonatal procedures as a result of costs. We sought to study the prevalence and financial implications of nonneonatal circumcisions in Florida. A retrospective population study was performed using the Florida Agency for Health Care Administration outpatient procedure database. We queried for patients 0 to 17 years of age undergoing circumcision between 2003 and 2008. Demographics, charges, and insurance status were analyzed. From 2003 to 2008, 31,741 outpatient circumcisions were performed. Publicly funded circumcisions accounted for 17,537 charging the state $6,263 on average for each circumcision at an expense of $111.8 million for the 5-year time period analyzed. Publicly funded circumcision procedures increased more than sixfold (P < 0.0001) than those covered by private insurance. Black circumcision procedures increased 77.3 per cent, whereas white circumcisions increased 28.7 per cent. There has been a significant increase in the number of nonneonatal circumcisions performed. This has resulted in an increase in economic health care. Public funding of neonatal circumcision could result in significant cost savings and avoid potential complications of general anesthesia.

Effect of medicare payment on rural health care systems.

PubMed

McBride, Timothy D; Mueller, Keith J

2002-01-01

Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

Cost-effectiveness analysis of lapatinib in HER-2-positive advanced breast cancer.

PubMed

Le, Quang A; Hay, Joel W

2009-02-01

A recent clinical trial demonstrated that the addition of lapatinib to capecitabine in the treatment of HER-2-positive advanced breast cancer (ABC) significantly increases median time to progression. The objective of the current analysis was to assess the cost-effectiveness of this therapy from the US societal perspective. A Markov model comprising 4 health states (stable disease, respond-to-therapy, disease progression, and death) was developed to estimate the projected-lifetime clinical and economic implications of this therapy. The model used Monte Carlo simulation to imitate the clinical course of a typical patient with ABC and updated with response rates and major adverse effects. Transition probabilities were estimated based on the results from the EGF100151 and EGF20002 clinical trials of lapatinib. Health state utilities, direct and indirect costs of the therapy, major adverse events, laboratory tests, and costs of disease progression were obtained from published sources. The model used a 3% discount rate and reported in 2007 US dollars. Over a lifetime, the addition of lapatinib to capecitabine as combination therapy was estimated to cost an additional $19,630, with an expected gain of 0.12 quality-adjusted life years (QALY) or an incremental cost-effectiveness ratio (ICER) of $166,113 per QALY gained. The 95% confidence limits of the ICER ranged from $158,000 to $215,000/QALY. A cost-effectiveness acceptability curve indicated less than 1% probability that the ICER would be lower than $100,000/QALY. Compared with commonly accepted willingness-to-pay thresholds in oncology treatment, the addition of lapatinib to capecitabine is not clearly cost-effective; and most likely to result in an ICER somewhat higher than the societal willingness-to-pay threshold limits. (c) 2008 American Cancer Society.

The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial).

PubMed

Ahmed, Rashid J; Gafni, Amiram; Hutton, Eileen K; Hu, Zheng Jing; Pullenayegum, Eleanor; von Dadelszen, Peter; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E; Menzies, Jennifer; Sanchez, J Johanna; Ganzevoort, Wessel; Helewa, Michael; Lee, Shoo K; Lee, Terry; Logan, Alexander G; Moutquin, Jean-Marie; Singer, Joel; Thornton, Jim G; Welch, Ross; Magee, Laura A

2016-10-01

The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned "less tight" (target diastolic 100 mm Hg) and "tight" (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman-infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412. © 2016 The Authors.

Addressing the risk of bacterial contamination in platelets: a hospital economic perspective.

PubMed

Li, Justin W; Brecher, Mark E; Jacobson, Jessica L; Harm, Sarah K; Chen, Dorothy; El-Gamil, Audrey; Dobson, Al; Mintz, Paul D

2017-10-01

Bacterially contaminated platelets (PLTs) remain a serious risk. The Food and Drug Administration has issued draft guidance recommending hospitals implement secondary testing or transfuse PLTs that have been treated with pathogen reduction technology (PRT). The cost implications of these approaches are not well understood. We modeled incurred costs when hospitals acquire, process, and transfuse PLTs that are PRT treated with INTERCEPT (Cerus Corp.) or secondary tested with the PLT PGD Test (Verax Biomedical). Hospitals will spend $221.27 (30.0%) more per PRT-treated apheresis PLT unit administered compared to a Zika-tested apheresis PLT unit that is irradiated and PGD tested in hospital. This difference is reflected in PRT PLT units having: 1) a higher hospital purchase price ($100.00 additional charge compared to an untreated PLT); 2) lower therapeutic effectiveness than untreated PLTs among hematologic-oncologic patients, which contributes to additional transfusions ($96.05); or 3) fewer PLT storage days, which contributes to higher outdating cost from expired PLTs ($67.87). Only a small portion of the incremental costs for PRT-treated PLTs are offset by costs that may be avoided, including primary bacterial culture, secondary bacterial testing ($26.65), hospital irradiation ($8.50), Zika testing ($4.47), and other costs ($3.03). The significantly higher cost of PRT-treated PLTs over PGD-tested PLTs should interest stakeholders. For hospitals that outdate PLTs, savings associated with expiration extension to 7 days by adding PGD testing will likely be substantially greater than the cost of implementing PGD-testing. Our findings might usefully inform a hospital's decision to select a particular blood safety approach. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

Breast cancer treatment costs in younger, privately insured women.

PubMed

Allaire, Benjamin T; Ekwueme, Donatus U; Poehler, Diana; Thomas, Cheryll C; Guy, Gery P; Subramanian, Sujha; Trogdon, Justin G

2017-07-01

Younger women (under age 45 years) diagnosed with breast cancer often face more aggressive tumors, higher treatment intensity, lower survival rates, and greater financial hardship. The purpose of this study was to estimate breast cancer costs by stage at diagnosis during the first 18 months of treatment for privately insured younger women. We analyzed North Carolina cancer registry data linked to claims data from private insurers from 2003 to 2010. Breast cancer patients were split into two cohorts: a younger and older group aged 21-44 and 45-64 years, respectively. We conducted a cohort study and matched women with and without breast cancer using age, ZIP, and Charlson Comorbidity Index. We calculated mean excess costs between breast cancer and non-breast cancer patients at 6, 12, and 18 months. For younger women, AJCC 6th edition stage II cancer was the most common at diagnosis (40%), followed by stage I (34%). On the other hand, older women had more stage I (46%) cancer followed by stage II (34%). The excess costs for younger and older women at 12 months were $97,486 (95% confidence interval [CI] $93,631-101,341) and $75,737 (95% CI $73,962-77,512), respectively. Younger breast cancer patients had both a higher prevalence of later-stage disease and higher within-stage costs. The study reports high costs of treatment for both younger and older women than a non-cancer comparison group; however, the estimated excess cost was significantly higher for younger women. The financial implications of breast cancer treatment costs for younger women need to be explored in future studies.

Role determination in nursing--implications for service provision.

PubMed

Chang, A M; Twinn, S

1995-01-01

The current changes in nursing practice which have placed a greater need than ever before for nurses to have clearly defined roles, has resulted from the demand for cost-effective care and for nurses to justify their contribution to that care. This two stage, descriptive study was undertaken as part of a larger study to determine the implications of definition of the role of nursing for service provision in Hong Kong. The initial data collected using group interviews to generate ideas about the activities of the registered nurse (RN) and enrolled nurse (EN), was followed by a questionnaire to a sample of 410 RNs, representing three different grades of nursing staff. The 5-point Likert type questionnaire asked respondents to indicate levels of agreement with 67 activities. Sixty-five of the 67 activities of the RN were agreed to and were statistically significant (P < 0.001) in the difference from the undecided position. The findings also demonstrated a lack of agreement amongst grades of staff in their perception of nursing role. Fifty-six of the same 67 activities were agreed to for the EN and were statistically significant (P < 0.001) in the difference from the undecided position. This similarity between perceptions of EN and RN activities highlights the need to reconsider the contribution of ENs to patient care within the nursing structure in Hong Kong. These findings have implications not only for the management of nursing but also for further research in determining the interpretation of role in nursing to high quality patient care.

IPAD products and implications for the future

NASA Technical Reports Server (NTRS)

Miller, R. E., Jr.

1980-01-01

The betterment of productivity through the improvement of product quality and the reduction of cost is addressed. Productivity improvement is sought through (1) reduction of required resources, (2) improved ask results through the management of such saved resources, (3) reduced downstream costs through manufacturing-oriented engineering, and (4) lowered risks in the making of product design decisions. The IPAD products are both hardware architecture and software distributed over a number of heterogeneous computers in this architecture. These IPAD products are described in terms of capability and engineering usefulness. The future implications of state-of-the-art IPAD hardware and software architectures are discussed in terms of their impact on the functions and on structures of organizations concerned with creating products.

MESSOC capabilities and results. [Model for Estimating Space Station Opertions Costs

NASA Technical Reports Server (NTRS)

Shishko, Robert

1990-01-01

MESSOC (Model for Estimating Space Station Operations Costs) is the result of a multi-year effort by NASA to understand and model the mature operations cost of Space Station Freedom. This paper focuses on MESSOC's ability to contribute to life-cycle cost analyses through its logistics equations and databases. Together, these afford MESSOC the capability to project not only annual logistics costs for a variety of Space Station scenarios, but critical non-cost logistics results such as annual Station maintenance crewhours, upweight/downweight, and on-orbit sparing availability as well. MESSOC results using current logistics databases and baseline scenario have already shown important implications for on-orbit maintenance approaches, space transportation systems, and international operations cost sharing.

Determinants of customer satisfaction with hospitals: a managerial model.

PubMed

Andaleeb, S S

1998-01-01

States that rapid changes in the environment have exerted significant pressures on hospitals to incorporate patient satisfaction in their strategic stance and quest for market share and long-term viability. This study proposes and tests a five-factor model that explains considerable variation in customer satisfaction with hospitals. These factors include communication with patients, competence of the staff, their demeanour, quality of the facilities, and perceived costs; they also represent strategic concepts that managers can address in their bid to remain competitive. A probability sample was selected and a multiple regression model used to test the hypotheses. The results indicate that all five variables were significant in the model and explained 62 per cent of the variation in the dependent variable. Managerial implications of the proposed model are discussed.

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study.

PubMed

Poudel, Ak Narayan; Newlands, David; Simkhada, Padam

2017-01-24

There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs. This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household's perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations. Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$ 30.2/month), which was 28.5% of the sample households' average monthly income. The average total direct costs for seeking HIV/AIDS treatment were NRs 1512 (US$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs. The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households.

Delivery of antiretroviral treatment services in India: Estimated costs incurred under the National AIDS Control Programme.

PubMed

Agarwal, Reshu; Rewari, Bharat Bhushan; Shastri, Suresh; Nagaraja, Sharath Burugina; Rathore, Abhilakh Singh

2017-04-01

Competing domestic health priorities and shrinking financial support from external agencies necessitates that India's National AIDS Control Programme (NACP) brings in cost efficiencies to sustain the programme. In addition, current plans to expand the criteria for eligibility for antiretroviral therapy (ART) in India will have significant financial implications in the near future. ART centres in India provide comprehensive services to people living with HIV (PLHIV): those fulfilling national eligibility criteria and receiving ART and those on pre-ART care, i.e. not on ART. ART centres are financially supported (i) directly by the NACP; and (ii) indirectly by general health systems. This study was conducted to determine (i) the cost incurred per patient per year of pre-ART and ART services at ART centres; and (ii) the proportion of this cost incurred by the NACP and by general health systems. The study used national data from April 2013 to March 2014, on ART costs and non-ART costs (human resources, laboratory tests, training, prophylaxis and management of opportunistic infections, hospitalization, operational, and programme management). Data were extracted from procurement records and reports, statements of expenditure at national and state level, records and reports from ART centres, databases of the National AIDS Control Organisation, and reports on use of antiretroviral drugs. The analysis estimates the cost for ART services as US$ 133.89 (?8032) per patient per year, of which 66% (US$ 88.66, ?5320) is for antiretroviral drugs and 34% (US$ 45.23, ?2712) is for non-ART recurrent expenditure, while the cost for pre-ART care is US$ 33.05 (?1983) per patient per year. The low costs incurred for patients in ART and pre-ART care services can be attributed mainly to the low costs of generic drugs. However, further integration with general health systems may facilitate additional cost saving, such as in human resources.

Examining the production costs of antiretroviral drugs.

PubMed

Pinheiro, Eloan; Vasan, Ashwin; Kim, Jim Yong; Lee, Evan; Guimier, Jean Marc; Perriens, Joseph

2006-08-22

To present direct manufacturing costs and price calculations of individual antiretroviral drugs, enabling those responsible for their procurement to have a better understanding of the cost structure of their production, and to indicate the prices at which these antiretroviral drugs could be offered in developing country markets. Direct manufacturing costs and factory prices for selected first and second-line antiretroviral drugs were calculated based on cost structure data from a state-owned company in Brazil. Prices for the active pharmaceutical ingredients (API) were taken from a recent survey by the World Health Organization (WHO). The calculated prices for antiretroviral drugs are compared with quoted prices offered by privately-owned, for-profit manufacturers. The API represents the largest component of direct manufacturing costs (55-99%), while other inputs, such as salaries, equipment costs, and scale of production, have a minimal impact. The calculated prices for most of the antiretroviral drugs studied fall within the lower quartile of the range of quoted prices in developing country markets. The exceptions are those drugs, primarily for second-line therapy, for which the API is either under patent, in short supply, or in limited use in developing countries (e.g. abacavir, lopinavir/ritonavir, nelfinavir, saquinavir). The availability of data on the cost of antiretroviral drug production and calculation of factory prices under a sustainable business model provide benchmarks that bulk purchasers of antiretroviral drugs could use to negotiate lower prices. While truly significant price decreases for antiretroviral drugs will depend largely on the future evolution of API prices, the present study demonstrates that for several antiretroviral drugs price reduction is currently possible. Whether or not these reductions materialize will depend on the magnitude of indirect cost and profit added by each supplier over the direct production costs. The ability to achieve price reductions in line with production costs will have critical implications for sustainable treatment for HIV/AIDS in the developing world.

Characteristics of acute treatment costs of traumatic brain injury in Eastern China--a multi-centre prospective observational study.

PubMed

Yuan, Qiang; Liu, Hua; Wu, Xing; Sun, Yirui; Yao, Haijun; Zhou, Liangfu; Hu, Jin

2012-12-01

This study investigated acute treatment costs and related factors for traumatic brain injuries (TBI) in eastern China based on a prospective multicentre study. Data were prospectively collected from 80 hospitals in eastern China by standardized structured questionnaires during 2004. Included patients were admitted to hospitals via an emergency service with a diagnosis of TBI. The total acute hospitalization treatment costs derived from unsubsidized total hospital billings were used as the main outcome measure. Univariate and multivariable regression models were used to examine factors associated with each outcome. In total, 13,007 TBI cases were identified from 80 hospitals in eastern China. The median cost per hospitalization was $879 US (range, $72-45,894). The median cost per day was $79 (interquartile range, $49-126). The hospitalization costs varied based on the cause of TBI, with a median of $1017 for traffic accidents, $816 for falls, $490 for blows to the head, and $712 for falls. The hospitalization costs also varied by injury type with a mean of $918 for TBI associated with other injuries and $831 for isolated TBI. Using multiple regression analyses, lower admission Glasgow Coma score, longer hospital stay (LOS), male sex, transient patient status, traffic accident, injury occurring on a construction site, treatment at a tertiary hospital, neurosurgical intensive care unit (NICU) or ICU stay, associated polytrauma, and those who needed a neurosurgical operation had significantly higher total acute hospitalization costs than those of other groups. Good recovery and self-paying patients had lower total costs. A double LOS was associated with a 1.61 (95% confidence interval, 1.59-1.62) times higher hospital cost. Our results have potential implications for health-care resource planning during TBI treatment. Measures to prevent traffic accidents and reduce the LOS may help to reduce acute hospitalization costs. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review.

PubMed

Zakiyah, Neily; van Asselt, Antoinette D I; Roijmans, Frank; Postma, Maarten J

2016-01-01

A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research. A systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors. Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate further evidence on costs, cost-effectiveness, and affordability, and to support increased funding and investments in family planning programs.

Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review

PubMed Central

Zakiyah, Neily; van Asselt, Antoinette D. I.; Roijmans, Frank; Postma, Maarten J.

2016-01-01

Background A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research. Study design A systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors. Conclusion Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate further evidence on costs, cost-effectiveness, and affordability, and to support increased funding and investments in family planning programs. PMID:27992552

Cost-benefit analysis of space technology

NASA Technical Reports Server (NTRS)

Hein, G. F.; Stevenson, S. M.; Sivo, J. N.

1976-01-01

A discussion of the implications and problems associated with the use of cost-benefit techniques is presented. Knowledge of these problems is useful in the structure of a decision making process. A methodology of cost-benefit analysis is presented for the evaluation of space technology. The use of the methodology is demonstrated with an evaluation of ion thrusters for north-south stationkeeping aboard geosynchronous communication satellites. A critique of the concept of consumers surplus for measuring benefits is also presented.

Foreign Military Sales: A Growing Concern. Departments of State and Defense

DTIC Science & Technology

1976-06-01

See p. 27.) --Implications of providing lo1.stical sup- port for de ~ense articles sold to foreign countries. (Seep. 28.) --Recovery of full cost ...items. we have taken exception to De - f~nse’s decision to exclude certain costs in its FMS pricing. ~ From November 1969 to December 1~75, we issued 10...Force readiness Follow-on support Recovering costs of sal~s Legislation to control growing arms sales \\ Opportunities identified by GAO for

Modelling the resource implications and budget impact of managing cow milk allergy in Australia.

PubMed

Guest, J F; Nagy, E

2009-02-01

To estimate the resource implications and budget impact of current clinical practice for managing cow milk allergy (CMA) in Australia, from the perspective of the publicly funded healthcare system. A decision model was constructed using published clinical outcomes and clinician-derived resource utilisation estimates. The model was used to estimate the expected 6-monthly levels of healthcare resource use and corresponding costs attributable to managing 6150 new CMA sufferers following referral to a specialist. The expected 6-monthly costs of managing 6150 newly-diagnosed infants with CMA following referral to a specialist was an estimated (Australian dollars, AU$) AU$6.5 million at 2006/07 prices. Clinical nutrition preparations were found to be the primary cost driver accounting for 62% of the total 6-monthly cost and clinician visits were the secondary cost driver accounting for up to a further 28% of the total 6-monthly cost. Sensitivity analysis showed there would be fewer visits to hospital-based paediatric gastroenterologists and paediatric immunologists/allergists if all newly-diagnosed patients were prescribed an amino acid formula (AAF) following referral to a specialist, instead of being managed according to current practice. CMA imposes a substantial burden on the publicly funded healthcare system in Australia. However, using an AAF as the initial treatment for CMA can potentially release limited hospital resources for alternative use within the paediatric healthcare system.

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

PubMed

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

2016-04-01

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

Dietary variation and mechanical properties of articular cartilage in the temporomandibular joint: implications for the role of plasticity in mechanobiology and pathobiology.

PubMed

Ravosa, Matthew J; Kane, Robert J

2017-10-01

Due to their nature as tissue composites, skeletal joints pose an additional challenge in terms of evaluating the functional significance of morphological variation in their bony and cartilaginous components in response to altered loading conditions. Arguably, this complexity requires more direct means of investigating joint plasticity and performance than typically employed to analyze macro- and micro-anatomical phenomena. To address a significant gap in our understanding of the plasticity of the mammalian temporomandibular joint (TMJ), we investigated the histology and mechanical properties of condylar articular cartilage in rabbits subjected to long-term variation in diet-induced masticatory stresses, specifically cyclical loading. Three cohorts of male weanlings were raised for six months on different diets until adulthood. Following euthanasia, the TMJ condyles on one side were dissected away, fixed, decalcified, dehydrated, embedded and sectioned. Safranin O staining was employed to identify variation in proteoglycan content, which in turn was used to predict patterns of articular cartilage stiffness in contralateral condylar specimens for each treatment group. Hematoxylin and eosin staining was used to quantify diet-induced changes in chondrocyte hypertrophy and cellularity. Mechanical tests document significant decreases in articular cartilage stiffness corresponding to patterns of extracellular matrix relative protein abundance in rabbits subjected to greater cyclical loading. This indicates that TMJs routinely subjected to higher masticatory stresses due to a challenging diet eventually develop postnatal decreases in the ability to counter compressive loads during postcanine biting and chewing. These findings provide novel information regarding TMJ performance, with broader implications about the costs and benefits of phenotypic plasticity as well as implications for how such biological processes affect connective tissue mechanobiology and pathobiology. Copyright © 2017 Elsevier GmbH. All rights reserved.

Screening for diabetes in unconventional locations: resource implications and economics of screening in optometry practices.

PubMed

Howse, Jennifer H; Jones, Steve; Hungin, A Pali S

2011-10-01

Unconventional locations outwith general medical practice may prove opportunities for screening. The aim was to determine the resource implications and economics of a screening service using random capillary blood glucose (rCBG) tests to detect raised blood glucose levels in the "at risk" population attending high street optometry practices. A screening service was implemented in optometry practices in North East England: the cost of the service and the implication of different screening strategies was estimated. The cost of a screening test was £5.53-£11.20, depending on the screening strategy employed and who carried out the testing. Refining the screening strategy to target those ≥40 years with BMI of ≥25 kg/m(2) and/or family history of diabetes resulted in a cost per case referred to the GP of £14.38-£26.36. Implementing this strategy in half of optometric practices in England would have the potential to identify up to 150,000 new cases of diabetes and prediabetes a year. Optometry practices provide an effective way of identifying people who would benefit from further investigation for diabetes. Effectiveness could be improved further by improving cooperation and communication between optometrists and medical practitioners. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Economic and clinical evaluation of fondaparinux vs. enoxaparin for thromboprophylaxis following general surgery.

PubMed

Farias-Eisner, Robin; Horblyuk, Ruslan; Franklin, Meg; Lunacsek, Orsolya E; Happe, Laura E

2009-05-01

Patients undergoing general surgical procedures are at increased risk for venous thromboembolism (VTE). Compliance rates with established guidelines for VTE thromboprophylaxis in patients at moderate-to-high risk are notably low. Recent literature has demonstrated that fondaparinux is associated with lower costs and fewer VTEs than enoxaparin in patients undergoing major orthopedic surgery (MOS), but data are limited in patients undergoing general surgery. This study was conducted to evaluate the cost implications and relative real-world effectiveness of fondaparinux vs. enoxaparin in general surgery patients. Data were obtained from inpatient billing records from over 500 hospitals using Premier's Perspective Comparative Database. Patients hospitalized for general surgery between July 1, 2003 and January 31, 2006 were eligible for inclusion. Eligible patients were included if they received fondaparinux or enoxaparin after their general surgery date. Patients were excluded if they received both anticoagulants on their first day of therapy, were <18 years of age on the surgery date, or did not have data 6 months prior and 1 month post hospitalization. Included patients were stratified into two cohorts based on their first anticoagulant, fondaparinux or enoxaparin. Patients were matched in each group on 1:1 case-control matching based on propensity scores. A total of 5364 patients were included (n = 2682 for each cohort) from 326 unique hospitals. Average total costs per patient for the fondaparinux group were significantly lower than the enoxaparin group ($15 156 vs. 17 741, p < 0.0001). Patients receiving fondaparinux were significantly less likely to experience a VTE (2.80 vs. 3.77%, p = 0.046, a 35% relative risk reduction). No significant differences in bleeding events between the cohorts were observed (p = 0.6047), and no significant differences in all-cause inpatient death were noted (p = 0.3673). Fondaparinux was associated with significantly lower costs and fewer VTEs compared to enoxaparin without an increase in bleed rates or all-cause inpatient mortality. The findings from this study are limited by the retrospective study design and should only be generalized to a similar patient population.

Applying geologic sensitivity analysis to environmental risk management: The financial implications

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

Rogers, D.T.

The financial risks associated with environmental contamination can be staggering and are often difficult to identify and accurately assess. Geologic sensitivity analysis is gaining recognition as a significant and useful tool that can empower the user with crucial information concerning environmental risk management and brownfield redevelopment. It is particularly useful when (1) evaluating the potential risks associated with redevelopment of historical industrial facilities (brownfields) and (2) planning for future development, especially in areas of rapid development because the number of potential contaminating sources often increases with an increase in economic development. An examination of the financial implications relating to geologicmore » sensitivity analysis in southeastern Michigan from numerous case studies indicate that the environmental cost of contamination may be 100 to 1,000 times greater at a geologically sensitive location compared to the least sensitive location. Geologic sensitivity analysis has demonstrated that near-surface geology may influence the environmental impact of a contaminated site to a greater extent than the amount and type of industrial development.« less

Creating value in health care through big data: opportunities and policy implications.

PubMed

Roski, Joachim; Bo-Linn, George W; Andrews, Timothy A

2014-07-01

Big data has the potential to create significant value in health care by improving outcomes while lowering costs. Big data's defining features include the ability to handle massive data volume and variety at high velocity. New, flexible, and easily expandable information technology (IT) infrastructure, including so-called data lakes and cloud data storage and management solutions, make big-data analytics possible. However, most health IT systems still rely on data warehouse structures. Without the right IT infrastructure, analytic tools, visualization approaches, work flows, and interfaces, the insights provided by big data are likely to be limited. Big data's success in creating value in the health care sector may require changes in current polices to balance the potential societal benefits of big-data approaches and the protection of patients' confidentiality. Other policy implications of using big data are that many current practices and policies related to data use, access, sharing, privacy, and stewardship need to be revised. Project HOPE—The People-to-People Health Foundation, Inc.

Heat treatment induced bacterial changes in irrigation water and their implications for plant disease management.

PubMed

Hao, W; Hong, C X

2014-05-01

A new heat treatment for recycled irrigation water using 48 °C for 24 h to inactivate Phytophthora and bacterial plant pathogens is estimated to reduce fuel cost and environmental footprint by more than 50 % compared to current protocol (95 °C for 30 s). The objective of this study was to determine the impact of this new heat treatment temperature regime on bacterial community structure in water and its practical implications. Bacterial communities in irrigation water were analyzed before and after heat treatment using both culture-dependent and -independent strategies based on the 16S ribosomal DNA. A significant shift was observed in the bacterial community after heat treatment. Most importantly, bacteria with biological control potential--Bacillus and Paenibacillus, and Pseudomonas species became more abundant at both 48 and 42 °C. These findings imply that the new heat treatment procedure not only controls existing plant pathogens but also may make the heat-treated irrigation water a more antagonistic environment against plant pathogens, promoting sustainable disease management.

Fundus Photography in the 21st Century--A Review of Recent Technological Advances and Their Implications for Worldwide Healthcare.

PubMed

Panwar, Nishtha; Huang, Philemon; Lee, Jiaying; Keane, Pearse A; Chuan, Tjin Swee; Richhariya, Ashutosh; Teoh, Stephen; Lim, Tock Han; Agrawal, Rupesh

2016-03-01

The introduction of fundus photography has impacted retinal imaging and retinal screening programs significantly. Fundus cameras play a vital role in addressing the cause of preventive blindness. More attention is being turned to developing countries, where infrastructure and access to healthcare are limited. One of the major limitations for tele-ophthalmology is restricted access to the office-based fundus camera. Recent advances in access to telecommunications coupled with introduction of portable cameras and smartphone-based fundus imaging systems have resulted in an exponential surge in available technologies for portable fundus photography. Retinal cameras in the near future would have to cater to these needs by featuring a low-cost, portable design with automated controls and digitalized images with Web-based transfer. In this review, we aim to highlight the advances of fundus photography for retinal screening as well as discuss the advantages, disadvantages, and implications of the various technologies that are currently available.

Penicillin skin testing: potential implications for antimicrobial stewardship.

PubMed

Unger, Nathan R; Gauthier, Timothy P; Cheung, Linda W

2013-08-01

As the progression of multidrug-resistant organisms and lack of novel antibiotics move us closer toward a potential postantibiotic era, it is paramount to preserve the longevity of current therapeutic agents. Moreover, novel interventions for antimicrobial stewardship programs are integral to combating antimicrobial resistance worldwide. One unique method that may decrease the use of second-line antibiotics (e.g., fluoroquinolones, vancomycin) while facilitating access to a preferred β-lactam regimen in numerous health care settings is a penicillin skin test. Provided that up to 10% of patients have a reported penicillin allergy, of whom ~10% have true IgE-mediated hypersensitivity, significant potential exists to utilize a penicillin skin test to safely identify those who may receive penicillin or a β-lactam antibiotic. In this article, we provide information on the background, associated costs, currently available literature, pharmacists' role, antimicrobial stewardship implications, potential barriers, and misconceptions, as well as future directions associated with the penicillin skin test. © 2013 Pharmacotherapy Publications, Inc.

Fundus Photography in the 21st Century—A Review of Recent Technological Advances and Their Implications for Worldwide Healthcare

PubMed Central

Panwar, Nishtha; Huang, Philemon; Lee, Jiaying; Keane, Pearse A.; Chuan, Tjin Swee; Richhariya, Ashutosh; Teoh, Stephen; Lim, Tock Han

2016-01-01

Abstract Background: The introduction of fundus photography has impacted retinal imaging and retinal screening programs significantly. Literature Review: Fundus cameras play a vital role in addressing the cause of preventive blindness. More attention is being turned to developing countries, where infrastructure and access to healthcare are limited. One of the major limitations for tele-ophthalmology is restricted access to the office-based fundus camera. Results: Recent advances in access to telecommunications coupled with introduction of portable cameras and smartphone-based fundus imaging systems have resulted in an exponential surge in available technologies for portable fundus photography. Retinal cameras in the near future would have to cater to these needs by featuring a low-cost, portable design with automated controls and digitalized images with Web-based transfer. Conclusions: In this review, we aim to highlight the advances of fundus photography for retinal screening as well as discuss the advantages, disadvantages, and implications of the various technologies that are currently available. PMID:26308281

Effects of Wolves on Elk and Cattle Behaviors: Implications for Livestock Production and Wolf Conservation

PubMed Central

Laporte, Isabelle; Muhly, Tyler B.; Pitt, Justin A.; Alexander, Mike; Musiani, Marco

2010-01-01

Background In many areas, livestock are grazed within wolf (Canis lupus) range. Predation and harassment of livestock by wolves creates conflict and is a significant challenge for wolf conservation. Wild prey, such as elk (Cervus elaphus), perform anti-predator behaviors. Artificial selection of cattle (Bos taurus) might have resulted in attenuation or absence of anti-predator responses, or in erratic and inconsistent responses. Regardless, such responses might have implications on stress and fitness. Methodology/Principal Findings We compared elk and cattle anti-predator responses to wolves in southwest Alberta, Canada within home ranges and livestock pastures, respectively. We deployed satellite- and GPS-telemetry collars on wolves, elk, and cattle (n = 16, 10 and 78, respectively) and measured seven prey response variables during periods of wolf presence and absence (speed, path sinuosity, time spent head-up, distance to neighboring animals, terrain ruggedness, slope and distance to forest). During independent periods of wolf presence (n = 72), individual elk increased path sinuosity (Z = −2.720, P = 0.007) and used more rugged terrain (Z = −2.856, P = 0.004) and steeper slopes (Z = −3.065, P = 0.002). For cattle, individual as well as group behavioral analyses were feasible and these indicated increased path sinuosity (Z = −2.720, P = 0.007) and decreased distance to neighbors (Z = −2.551, P = 0.011). In addition, cattle groups showed a number of behavioral changes concomitant to wolf visits, with variable direction in changes. Conclusions/Significance Our results suggest both elk and cattle modify their behavior in relation to wolf presence, with potential energetic costs. Our study does not allow evaluating the efficacy of anti-predator behaviors, but indicates that artificial selection did not result in their absence in cattle. The costs of wolf predation on livestock are often compensated considering just the market value of the animal killed. However, society might consider refunding some additional costs (e.g., weight loss and reduced reproduction) that might be associated with the changes in cattle behaviors that we documented. PMID:20694139

Economic implications of using bendamustine, alemtuzumab, or chlorambucil as a first-line therapy for chronic lymphocytic leukemia in the US: a cost-effectiveness analysis.

PubMed

Kongnakorn, Thitima; Sterchele, James A; Salvador, Christopher G; Getsios, Denis; Mwamburi, Mkaya

2014-01-01

The objective of this analysis was to evaluate the cost-effectiveness of using bendamustine versus alemtuzumab or bendamustine versus chlorambucil as a first-line therapy in patients with Binet stage B or C chronic lymphocytic leukemia (CLL) in the US. A discrete event simulation of the disease course of CLL was developed to evaluate the economic implications of single-agent treatment with bendamustine, alemtuzumab, or chlorambucil, which are indicated for a treatment-naïve patient population with Binet stage B or C CLL. Data from clinical trials were used to create a simulated patient population, risk equations for progression-free survival and survival post disease progression, response rates, and rates of adverse events. Costs from a US health care payer perspective in 2012 US dollars, survival (life years), and quality-adjusted life years (QALYs) were estimated over a patient's lifetime; all were discounted at 3% per year. Compared with alemtuzumab, bendamustine was considered to be a dominant treatment providing greater benefit (6.10 versus 5.37 life years and 4.02 versus 3.45 QALYs) at lower cost ($78,776 versus $121,441). Compared with chlorambucil, bendamustine was associated with higher costs ($78,776 versus $42,337) but with improved health outcomes (6.10 versus 5.21 life years and 4.02 versus 3.30 QALYs), resulting in incremental cost-effectiveness ratios of $40,971 per life year gained and $50,619 per QALY gained. Bendamustine is expected to provide cost savings and greater health benefit than alemtuzumab in treatment-naïve patients with CLL. Furthermore, it can be considered as a cost-effective treatment providing health benefits at an acceptable cost versus chlorambucil in the US.

Life beyond earth and the mind of man

NASA Technical Reports Server (NTRS)

Berendzen, R. (Editor)

1973-01-01

A symposium is reported on the implications of the possibility of extraterrestrial life for social, philosophical, and humanistic impacts. The viewpoints from astronomers, biologists, physicists, anthropologists, and theologians are given. Costs involved for finding this life are discussed along with the possible benefits to society. The direct implications from radio telescopes, the Pioneer 10 plaque, and discussions between the panelists are also reported.

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations

PubMed Central

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2015-01-01

Background: While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. Aim: This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. Design: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Results and discussion: Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Normative appraisal: Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. Conclusion: The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. PMID:26294218

Changing paradigms: Manufacturing vs. fabricating a high volume Hold Down and Release Mechanism

NASA Technical Reports Server (NTRS)

Maus, Daryl; Monick, Doug

1995-01-01

A detailed description of the Hold Down and Release Mechanisms designed for a 70+ constellation of spacecraft is presented. The design is reviewed to understand the practical implications of severely constraining cost. Strategies for adapting the traditional aerospace design paradigm to a more commercial, cost driven paradigm are discussed and practical examples are cited.

Costs of Success: Financial Implications of Implementation of Active Learning in Introductory Physics Courses for Students and Administrators

ERIC Educational Resources Information Center

Brewe, Eric; Dou, Remy; Shand, Robert

2018-01-01

Although active learning is supported by strong evidence of efficacy in undergraduate science instruction, institutions of higher education have yet to embrace comprehensive change. Costs of transforming instruction are regularly cited as a key factor in not adopting active-learning instructional practices. Some cite that alternative methods to…

Financial Implications of the Extended School Year.

ERIC Educational Resources Information Center

San Diego Unified School District, CA. Administrative Research Dept.

This report considers the costs of three types of extended school year programs--all modifications of the quarter system--and compares these costs to the regular program. Compared against the traditional approach are: (1) a quarter system in which students attend three quarters a year and are off one quarter, meaning that 75% of all students are…

An Analysis of Staff Development Programs and Their Costs in Three Urban School Districts.

ERIC Educational Resources Information Center

Moore, Donald R.; Hyde, Arthur A.

This report analyzes teacher staff development programs and their costs in three large urban school districts, and discusses research and policy implications of the research results. The districts were selected through a survey of school districts serving the 75 largest U.S. cities, and were chosen because of their respectively high, medium, and…

Reducing Lifecycle Sustainment Costs

DTIC Science & Technology

2015-05-01

ahead of government systems – Specific O&S needs in government: depots, software centers, VAMOSC/ ERP interfaces Implications of ERP Systems...funding is not allocated for its implementation .  Technology Refresh often requires non-recurring engineering investment, but the Working Capital Funds...VAMOSC Systems – Cost and Software Data Reports (CSDRs) • Contractor Logistics Support Contracts • Includes subcontractor reporting – Effects of

Inactive Lifestyles and Obesity in Chilean Youth: Individual Costs in Health-Related Choices

ERIC Educational Resources Information Center

Correa-Burrows, Paulina; Burrows, Raquel A.

2014-01-01

Objective: A recent economic approach suggests that people do not account for the long-term implications of unhealthy behaviours, preventing them from performing a fully rational trade-off between current benefits and future costs, leading to negative health outcomes. We examined whether the current allocation of time to physical activity among…

Comparative Benefit-Cost Analysis of the Abecedarian Program and Its Policy Implications

ERIC Educational Resources Information Center

Barnett, W. S.; Masse, Leonard N.

2007-01-01

Child care and education are to some extent joint products of preschool programs, but public policy and research frequently approach these two goals independently. We present a benefit-cost analysis of a preschool program that provided intensive education during full-day child care. Data were obtained from a randomized trial with longitudinal…

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

Parmesano, Hethie; Kury, Theodore J.

The price of CO{sub 2} emissions allowances affects the structure of the utility's costs, which has implications for rate design and load management programs. Depending on the design of the program to recover these costs, utility total revenue requirements - and the rate design utilized to recover these requirements - may be impacted. A new way to think about rate design may be required. (author)

The Affordable Care Act and Implications for Health Care Services for American Indian and Alaska Native Individuals

PubMed Central

Ross, Raven E.; Garfield, Lauren D.; Brown, Derek S.; Raghavan, Ramesh

2016-01-01

American Indian and Alaska Native (AI/AN) populations report poor physical and mental health outcomes while tribal health providers and the Indian Health Service (IHS) operate in a climate of significant under funding. Understanding how the Patient Protection and Affordable Care Act (ACA) affects Native American tribes and the IHS is critical to addressing the improvement of the overall access, quality, and cost of health care within AI/AN communities. This paper summarizes the ACA provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the IHS. PMID:26548665

Housing Mobility and Downsizing at Older Ages in Britain and the United States

PubMed Central

Banks, James; Blundell, Richard; Oldfield, Zoë; Smith, James P.

2013-01-01

This paper examines geographic mobility and housing downsizing at older ages in Britain and America. Americans downsize housing much more than the British largely because Americans are much more mobile. The principal reasons for greater mobility among older Americans are two fold: (1) greater spatial distribution of geographic distribution of amenities (such as warm weather) and housing costs and (2) greater institutional rigidities in subsidized British rental housing providing stronger incentives for British renters not to move. This relatively flat British housing consumption with age may have significant implications for the form and amount of consumption smoothing at older ages. PMID:23888295

Biophysical and economic limits to negative CO2 emissions

NASA Astrophysics Data System (ADS)

Smith, Pete; Davis, Steven J.; Creutzig, Felix; Fuss, Sabine; Minx, Jan; Gabrielle, Benoit; Kato, Etsushi; Jackson, Robert B.; Cowie, Annette; Kriegler, Elmar; van Vuuren, Detlef P.; Rogelj, Joeri; Ciais, Philippe; Milne, Jennifer; Canadell, Josep G.; McCollum, David; Peters, Glen; Andrew, Robbie; Krey, Volker; Shrestha, Gyami; Friedlingstein, Pierre; Gasser, Thomas; Grübler, Arnulf; Heidug, Wolfgang K.; Jonas, Matthias; Jones, Chris D.; Kraxner, Florian; Littleton, Emma; Lowe, Jason; Moreira, José Roberto; Nakicenovic, Nebojsa; Obersteiner, Michael; Patwardhan, Anand; Rogner, Mathis; Rubin, Ed; Sharifi, Ayyoob; Torvanger, Asbjørn; Yamagata, Yoshiki; Edmonds, Jae; Yongsung, Cho

2016-01-01

To have a >50% chance of limiting warming below 2 °C, most recent scenarios from integrated assessment models (IAMs) require large-scale deployment of negative emissions technologies (NETs). These are technologies that result in the net removal of greenhouse gases from the atmosphere. We quantify potential global impacts of the different NETs on various factors (such as land, greenhouse gas emissions, water, albedo, nutrients and energy) to determine the biophysical limits to, and economic costs of, their widespread application. Resource implications vary between technologies and need to be satisfactorily addressed if NETs are to have a significant role in achieving climate goals.

The money laundering control act and proposed amendments: Its impact on the casino industry.

PubMed

Mills, J

1991-12-01

In their efforts to track unreported income, Congress passed the Money Laundering Control Act in 1985. Because they are often involved in large cash transactions, casinos were required to report on cash transactions in amounts of $10,000 or more in much the same manner as banks and other financial institutions. However, because of the unique nature of cash and chip transactions within modern casinos, the Act, or state variants of it, have created significant compliance costs for casinos. This analysis examines the implications of the Act for the casino gaming industry, and evaluates some of the recent suggested Amendments to the Act.

Resting-State Functional Connectivity Underlying Costly Punishment: A Machine-Learning Approach.

PubMed

Feng, Chunliang; Zhu, Zhiyuan; Gu, Ruolei; Wu, Xia; Luo, Yue-Jia; Krueger, Frank

2018-06-08

A large number of studies have demonstrated costly punishment to unfair events across human societies. However, individuals exhibit a large heterogeneity in costly punishment decisions, whereas the neuropsychological substrates underlying the heterogeneity remain poorly understood. Here, we addressed this issue by applying a multivariate machine-learning approach to compare topological properties of resting-state brain networks as a potential neuromarker between individuals exhibiting different punishment propensities. A linear support vector machine classifier obtained an accuracy of 74.19% employing the features derived from resting-state brain networks to distinguish two groups of individuals with different punishment tendencies. Importantly, the most discriminative features that contributed to the classification were those regions frequently implicated in costly punishment decisions, including dorsal anterior cingulate cortex (dACC) and putamen (salience network), dorsomedial prefrontal cortex (dmPFC) and temporoparietal junction (mentalizing network), and lateral prefrontal cortex (central-executive network). These networks are previously implicated in encoding norm violation and intentions of others and integrating this information for punishment decisions. Our findings thus demonstrated that resting-state functional connectivity (RSFC) provides a promising neuromarker of social preferences, and bolster the assertion that human costly punishment behaviors emerge from interactions among multiple neural systems. Copyright © 2018 IBRO. Published by Elsevier Ltd. All rights reserved.

Barriers to compliance with screening guidelines for diabetic retinopathy.

PubMed

Mukamel, D B; Bresnick, G H; Wang, Q; Dickey, C F

1999-03-01

To identify barriers to compliance with guidelines for diabetic retinopathy screening. The population studied included 4410 adults, aged 31 to 64, enrolled in an Independent Practice Association (IPA) plan in Upstate New York, who were diagnosed with diabetes, and their Primary Care Physicians (408 PCPs). Claims data were used to calculate variables characterizing patients and their PCPs. Logistic regression models were estimated to identify factors associated with higher probability of screening. 34% of patients were screened in 1993. The probability of screening was significantly higher for older patients, for women, for patients who visit their PCPs more often and for those living in areas of higher average education and lower percentage of blacks. However, only 16% of diabetic patients received an annual screen in two consecutive years (1992 and 1993). The probability of consecutive annual screening was significantly associated only with gender and patient expenditures per month. The very low rate of diabetic retinopathy screening has implications for quality of life of patients with diabetes, long term costs of caring for them and social costs due to lost productivity. Interventions to increase screening rates are needed and should target both patients and their Primary Care Physicians.

Costs and benefits of sublethal Drosophila C virus infection.

PubMed

Gupta, V; Stewart, C O; Rund, S S C; Monteith, K; Vale, P F

2017-07-01

Viruses are major evolutionary drivers of insect immune systems. Much of our knowledge of insect immune responses derives from experimental infections using the fruit fly Drosophila melanogaster. Most experiments, however, employ lethal pathogen doses through septic injury, frequently overwhelming host physiology. While this approach has revealed several immune mechanisms, it is less informative about the fitness costs hosts may experience during infection in the wild. Using both systemic and oral infection routes, we find that even apparently benign, sublethal infections with the horizontally transmitted Drosophila C virus (DCV) can cause significant physiological and behavioural morbidity that is relevant for host fitness. We describe DCV-induced effects on fly reproductive output, digestive health and locomotor activity, and we find that viral morbidity varies according to the concentration of pathogen inoculum, host genetic background and sex. Notably, sublethal DCV infection resulted in a significant increase in fly reproduction, but this effect depended on host genotype. We discuss the relevance of sublethal morbidity for Drosophila ecology and evolution, and more broadly, we remark on the implications of deleterious and beneficial infections for the evolution of insect immunity. © 2017 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2017 European Society For Evolutionary Biology.

Telemedicine in the Intensive Care Unit: Improved Access to Care at What Cost?

PubMed

Binder, William J; Cook, Jennifer L; Gramze, Nickalaus; Airhart, Sophia

2018-06-01

Health systems across the United States are adopting intensive care unit telemedicine programs to improve patient outcomes. Research demonstrates the potential for decreased mortality and length of stay for patients of these remotely monitored units. Financial models and studies point to cost-effectiveness and the possibility of cost savings in the face of abundant startup costs. Questions remain as to the true financial implications of these programs and targeted populations that may see the greatest benefit. Despite recent growth, widespread adoption may be limited until these unknowns are answered. Copyright © 2018 Elsevier Inc. All rights reserved.

Economics of Automation in Space: Implications of Automated Versus Manned Operations on the High Cost of On-Orbit Assembly, Control and Servicing of Spacecraft

NASA Technical Reports Server (NTRS)

Zimmerman, W. F.

1994-01-01

The continued high cost and risk of placing astronauts in space has placed considerable burden on NASA to cut costs and consider other means of achieving mission goals both effectively and safely. Additionally, future science missions which might place a tremendous burden on Shuttle availability, or require extended vehicle duty cycles on the Lunar surface and Mars surface, might preclude the presence of astronauts altogether.

Breaking the Bank: Three Financing Models for Addressing the Drug Innovation Cost Crisis.

PubMed

Kleinke, J D; McGee, Nancy

2015-05-01

The introduction of innovative specialty pharmaceuticals with high prices has renewed efforts by public and private healthcare payers to constrain their utilization, increase patient cost-sharing, and compel government intervention on pricing. These efforts, although rational for individual payers, have the potential to undermine the public health impact and overall economic value of these innovations for society. The emerging archetypal example is the outcry over the cost of sofosbuvir, a drug proved to cure hepatitis C infection at a cost of $84,000 per person for a course of treatment (or $1000 per tablet). This represents a radical medical breakthrough for public health, with great promise for the long-term costs associated with this disease, but with major short-term cost implications for the budgets of healthcare payers. To propose potential financing models to provide a workable and lasting solution that directly addresses the misalignment of incentives between healthcare payers confronted with the high upfront costs of innovative specialty drugs and the rest of the US healthcare system, and to articulate these in the context of the historic struggle over paying for innovation. We describe 3 innovative financing models to manage expensive specialty drugs that will significantly reduce the direct, immediate cost burden of these drugs to public and private healthcare payers. The 3 financing models include high-cost drug mortgages, high-cost drugs reinsurance, and high-cost drug patient rebates. These models have been proved successful in other areas and should be adopted into healthcare to mitigate the high-cost of specialty drugs. We discuss the distribution of this burden over time and across the healthcare system, and we match the financial burden of medical innovations to the healthcare stakeholders who capture their overall value. All 3 models work within or replicate the current healthcare marketplace mechanisms for distributing immediate high-cost events across multiple at-risk stakeholders, and/or encouraging active participation by patients as consumers. The adoption of these 3 models for the financing of high-cost drugs would ameliorate decades-long economic conflict in the healthcare system over the value of, and financial responsibility for, drug innovation.