Sample records for system total cost
-
The total cost of EHR ownership.
Eastaugh, Steven R
2013-02-01
Consider total cost of ownership, not just initial cost of acquisition and annual maintenance, when reviewing electronic health record (EHR) system bids. Support costs--a key part of total cost of ownership--include FTEs dedicated to the system. The long-term costs of an EHR system can vary dramatically (up to 200 percent) depending on which system is selected.
-
Cost optimization for buildings with hybrid ventilation systems
DOE Office of Scientific and Technical Information (OSTI.GOV)
Ji, Kun; Lu, Yan
A method including: computing a total cost for a first zone in a building, wherein the total cost is equal to an actual energy cost of the first zone plus a thermal discomfort cost of the first zone; and heuristically optimizing the total cost to identify temperature setpoints for a mechanical heating/cooling system and a start time and an end time of the mechanical heating/cooling system, based on external weather data and occupancy data of the first zone.
-
Economics of human performance and systems total ownership cost.
Onkham, Wilawan; Karwowski, Waldemar; Ahram, Tareq Z
2012-01-01
Financial costs of investing in people is associated with training, acquisition, recruiting, and resolving human errors have a significant impact on increased total ownership costs. These costs can also affect the exaggerate budgets and delayed schedules. The study of human performance economical assessment in the system acquisition process enhances the visibility of hidden cost drivers which support program management informed decisions. This paper presents the literature review of human total ownership cost (HTOC) and cost impacts on overall system performance. Economic value assessment models such as cost benefit analysis, risk-cost tradeoff analysis, expected value of utility function analysis (EV), growth readiness matrix, multi-attribute utility technique, and multi-regressions model were introduced to reflect the HTOC and human performance-technology tradeoffs in terms of the dollar value. The human total ownership regression model introduces to address the influencing human performance cost component measurement. Results from this study will increase understanding of relevant cost drivers in the system acquisition process over the long term.
-
Effects of housing system on the costs of commercial egg production1
Matthews, W. A.; Sumner, D. A.
2014-01-01
This article reports the first publicly available egg production costs compared across 3 hen-housing systems. We collected detailed data from 2 flock cycles from a commercial egg farm operating a conventional barn, an aviary, and an enriched colony system at the same location. The farm employed the same operational and accounting procedures for each housing system. Results provide clear evidence that egg production costs are much higher for the aviary system than the other 2 housing systems. Feed costs per dozen eggs are somewhat higher for the aviary and lower for the enriched house compared with the conventional house. Labor costs are much lower for the conventional house than the other 2, and pullet costs are much higher for the aviary. Energy and miscellaneous costs are a minimal part of total operating costs and do not differ by housing system. Total capital investments per hen-capacity are much higher for the aviary and the enriched house. Capital costs per dozen eggs depend on assumptions about appropriate interest and depreciation rates. Using the same 10% rate for each housing system shows capital costs per dozen for the aviary and the enriched housing system are much higher than capital costs per dozen for the conventional house. The aviary has average operating costs (feed, labor, pullet, energy, and miscellaneous costs that recur for each flock and vary with egg production) about 23% higher and average total costs about 36% higher compared with the conventional house. The enriched housing system has average operating costs only about 4% higher compared with the conventional house, but average total costs are 13% higher than for the conventional house. PMID:25480736
-
Effects of housing system on the costs of commercial egg production.
Matthews, W A; Sumner, D A
2015-03-01
This article reports the first publicly available egg production costs compared across 3 hen-housing systems. We collected detailed data from 2 flock cycles from a commercial egg farm operating a conventional barn, an aviary, and an enriched colony system at the same location. The farm employed the same operational and accounting procedures for each housing system. Results provide clear evidence that egg production costs are much higher for the aviary system than the other 2 housing systems. Feed costs per dozen eggs are somewhat higher for the aviary and lower for the enriched house compared with the conventional house. Labor costs are much lower for the conventional house than the other 2, and pullet costs are much higher for the aviary. Energy and miscellaneous costs are a minimal part of total operating costs and do not differ by housing system. Total capital investments per hen-capacity are much higher for the aviary and the enriched house. Capital costs per dozen eggs depend on assumptions about appropriate interest and depreciation rates. Using the same 10% rate for each housing system shows capital costs per dozen for the aviary and the enriched housing system are much higher than capital costs per dozen for the conventional house. The aviary has average operating costs (feed, labor, pullet, energy, and miscellaneous costs that recur for each flock and vary with egg production) about 23% higher and average total costs about 36% higher compared with the conventional house. The enriched housing system has average operating costs only about 4% higher compared with the conventional house, but average total costs are 13% higher than for the conventional house. © The Author 2015. Published by Oxford University Press on behalf of Poultry Science Association.
-
Effects of different broiler production systems on health care costs in the Netherlands.
Gocsik, É; Kortes, H E; Lansink, A G J M Oude; Saatkamp, H W
2014-06-01
This study analyzed the effects of different broiler production systems on health care costs in the Netherlands. In addition to the conventional production system, the analysis also included 5 alternative animal welfare systems representative of the Netherlands. The study was limited to the most prevalent and economically relevant endemic diseases in the broiler farms. Health care costs consisted of losses and expenditures. The study investigated whether higher animal welfare standards increased health care costs, in both absolute and relative terms, and also examined which cost components (losses or expenditures) were affected and, if so, to what extent. The results show that health care costs represent only a small proportion of total production costs in each production system. Losses account for the major part of health care costs, which makes it difficult to detect the actual effect of diseases on total health care costs. We conclude that, although differences in health care costs exist across production systems, health care costs only make a minor contribution to the total production costs relative to other costs, such as feed costs and purchase of 1-d-old chicks. Poultry Science Association Inc.
-
Cost of photovoltaic energy systems as determined by balance-of-system costs
NASA Technical Reports Server (NTRS)
Rosenblum, L.
1978-01-01
The effect of the balance-of-system (BOS), i.e., the total system less the modules, on photo-voltaic energy system costs is discussed for multikilowatt, flat-plate systems. Present BOS costs are in the range of 10 to 16 dollars per peak watt (1978 dollars). BOS costs represent approximately 50% of total system cost. The possibility of future BOS cost reduction is examined. It is concluded that, given the nature of BOS costs and the lack of comprehensive national effort focussed on cost reduction, it is unlikely that BOS costs will decline greatly in the next several years. This prognosis is contrasted with the expectations of the Department of Energy National Photovoltaic Program goals and pending legislation in the Congress which require a BOS cost reduction of an order of magnitude or more by the mid-1980s.
-
Laser and solar-photovoltaic space power systems comparison. II.
NASA Technical Reports Server (NTRS)
De Young, R. J.; Stripling, J.; Enderson, T. M.; Humes, D. H.; Davis, W. T.
1984-01-01
A comparison of total system cost is made between solar photovoltaic and laser/receiver systems. The laser systems assume either a solar-pumped CO2 blackbody transfer laser with MHD receiver or a solar pumped liquid neodymium laser with a photovoltaic receiver. Total system costs are less for the laser systems below 300 km where drag is significant. System costs are highly dependent on altitude.
-
A decision-making framework for total ownership cost management of complex systems: A Delphi study
NASA Astrophysics Data System (ADS)
King, Russel J.
This qualitative study, using a modified Delphi method, was conducted to develop a decision-making framework for the total ownership cost management of complex systems in the aerospace industry. The primary focus of total ownership cost is to look beyond the purchase price when evaluating complex system life cycle alternatives. A thorough literature review and the opinions of a group of qualified experts resulted in a compilation of total ownership cost best practices, cost drivers, key performance factors, applicable assessment methods, practitioner credentials and potential barriers to effective implementation. The expert panel provided responses to the study questions using a 5-point Likert-type scale. Data were analyzed and provided to the panel members for review and discussion with the intent to achieve group consensus. As a result of the study, the experts agreed that a total ownership cost analysis should (a) be as simple as possible using historical data; (b) establish cost targets, metrics, and penalties early in the program; (c) monitor the targets throughout the product lifecycle and revise them as applicable historical data becomes available; and (d) directly link total ownership cost elements with other success factors during program development. The resultant study framework provides the business leader with incentives and methods to develop and implement strategies for controlling and reducing total ownership cost over the entire product life cycle when balancing cost, schedule, and performance decisions.
-
Analysis of electric vehicle's trip cost without late arrival
NASA Astrophysics Data System (ADS)
Leng, Jun-Qiang; Zhao, Lin
2017-03-01
In this paper, we use a car-following model to study each electric vehicle's trip cost and the corresponding total trip cost without late arrival. The numerical result show that the electricity cost has significant effects on each electric vehicle's trip cost and the corresponding total trip costs and that the effects are dependent on its time headway at the origin, but the electricity cost has no prominent effects on the minimum value of the system's total trip cost.
-
Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M
2015-01-01
Objectives To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. Design In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals’ outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. Setting USA VA Health Care System. Participants 5.2 million VA patients. Measures Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. Results The 5% highest cost patients (n=261 699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (−0.6 percentage points per affected body system, p<0.01). Conclusions Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions. PMID:25882486
-
NASA Astrophysics Data System (ADS)
Pirayesh Neghab, Mohammadali; Haji, Rasoul
This study considers a two-level supply chain system consisting of one warehouse and a number of identical retailers. In this system, we incorporate transportation costs into inventory replenishment decisions. The transportation cost contains a fixed cost and a variable cost. We assume that the demand rate at each retailer is known and the demand is confined to a single item. First, we derive the total cost which is the sum of the holding and ordering cost at the warehouse and retailers as well as the transportation cost from the warehouse to retailers. Then, we propose a search algorithm to find the economic order quantities for the warehouse and retailers which minimize the total cost.
-
Zagar, Agata Karolina; Zagar, Robert John; Bartikowski, Boris; Busch, Kenneth G
2009-02-01
Data from youth studied by Zagar and colleagues were randomly sampled to create groups of controls and abused, delinquent, violent, and homicidal youth (n=30 in each). Estimated costs of raising a nondelinquent youth from birth to 17 yr. were compared with the average costs incurred by other youth in each group. Estimates of living expenses, direct and indirect costs of victimization, and criminal justice system expenditures were summed. Groups differed significantly on total expenses, victimization costs, and criminal justice expenditures. Mean total costs for a homicidal youth were estimated at $3,935,433, while those for a control youth were $150,754. Abused, delinquent, and violent youth had average total expenses roughly double the total mean costs of controls. Prevention of dropout, alcoholism, addiction, career delinquency, or homicide justifies interception and empirical treatment on a cost-benefit basis, but also based on the severe personal costs to the victims and to the youth themselves.
-
Direct costs of emergency medical care: a diagnosis-based case-mix classification system.
Baraff, L J; Cameron, J M; Sekhon, R
1991-01-01
To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. Three community hospital EDs in Los Angeles County during selected times in 1984. Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients versus 80% of ancillary service costs and 51% of total direct costs for admitted patients. We have developed a diagnosis-based case mix classification system for ED patient visits based on direct costs of care designed for an outpatient setting which, unlike diagnosis-related groups, includes the measurement of time-based cost for physician and nonphysician services. This classification system helps to define direct costs of hospital and physician emergency services by type of patient.
-
SCATS: SRB Cost Accounting and Tracking System handbook
NASA Technical Reports Server (NTRS)
Zorv, R. B.; Stewart, R. D.; Coley, G.; Higginbotham, M.
1978-01-01
The Solid Rocket Booster Cost Accounting and Tracking System (SCATS) which is an automatic data processing system designed to keep a running account of the number, description, and estimated cost of Level 2, 3, and 4 changes is described. Although designed specifically for the Space Shuttle Solid Rocket Booster Program, the ADP system can be used for any other program that has a similar structure for recording, reporting, and summing numbers and costs of changes. The program stores the alpha-numeric designators for changes, government estimated costs, proposed costs, and negotiated value in a MIRADS (Marshall Information Retrieval and Display System) format which permits rapid access, manipulation, and reporting of current change status. Output reports listing all changes, totals of each level, and totals of all levels, can be derived for any calendar interval period.
-
Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G
2014-11-13
The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375 ($254 - $507) billion, or 80%, represents the added BIR costs of the current multi-payer system. A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending.
-
Computer Support for Conducting Supportability Trade-Offs in a Team Setting
1990-01-01
maintenance visits, and spares costs. To minimize the total system LCC, which includes both acquisition and support costs, a method for obtaining the...from different departments with a range of skills to work for a common goal is not an easy task. Ignoring the logistical concerns, a fundamental problem...maintenance visits, and spares costs. To minimize the total system LCC, which includes both acquisition and support costs, a method for obtaining the
-
[The cost of tobacco-related diseases for Brazil's Unified National Health System].
Pinto, Márcia; Ugá, Maria Alicia Domínguez
2010-06-01
This study aimed to identify the direct costs of hospitalizations due to three smoking-related groups of diseases - cancer and circulatory and respiratory diseases - in Brazil's Unified National Health System (SUS) in 2005. For cancer, the cost of chemotherapy was also included. The study derived cost estimates using administrative databases, relative risks, smoking prevalence, and smoking-attributable fraction. According to the estimates, smoking- attributable medical expenditures for the three disease groups amounted to R$338,692,516.02 (approximately U$185 million), accounting for 27.6% of total medical expenditures. Considering all hospitalizations and chemotherapy provided by the National Health System, tobacco-related diseases accounted for 7.7% of total medical expenditures. These costs also represented 0.9% of expenditures by federally funded public health services. This study provides a conservative estimate of smoking-related costs and suggests the need for continued research on comprehensive approaches to measure the total burden of smoking for society.
-
Economic burden of psoriatic patients in Japan: Analysis from a single outpatient clinic.
Takahashi, Hidetoshi; Satoh, Katsuhiko; Takagi, Akiyoshi; Iizuka, Hajime
2017-09-01
Topical and systemic agents have dramatically improved the treatment efficacy of psoriasis. Few reports, however, exist describing the economic burden in Japanese psoriatic patients. The aim of the study was to evaluate the total costs as well as cost versus efficacy of topical and systemic treatments of psoriatic patients under the Japanese health insurance system. The retrospective study was performed from the database of our clinic, which is located in Hokkaido Prefecture. Cost and effectiveness of psoriatic patients were evaluated during the 12-month period from April 2015 to March 2016. Data were collected and calculated for the total cost per year, treatment efficacy and cost versus efficacy. The mean total cost of topical corticosteroid treatment was ¥18 184/year and was lowest among the treatments. The systemic treatment with biologics was most expensive and the costs were over ¥400 000/year. Among the topical treatments, calcipotriol/betamethasone dipropionate was most expensive (¥34 693/year). However, cost versus efficacy was not significantly different from that of topical corticosteroid treatments. The cost of secukinumab was highest among all the treatments (¥631 600/year). However, treatment day per cost was lowest of all the psoriasis treatments. Biologics showed the highest cost than topical or systemic treatments. However, they showed most marked efficacy in terms of improving the psoriatic skin lesions. © 2017 Japanese Dermatological Association.
-
Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system.
Clark, P; Carlos, F; Barrera, C; Guzman, J; Maetzel, A; Lavielle, P; Ramirez, E; Robinson, V; Rodriguez-Cabrera, R; Tamayo, J; Tugwell, P
2008-03-01
This study reports the direct costs related to osteoporosis and hip fractures paid for governmental and private institutions in the Mexican health system and estimates the impact of these entities on Mexico. We conclude that the economic burden due to the direct costs of hip fracture justifies wide-scale prevention programs for osteoporosis (OP). To estimate the total direct costs of OP and hip fractures in the Mexican Health care system, a sample of governmental and private institutions were studied. Information was gathered through direct questionnaires in 275 OP patients and 218 hip fracture cases. Additionally, a chart review was conducted and experts' opinions obtained to get accurate protocol scenarios for diagnoses and treatment of OP with no fracture. Microcosting and activity-based costing techniques were used to yield unit costs. The total direct costs for OP and hip fracture were estimated for 2006 based on the projected annual incidence of hip fractures in Mexico. A total of 22,233 hip fracture cases were estimated for 2006 with a total cost to the healthcare system of US$ 97,058,159 for the acute treatment alone ($4,365.50 per case). We found considerable differences in costs and the way the patients were treated across the different health sectors within the country. Costs of the acute treatment of hip fractures in Mexico are high and are expected to increase with the predicted increment of life expectancy and the number of elderly in our population.
-
Novaes, Hillegonda Maria Dutilh; Itria, Alexander; Silva, Gulnar Azevedo e; Sartori, Ana Marli Christovam; Rama, Cristina Helena; de Soárez, Patrícia Coelho
2015-01-01
OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management. PMID:26017797
-
Code of Federal Regulations, 2010 CFR
2010-01-01
... Annual Loan Cost Rates L Appendix L to Part 226 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM TRUTH IN LENDING (REGULATION Z) Pt. 226, App. L Appendix L to Part 226—Assumed Loan Periods for Computations of Total Annual Loan Cost Rates (a) Required...
-
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
-
The socioeconomic costs of mental illness in Spain.
Oliva-Moreno, Juan; López-Bastida, Julio; Montejo-González, Angel Luis; Osuna-Guerrero, Rubén; Duque-González, Beatriz
2009-10-01
Mental illness affects a large number of people in the world, seriously impairing their quality of life and resulting in high socioeconomic costs for health care systems and society. Our aim is to estimate the socioeconomic impact of mental illness in Spain for the year 2002, including health care resources, informal care and loss of labour productivity. A prevalence-based approach was used to estimate direct medical costs, direct non-medical costs, and loss of labour productivity. The total costs of mental illness have been estimated at 7,019 million euros. Direct medical costs represented 39.6% of the total costs and 7.3% of total public healthcare expenditure in Spain. Informal care costs represented 17.7% of the total costs. Loss of labour productivity accounted for 42.7% of total costs. In conclusion, the costs of mental illness in Spain make a considerable economic impact from a societal perspective.
-
Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M
2015-04-16
To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals' outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. USA VA Health Care System. 5.2 million VA patients. Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. The 5% highest cost patients (n=261,699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (-0.6 percentage points per affected body system, p<0.01). Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
-
Code of Federal Regulations, 2011 CFR
2011-10-01
... produce quality systems. This includes ensuring that only necessary and cost-effective requirements are... that involve redesign of systems or subsystems. Life-cycle cost means the total cost to the Government...
-
Code of Federal Regulations, 2013 CFR
2013-10-01
... produce quality systems. This includes ensuring that only necessary and cost-effective requirements are... that involve redesign of systems or subsystems. Life-cycle cost means the total cost to the Government...
-
Economic analysis of the design and fabrication of a space qualified power system
NASA Technical Reports Server (NTRS)
Ruselowski, G.
1980-01-01
An economic analysis was performed to determine the cost of the design and fabrication of a low Earth orbit, 2 kW photovoltaic/battery, space qualified power system. A commercially available computer program called PRICE (programmed review of information for costing and evaluation) was used to conduct the analysis. The sensitivity of the various cost factors to the assumptions used is discussed. Total cost of the power system was found to be $2.46 million with the solar array accounting for 70.5%. Using the assumption that the prototype becomes the flight system, 77.3% of the total cost is associated with manufacturing. Results will be used to establish whether the cost of space qualified hardware can be reduced by the incorporation of commercial design, fabrication, and quality assurance methods.
-
ERIC Educational Resources Information Center
Pressman, Israel; Rosenbloom, Bruce
1984-01-01
Describes and evaluates costs of hardware, software, training, and maintenance for computer assisted instruction (CAI) as they relate to total system cost. An example of an educational system provides an illustration of CAI cost analysis. Future developments, cost effectiveness, affordability, and applications in public and private environments…
-
Bett, R C; Kosgey, I S; Bebe, B O; Kahi, A K
2007-10-01
A deterministic model was developed and applied to evaluate biological and economic variables that characterize smallholder production systems utilizing the Kenya Dual Purpose goat (KDPG) in Kenya. The systems were defined as: smallholder low-potential (SLP), smallholder medium-potential (SMP) and smallholder high-potential (SHP). The model was able to predict revenues and costs to the system. Revenues were from sale of milk, surplus yearlings and cull-forage animals, while costs included those incurred for feeds, husbandry, marketing and fixed asset (fixed costs). Of the total outputs, revenue from meat and milk accounted for about 55% and 45%, respectively, in SMP and 39% and 61% in SHP. Total costs comprised mainly variable costs (98%), with husbandry costs being the highest in both SMP and SLP. The total profit per doe per year was KSh 315.48 in SMP, KSh -1352.75 in SLP and KSh -80.22 in SHP. Results suggest that the utilization of the KDPG goat in Kenya is more profitable in the smallholder medium-potential production system. The implication for the application of the model to smallholder production systems in Kenya is discussed.
-
Solar energy system economic evaluation: Contemporary Newman, Georgia
NASA Technical Reports Server (NTRS)
1980-01-01
An economic evaluation of performance of the solar energy system (based on life cycle costs versus energy savings) for five cities considered to be representative of a broad range of environmental and economic conditions in the United States is discussed. The considered life cycle costs are: hardware, installation, maintenance, and operating costs for the solar unique components of the total system. The total system takes into consideration long term average environmental conditions, loads, fuel costs, and other economic factors applicable in each of five cities. Selection criteria are based on availability of long term weather data, heating degree days, cold water supply temperature, solar insolation, utility rates, market potential, and type of solar system.
-
Solar energy system economic evaluation: Contemporary Newman, Georgia
NASA Astrophysics Data System (ADS)
1980-09-01
An economic evaluation of performance of the solar energy system (based on life cycle costs versus energy savings) for five cities considered to be representative of a broad range of environmental and economic conditions in the United States is discussed. The considered life cycle costs are: hardware, installation, maintenance, and operating costs for the solar unique components of the total system. The total system takes into consideration long term average environmental conditions, loads, fuel costs, and other economic factors applicable in each of five cities. Selection criteria are based on availability of long term weather data, heating degree days, cold water supply temperature, solar insolation, utility rates, market potential, and type of solar system.
-
Financial Effect of a Drug Distribution Model Change on a Health System.
Turingan, Erin M; Mekoba, Bijan C; Eberwein, Samuel M; Roberts, Patricia A; Pappas, Ashley L; Cruz, Jennifer L; Amerine, Lindsey B
2017-06-01
Background: Drug manufacturers change distribution models based on patient safety and product integrity needs. These model changes can limit health-system access to medications, and the financial impact on health systems can be significant. Objective: The primary aim of this study was to determine the health-system financial impact of a manufacturer's change from open to limited distribution for bevacizumab (Avastin), rituximab (Rituxan), and trastuzumab (Herceptin). The secondary aim was to identify opportunities to shift administration to outpatient settings to support formulary change. Methods: To assess the financial impact on the health system, the cost minus discount was applied to total drug expenditure during a 1-year period after the distribution model change. The opportunity analysis was conducted for three institutions within the health system through chart review of each inpatient administration. Opportunity cost was the sum of the inpatient administration cost and outpatient administration margin. Results: The total drug expenditure for the study period was $26 427 263. By applying the cost minus discount, the financial effect of the distribution model change was $1 393 606. A total of 387 administrations were determined to be opportunities to be shifted to the outpatient setting. During the study period, the total opportunity cost was $1 766 049. Conclusion: Drug expenditure increased for the health system due to the drug distribution model change and loss of cost minus discount. The opportunity cost of shifting inpatient administrations could offset the increase in expenditure. It is recommended to restrict bevacizumab, rituximab, and trastuzumab through Pharmacy & Therapeutics Committees to outpatient use where clinically appropriate.
-
NASA Astrophysics Data System (ADS)
Jonrinaldi, Hadiguna, Rika Ampuh; Salastino, Rades
2017-11-01
Environmental consciousness has paid many attention nowadays. It is not only about how to recycle, remanufacture or reuse used end products but it is also how to optimize the operations of the reverse system. A previous research has proposed a design of reverse supply chain of biodiesel network from used cooking oil. However, the research focused on the design of the supply chain strategy not the operations of the supply chain. It only decided how to design the structure of the supply chain in the next few years, and the process of each stage will be conducted in the supply chain system in general. The supply chain system has not considered operational policies to be conducted by the companies in the supply chain. Companies need a policy for each stage of the supply chain operations to be conducted so as to produce the optimal supply chain system, including how to use all the resources that have been designed in order to achieve the objectives of the supply chain system. Therefore, this paper proposes a model to optimize the operational planning of a biodiesel supply chain network from used cooking oil. A mixed integer linear programming is developed to model the operational planning of biodiesel supply chain in order to minimize the total operational cost of the supply chain. Based on the implementation of the model developed, the total operational cost of the biodiesel supply chain incurred by the system is less than the total operational cost of supply chain based on the previous research during seven days of operational planning about amount of 2,743,470.00 or 0.186%. Production costs contributed to 74.6 % of total operational cost and the cost of purchasing the used cooking oil contributed to 24.1 % of total operational cost. So, the system should pay more attention to these two aspects as changes in the value of these aspects will cause significant effects to the change in the total operational cost of the supply chain.
-
Loving, Vilert A; Edwards, David B; Roche, Kevin T; Steele, Joseph R; Sapareto, Stephen A; Byrum, Stephanie C; Schomer, Donald F
2014-06-01
In breast-conserving surgery for nonpalpable breast cancers, surgical reexcision rates are lower with radioactive seed localization (RSL) than wire localization. We evaluated the cost-benefit of switching from wire localization to RSL in two competing payment systems: a fee-for-service (FFS) system and a bundled payment system, which is typical for accountable care organizations. A Monte Carlo simulation was developed to compare the cost-benefit of RSL and wire localization. Equipment utilization, procedural workflows, and regulatory overhead differentiate the cost between RSL and wire localization. To define a distribution of possible cost scenarios, the simulation randomly varied cost drivers within fixed ranges determined by hospital data, published literature, and expert input. Each scenario was replicated 1000 times using the pseudorandom number generator within Microsoft Excel, and results were analyzed for convergence. In a bundled payment system, RSL reduced total health care cost per patient relative to wire localization by an average of $115, translating into increased facility margin. In an FFS system, RSL reduced total health care cost per patient relative to wire localization by an average of $595 but resulted in decreased facility margin because of fewer surgeries. In a bundled payment system, RSL results in a modest reduction of cost per patient over wire localization and slightly increased margin. A fee-for-service system suffers moderate loss of revenue per patient with RSL, largely due to lower reexcision rates. The fee-for-service system creates a significant financial disincentive for providers to use RSL, although it improves clinical outcomes and reduces total health care costs.
-
NASA Astrophysics Data System (ADS)
Tang, Tie-Qiao; Luo, Xiao-Feng; Liu, Kai
2016-09-01
The driver's bounded rationality has significant influences on the micro driving behavior and researchers proposed some traffic flow models with the driver's bounded rationality. However, little effort has been made to explore the effects of the driver's bounded rationality on the trip cost. In this paper, we use our recently proposed car-following model to study the effects of the driver's bounded rationality on his running cost and the system's total cost under three traffic running costs. The numerical results show that considering the driver's bounded rationality will enhance his each running cost and the system's total cost under the three traffic running costs.
-
Marston, Luke; Kelly, Gerard C; Hale, Erick; Clements, Archie C A; Hodge, Andrew; Jimenez-Soto, Eliana
2014-08-18
The goal of malaria elimination faces numerous challenges. New tools are required to support the scale up of interventions and improve national malaria programme capacity to conduct detailed surveillance. This study investigates the cost factors influencing the development and implementation of a spatial decision support system (SDSS) for malaria elimination in the two elimination provinces of Isabel and Temotu, Solomon Islands. Financial and economic costs to develop and implement a SDSS were estimated using the Solomon Islands programme's financial records. Using an ingredients approach, verified by stakeholders and operational reports, total costs for each province were quantified. A budget impact sensitivity analysis was conducted to investigate the influence of variations in standard budgetary components on the costs and to identify potential cost savings. A total investment of US$ 96,046 (2012 constant dollars) was required to develop and implement the SDSS in two provinces (Temotu Province US$ 49,806 and Isabel Province US$ 46,240). The single largest expense category was for computerized equipment totalling approximately US$ 30,085. Geographical reconnaissance was the most expensive phase of development and implementation, accounting for approximately 62% of total costs. Sensitivity analysis identified different cost factors between the provinces. Reduced equipment costs would deliver a budget saving of approximately 10% in Isabel Province. Combined travel costs represented the greatest influence on the total budget in the more remote Temotu Province. This study provides the first cost analysis of an operational surveillance tool used specifically for malaria elimination in the South-West Pacific. It is demonstrated that the costs of such a decision support system are driven by specialized equipment and travel expenses. Such factors should be closely scrutinized in future programme budgets to ensure maximum efficiencies are gained and available resources are allocated effectively.
-
Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
2012-01-01
Introduction The EPaNIC randomized controlled multicentre trial showed that postponing initiation of parenteral nutrition (PN) in ICU-patients to beyond the first week (Late-PN) enhanced recovery, as compared with Early-PN. This was mediated by fewer infections, accelerated recovery from organ failure and reduced duration of hospitalization. Now, the trial's preplanned cost analysis (N = 4640) from the Belgian healthcare payers' perspective is reported. Methods Cost data were retrieved from individual patient invoices. Undiscounted total healthcare costs were calculated for the index hospital stay. A cost tree based on acquisition of new infections and on prolonged length-of-stay was constructed. Contribution of 8 cost categories to total hospitalization costs was analyzed. The origin of drug costs was clarified in detail through the Anatomical Therapeutic Chemical (ATC) classification system. The potential impact of Early-PN on total hospitalization costs in other healthcare systems was explored in a sensitivity analysis. Results ICU-patients developing new infection (24.4%) were responsible for 42.7% of total costs, while ICU-patients staying beyond one week (24.3%) accounted for 43.3% of total costs. Pharmacy-related costs represented 30% of total hospitalization costs and were increased by Early-PN (+608.00 EUR/patient, p = 0.01). Notably, costs for ATC-J (anti-infective agents) (+227.00 EUR/patient, p = 0.02) and ATC-B (comprising PN) (+220.00 EUR/patient, p = 0.006) drugs were increased by Early-PN. Sensitivity analysis revealed a mean total cost increase of 1,210.00 EUR/patient (p = 0.02) by Early-PN, when incorporating the full PN costs. Conclusions The increased costs by Early-PN were mainly pharmacy-related and explained by higher expenditures for PN and anti-infective agents. The use of Early-PN in critically ill patients can thus not be recommended for both clinical (no benefit) and cost-related reasons. Trial registration ClinicalTrials.gov NCT00512122. PMID:22632574
-
Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery.
Akhavan, Sina; Ward, Lorrayne; Bozic, Kevin J
2016-01-01
Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery. The purposes of this study were to compare the costs associated with (1) primary total hip arthroplasty (THA); (2) primary total knee arthroplasty (TKA); and (3) three surgeons performing these total joint arthroplasties (TJAs) as measured using TDABC versus traditional hospital accounting (TA). Process maps were developed for each phase of care (preoperative, intraoperative, and postoperative) for patients undergoing primary TJA performed by one of three surgeons at a tertiary care medical center. Personnel costs for each phase of care were measured using TDABC based on fully loaded labor rates, including physician compensation. Costs associated with consumables (including implants) were calculated based on direct purchase price. Total costs for 677 primary TJAs were aggregated over 17 months (January 2012 to May 2013) and organized into cost categories (room and board, implant, operating room services, drugs, supplies, other services). Costs derived using TDABC, based on actual time and intensity of resources used, were compared with costs derived using TA techniques based on activity-based costing and indirect costs calculated as a percentage of direct costs from the hospital decision support system. Substantial differences between cost estimates using TDABC and TA were found for primary THA (USD 12,982 TDABC versus USD 23,915 TA), primary TKA (USD 13,661 TDABC versus USD 24,796 TA), and individually across all three surgeons for both (THA: TDABC = 49%-55% of TA total cost; TKA: TDABC = 53%-55% of TA total cost). Cost categories with the most variability between TA and TDABC estimates were operating room services and room and board. Traditional hospital cost accounting systems overestimate the costs associated with many surgical procedures, including primary TJA. TDABC provides a more accurate measure of true resource use associated with TJAs and can be used to identify high-cost/high-variability processes that can be targeted for process/quality improvement. Level III, therapeutic study.
-
NASA Technical Reports Server (NTRS)
Summers, Geoffrey P.; Walters, Robert J.; Messenger, Scott R.; Burke, Edward A.
1996-01-01
An analysis embodied in a PC computer program is presented, which quantitatively demonstrates how the availability of radiation hard solar cells can help minimize the cost of a global satellite communications system. An important distinction between the currently proposed systems, such as Iridium, Odyssey and Ellipsat, is the number of satellites employed and their operating altitudes. Analysis of the major costs associated with implementing these systems shows that operation at orbital altitudes within the earth's radiation belts (10(exp 3) to 10(exp 4)km) can reduce the total cost of a system by several hundred percent, so long as radiation hard components including solar cells can be used. A detailed evaluation of the predicted performance of photovoltaic arrays using several different planar solar cell technologies is given, including commercially available Si and GaAs/Ge, and InP/Si which is currently under development. Several examples of applying the program are given, which show that the end of life (EOL) power density of different technologies can vary by a factor of ten for certain missions. Therefore, although a relatively radiation-soft technology can usually provide the required EOL power by simply increasing the size of the array, the impact upon the total system budget could be unacceptable, due to increased launch and hardware costs. In aggregate, these factors can account for more than a 10% increase in the total system cost. Since the estimated total costs of proposed global-coverage systems range from $1B to $9B, the availability of radiation-hard solar cells could make a decisive difference in the selection of a particular constellation architecture.
-
Development and Application of an Approach to Optimize Renewable Energy Systems in Afghanistan
2012-06-01
upon renewable energy sources for power production , the more desirable the system design. Total operations and maintenance cost has the third...Engineers (USACE) practices for implementing energy systems for ANSF infrastructure are limited to diesel generators, and, thus, preclude alternative...system attribute values: total O&M cost, renewable fraction, generator production , wind production , solar production , battery quantity, life cycle
-
Yokoi, Masayuki; Tashiro, Takao
2016-01-01
This study used publicly available data to examine the effect of the separation of dispensing and prescribing medicines between pharmacists in pharmacies and doctors in medical institutions (the separation system) and the generic medicine replacement ratio on the cost of various medicines in Japanese prefectures. For Japanese medical institutions, participation in the separation system is optional. Consequently, the expansion rate of the separation system for each administrative district is highly variable. In our multiple regression analysis, the dependent variables were the costs of daily medicines, specifically, total, internal, external, and injection medicines, as well as medical devices, and the independent variables were the expansion rate of the separation system and generic medicine replacement ratio. The expansion rate of the separation system showed a significant negative partial correlation with the daily costs of total, internal, and injection medicines as well as medical devices. Moreover, the rate of replacing brand name medicines with generic medicines showed a significant negative partial correlation with the daily costs of total and internal medicines. However, external and injection medicines and medical devices did not because only a few or no generic products of these types were sold in the Japanese market. Otherwise, expansion of the separation system was effective in reducing medicine costs, except in the case of external medicines. This suggests that the cost efficiency effect of the separation system does not function all the time. PMID:26234979
-
Code of Federal Regulations, 2014 CFR
2014-01-01
... 12 Banks and Banking 3 2014-01-01 2014-01-01 false Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions K Appendix K to Part 226 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED..., App. K Appendix K to Part 226—Total Annual Loan Cost Rate Computations for Reverse Mortgage...
-
Code of Federal Regulations, 2013 CFR
2013-01-01
... 12 Banks and Banking 3 2013-01-01 2013-01-01 false Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions K Appendix K to Part 226 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED..., App. K Appendix K to Part 226—Total Annual Loan Cost Rate Computations for Reverse Mortgage...
-
Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS)
da Silva, Gilmara Silveira; Colósimo, Flávia Cortez; de Sousa, Alexandre Gonçalves; Piotto, Raquel Ferrari; Castilho, Valéria
2017-01-01
Introduction Cost management has been identified as an essential tool for the general control and evaluation of health organizations. Objectives To identify the coverage percentage of transferred funds from the Unified Health System for coronary artery bypass grafts in a philanthropic hospital having a consolidated costing system in the municipality of São Paulo. Methods A quantitative, descriptive and cross-sectional research with information provided from a database composed of 1913 patients undergoing coronary artery bypass graft from March 13 to September 30, 2012, including isolated elective coronary artery bypass graft with the use of extracorporeal circulation. It excluded 551 (28.8%) patients, among them 76 (4.0%) deaths and 8 hospitalized patients, since the cost was compared according to the length of hospital stay. Therefore, the sample consisted of 1362 patients. Results The average total cost per patient was $7,992.55. The average fund transfer by the Unified Health System was $3,450.73 (48.66%), resulting in a deficit of $4,541.82 (51.34%). Conclusion The Unified Health System transfers covered 48.66% of the average total cost of hospitalization. Although the amount transferred increased with increasing costs, it was not proportional to the total cost, resulting in a percentage difference in revenue that was increasingly negative for each increase in cost and hospital stay. Those hospitalized for longer than seven days presented higher costs, older age, higher percentage of diabetics and chronic kidney disease patients and more postoperative complications. PMID:28977196
-
The economic cost of road traffic crashes in an urban setting
García‐Altés, A; Pérez, K
2007-01-01
The objective of this article is to assess the total economic costs of road traffic crashes in Barcelona, a metropolitan city located in Southern Europe. A cost‐of‐illness study was conducted using a prevalence approximation, a societal and healthcare system perspective, and a 1‐year time horizon. Results were measured in terms of Euros in 2003. Total costs of road traffic crashes in Barcelona in 2003 were €367 million. Direct costs equalled €329 million (89.8% of total costs), including property damage costs, insurance administration costs and hospital costs. Police, emergency costs and transportation costs had a minimum effect on total direct costs. Indirect costs were €37 million, including lost productivity due to hospitalization and mortality. The results of the sensitivity analysis showed the upper limit of total economic cost of road traffic crashes in Barcelona to be €782 million. This is the first study to estimate the costs of road traffic crashes for a city in a developed country. The importance of the problem calls for further interventions to reduce road traffic crashes. PMID:17296693
-
The indirect cost of Patient-Specific Instruments.
Thienpont, Emmanuel; Paternostre, Frederic; Van Wymeersch, Charles
2015-09-01
To calculate the indirect costs of Patient Specific Instruments (PSI) based on an opportunity cost, cost of efforts and a supply chain cost model to compare PSI for value with conventional total knee arthroplasty (TKA). In 81 patients the total (direct+indirect) cost of PSI-assisted TKA was compared with conventional TKA. Surgical times and coronal mechanical alignment were measured to evaluate the effectiveness of the PSI system. Indirect costs (459 euro) make up 40% of the total cost that can run up to 1142 euro for a patient operated with PSI guides. No difference in surgical times or coronal alignment was observed in between both groups. Considering the total cost of PSI no value was found for the use of PSI in primary TKA as measured by surgical times or for obtaining a neutral mechanical axis in the coronal plane.
-
Reliability and Cost Impacts for Attritable Systems
2017-03-23
and cost risk metrics to convey the value of reliability and reparability trades. Investigation of the benefit of trading system reparability...illustrates the benefit that reliability engineering can have on total cost . 2.3.1 Contexts of System Reliability Hogge (2012) identifies two distinct...reliability and reparability trades. Investigation of the benefit of trading system reparability shows a marked increase in cost risk. Yet, trades in
-
Mehra, Tarun; Koljonen, Virve; Seifert, Burkhardt; Volbracht, Jörk; Giovanoli, Pietro; Plock, Jan; Moos, Rudolf Maria
2015-01-01
Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems. A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established. The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS). Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.
-
NASA Astrophysics Data System (ADS)
Tang, Tie-Qiao; Wang, Tao; Chen, Liang; Shang, Hua-Yan
2017-11-01
In this paper, we first define each commuter's first, second and third trip costs, and then apply the full velocity difference model and the VT-Micro model to explore each commuter's three trip costs and the system's corresponding total trip costs in a traffic corridor with two entrances and one exit. The numerical results show that one entrance has prominent effects on the commuter's three trip costs and the system's corresponding total trip cost and that the impacts are directly related to the commuter's departure interval at this entrance. The results can provide some suggestions for reducing the commuters' trip costs in a traffic corridor with two entrances and one exit.
-
Comparison of solar-thermal and fossil total-energy systems for selected industrial applications
NASA Astrophysics Data System (ADS)
Pine, G. D.
1980-06-01
Economic analyses of a conventional system and total energy systems based on phosphoric acid fuel cells, diesel piston engines, and central receiver solar thermal systems were performed for each of four industrial applications; a concrete block plant in Arizona, a fluid milk processing plant in California, a sugar beet processing plant in Colorado, and a meat packing plant in Texas. A series of sensitivity analyses was performed to show the effects of variations in fuel price, system size, cost of capital, and system initial cost. Solar total energy systems (STES) are more capital intensive than the other systems, and significant economies of scale are associated with the STES. If DOE solar system cost goals are met, STES can compete with the other systems for facilities with electrical demands greater than two or three megawatts, but STES are not competitive for smaller facilities. Significant energy resource savings, especially of oil and gas, resulted from STES implementation in the four industries.
-
Cost-Based Optimization of a Papermaking Wastewater Regeneration Recycling System
NASA Astrophysics Data System (ADS)
Huang, Long; Feng, Xiao; Chu, Khim H.
2010-11-01
Wastewater can be regenerated for recycling in an industrial process to reduce freshwater consumption and wastewater discharge. Such an environment friendly approach will also lead to cost savings that accrue due to reduced freshwater usage and wastewater discharge. However, the resulting cost savings are offset to varying degrees by the costs incurred for the regeneration of wastewater for recycling. Therefore, systematic procedures should be used to determine the true economic benefits for any water-using system involving wastewater regeneration recycling. In this paper, a total cost accounting procedure is employed to construct a comprehensive cost model for a paper mill. The resulting cost model is optimized by means of mathematical programming to determine the optimal regeneration flowrate and regeneration efficiency that will yield the minimum total cost.
-
[Public free anonymous HIV testing centers: cost analysis and financing options].
Dozol, Adrien; Tribout, Martin; Labalette, Céline; Moreau, Anne-Christine; Duteil, Christelle; Bertrand, Dominique; Segouin, Christophe
2011-01-01
The services of general interest provided by hospitals, such as free HIV clinics, have been funded since 2005 by a lump sum covering all costs. The allocation of the budget was initially determined based on historical and declarative data. However, the French Ministry of Health (MoH) recently outlined new rules for determining the allocation of financial resources and contracting hospitals for each type of services of general interest provided. The aim of this study was to estimate the annual cost of a public free anonymous HIV-testing center and to assess the budgetary implications of new financing systems. Three financing options were compared: the historic block grant; a mixed system recommended by the MoH associating a lump sum covering the recurring costs of an average center and a variable part based on the type and volume of services provided; and a fee-for-services system. For the purposes of this retrospective study, the costs and activity data of the HIV testing clinic of a public hospital located in the North of Paris were obtained for 2007. The costs were analyzed from the perspective of the hospital. The total cost was estimated at 555,698 euros. Personnel costs accounted for 31% of the total costs, while laboratory expenses accounted for 36% of the total costs. While the estimated deficit was 292,553 euros under the historic system, the financial balance of the clinic was found to be positive under a fee-for-services system. The budget allocated to the HIV clinic under the system recommended by the MoH covers most of the current expenses of the HIV clinic while meeting the requirements of free confidential care.
-
Analysis of GaAs and Si solar energy hybrid systems
NASA Technical Reports Server (NTRS)
Heinbockel, J. H.; Roberts, A. S., Jr.
1977-01-01
Various silicon hybrid systems are modeled and compared with a gallium arsenide hybrid system. The hybrid systems modeled produce electric power and also thermal power which can be used for heating or air conditioning. Various performance indices are defined and used to compare the system performance: capital cost per electric power out; capital cost per total power out; capital cost per electric power plus mechanical power; annual cost per annual electric energy; and annual cost per annual electric energy plus annual mechanical work. These performance indices indicate that concentrator hybrid systems can be cost effective when compared with present day energy costs.
-
Health care utilization and costs for diseases of the circulatory system in a corporate setting.
Tsai, S P; Bernacki, E J; Reedy, S M; Miller, K E
1988-01-01
This article presents the health care utilization and costs for diseases of the circulatory system among 14,162 employees and their spouses based on medical insurance claims data analysis. Diseases of the circulatory system ranked first among insurance claims and costs accounting for 23% ($4.6 million) of the plan's total health care costs ($19.7 million) for the 1984 policy year. Overall, 57% of these expenditures were for hospital care, the proportion for hospital costs being as high as 64% for heart diseases and as low as 20% for hypertension. Male employees had higher utilization for both in-hospital and out-patient services than females. Utilization rates and costs dramatically increased for individuals 50 years or older. Costs for surgical and diagnostic procedures amounted to 8% of the total costs of circulatory system disorders. This article provides an example of the utility of claims analysis for morbidity surveillance. The analyses and parameters measured herein can be viewed as prerequisites to the development of health care management and health promotion strategies aimed at reducing health care cost for diseases of the circulatory system in a corporate setting.
-
Physician Impact on the Total Cost of Care
Taheri, Paul A.; Butz, David; Griffes, Louisa C.; Morlock, David R.; Greenfield, Lazar J.
2000-01-01
Background and Objectives Physicians’ efforts at cost containment focus on decreased resource utilization and reduced length of stay. Although these efforts appear to be appropriate, little data exist to gauge their success. As such, the goal of this study is to determine trauma service cost allocations and how this information can help physicians to contain costs. Materials and Methods The authors analyzed the costs for 696 trauma admissions at a level I trauma center for fiscal year 1997. Data were obtained from the hospital costing system. Costs analyzed were variable direct, fixed direct, and Indirect costs. Together, the fixed and indirect costs are referred to as “hospital overhead.” Total Cost equals variable direct plus fixed direct plus indirect costs. Results The mean variable, fixed, and indirect costs per patient were $7,998, $3,534, and $11,086, respectively. Mean total cost per patient was $22,618. Conclusion The 35% variable direct cost represents the percentage of total cost that is typically under the immediate influence of physicians, in contrast to the 65% of total cost over which physicians have little control. Physicians must gain a better understanding of cost drivers and must participate in the operations and allocations of institutional fixed direct and indirect costs if the overall cost of care is to be reduced. PMID:10714637
-
NASA Technical Reports Server (NTRS)
Handley, Thomas H., Jr.
1993-01-01
The issues of how to avoid future surprise growth in Mission Operations and Data Analysis (MO&DA) costs and how to minimize total MO&DA costs for planetary missions are discussed within the context of JPL mission operations support. It is argued that there is no simple, single solution: the entire Project life-cycle must be addressed. It is concluded that cost models that can predict both MO&DA cost as well as Ground System development costs are needed. The first year MO&DA budget plotted against the total of ground and flight systems developments is shown. In order to better recognize changes and control costs in general, a modified funding line item breakdown is recommended to distinguish between development costs (prelaunch and postlaunch) and MO&DA costs.
-
Code of Federal Regulations, 2011 CFR
2011-01-01
... Reverse Mortgage Transactions K Appendix K to Part 226 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM TRUTH IN LENDING (REGULATION Z) Pt. 226, App. K Appendix K to Part 226—Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions (a...
-
Code of Federal Regulations, 2012 CFR
2012-01-01
... Reverse Mortgage Transactions K Appendix K to Part 226 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM TRUTH IN LENDING (REGULATION Z) Pt. 226, App. K Appendix K to Part 226—Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions (a...
-
Code of Federal Regulations, 2010 CFR
2010-01-01
... Reverse Mortgage Transactions K Appendix K to Part 226 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM TRUTH IN LENDING (REGULATION Z) Pt. 226, App. K Appendix K to Part 226—Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions (a...
-
Cost of Surgery for Symptomatic Spinal Metastases in the United Kingdom.
Turner, Isobel; Minhas, Zulfiqar; Kennedy, Joanne; Morris, Stephen; Crockard, Alan; Choi, David
2015-11-01
Spinal metastases represent a significant health and economic burden. The average cost of surgical management varies between institutions and countries, partially a result of differences in health care system billing. This study assessed hospital costs from a single institute in the United Kingdom National Healthcare Service and identified patient factors associated with these costs. This prospective study recruited patients with confirmed symptomatic spinal metastases who presented for surgical treatment. The primary outcome was cost of inpatient treatment collected using the Patient Level Costing and Information System; preoperative details collected included patient demographics, primary tumor type, Tomita and Tokuhashi scores, pain level, EuroQol 5 dimension score, Frankel, Karnofsky, and American Society of Anesthesiologists' physical status classification system scores, and operative details. Costs were analyzed for 74 patients. The mean cost of treatment (standard deviation, SD) per patient was £ 16,885 (£ 10,687); which was mainly comprised of operating theater (25% of the total) and ward costs (27%). Better health status at presentation significantly increased total and ward costs (Frankel score P = 0.006, and EuroQol 5 dimension index P = 0.014 respectively); male sex also increased total and ward costs (P < 0.01 and P = 0.06). Operation cost showed a trend to increased costs with less impairment on American Society of Anesthesiologists' physical status classification system scores. The cost of surgical management of spinal metastases is associated with several factors but is greater in patients presenting with better health status, probably because of their suitability for larger operations, whereas those with poor health status undergo smaller, palliative operations, resulting in shorter inpatient postoperative recovery. Copyright © 2015 Elsevier Inc. All rights reserved.
-
Bread Basket: a gaming model for estimating home-energy costs
DOE Office of Scientific and Technical Information (OSTI.GOV)
Not Available
An instructional manual for answering the twenty variables on COLORADO ENERGY's computerized program estimating home energy costs. The program will generate home-energy cost estimates based on individual household data, such as total square footage, number of windows and doors, number and variety of appliances, heating system design, etc., and will print out detailed costs, showing the percentages of the total household budget that energy costs will amount to over a twenty-year span. Using the program, homeowners and policymakers alike can predict the effects of rising energy prices on total spending by Colorado households.
-
Tseng, Phillip; Kaplan, Robert S; Richman, Barak D; Shah, Mahek A; Schulman, Kevin A
2018-02-20
Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures. In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.
-
Optimization of conventional water treatment plant using dynamic programming.
Mostafa, Khezri Seyed; Bahareh, Ghafari; Elahe, Dadvar; Pegah, Dadras
2015-12-01
In this research, the mathematical models, indicating the capability of various units, such as rapid mixing, coagulation and flocculation, sedimentation, and the rapid sand filtration are used. Moreover, cost functions were used for the formulation of conventional water and wastewater treatment plant by applying Clark's formula (Clark, 1982). Also, by applying dynamic programming algorithm, it is easy to design a conventional treatment system with minimal cost. The application of the model for a case reduced the annual cost. This reduction was approximately in the range of 4.5-9.5% considering variable limitations. Sensitivity analysis and prediction of system's feedbacks were performed for different alterations in proportion from parameters optimized amounts. The results indicated (1) that the objective function is more sensitive to design flow rate (Q), (2) the variations in the alum dosage (A), and (3) the sand filter head loss (H). Increasing the inflow by 20%, the total annual cost would increase to about 12.6%, while 20% reduction in inflow leads to 15.2% decrease in the total annual cost. Similarly, 20% increase in alum dosage causes 7.1% increase in the total annual cost, while 20% decrease results in 7.9% decrease in the total annual cost. Furthermore, the pressure decrease causes 2.95 and 3.39% increase and decrease in total annual cost of treatment plants. © The Author(s) 2013.
-
2016-11-01
Target Attack Radar System Objective We determined whether the Air Force made cost-effective purchases on the performance-based logistics contract to... contract to Northrop Grumman Corporation to provide Total System Support Responsibility services to sustain 16 E-8C JSTARS aircraft. These services...customer support. The Total System Support Responsibility contract is valued at $7 billion, with a 6-year base period and 16 annual contract option
-
Estimated annual cost of arterial hypertension treatment in Brazil.
Dib, Murilo W; Riera, Rachel; Ferraz, Marcos B
2010-02-01
To estimate the direct annual cost of systemic arterial hypertension (SAH) treatment in Brazil's public and private health care systems, assess its economic impact on the total health care budget, and determine its proportion of the 2005 gross domestic product (GDP). A decision tree model was used to determine direct costs based on estimated use of various resources in SAH diagnosis and care, including treatment (medication and non-medication), complementary exams, doctor visits, nutritional assessments, and emergency room visits. Estimated direct annual cost of SAH treatment was approximately US$ 398.9 million for the public health care system and US$ 272.7 million for the private system, representing 0.08% of the 2005 GDP (ranging from 0.05% to 0.16%). With total health care expenses comprising about 7.6% of Brazil's GDP, this cost represented 1.11% of overall health care costs (0.62% to 2.06%)-1.43% of total expenses for the Unified Healthcare System (Sistema Unico de Saúde, SUS) (0.79% to 2.75%) and 0.83% of expenses for the private health care system (0.47% to 1.48%). Conclusion. To guarantee public or private health care based on the principles of universality and equality, with limited available resources, efforts must be focused on educating the population on prevention and treatment compliance in diseases such as SAH that require significant health resources.
-
Masdjedi, Kaneshka; Van Mieghem, Nicolas M; Diletti, Roberto; van Geuns, Robert-Jan; de Jaegere, Peter; Regar, Evelyn; Zijlstra, Felix; van Domburg, Ron T; Daemen, Joost
2017-04-15
To assess whether the RXi Navvus system compared to the use of standard Fractional Flow Reserve (FFR) wires reduces total contrast volume, radiation and overall study cost in a real world patient population referred for coronary angiography or percutaneous coronary intervention. FFR is the mainstay of functional hemodynamic assessment of coronary artery lesions. The RXi Navvus system (ACIST Medical Systems, Eden Prairie, MN) is a monorail microcatheter with FFR-measurement capability through optical pressure sensor technology. This is an investigator-initiated, prospective, single-center, observational cohort study. A total of 238 patients were enrolled, 97 patients with Navvus and 141 with conventional pressure-wire based FFR (PW-FFR). Final analyses were performed on the cohort in which only 1 device was used (82 Navvus procedures vs. 136 PW-FFR procedures). No significant differences were found in the total amount of contrast used (150±77 vs 147±79ml; p=0.81), radiation use (6200±4601 vs. 5076±4655 centiG∗cm 2 ; p=0.09) or costs (€1994,- vs. €1930,-; p=0.32) in the Navvus vs. PW-FFR groups respectively. No significant differences were found in the amount of contrast used, total procedural costs or radiation when the Navvus system was used as compared to conventional FFR wires. CONTRACT is an investigator-initiated, prospective, single-center, observational cohort study that evaluated whether the RXi Navvus system compared to the use of standard Fractional Flow Reserve (FFR) wires reduces total contrast volume, radiation and overall study cost in a real world patient population referred for coronary angiography or percutaneous coronary intervention. Use of the RXi Navvus system was associated with comparable procedural costs, amount of radiation and contrast used as compared to PW-FFR systems. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
-
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.
-
NREL Report Shows U.S. Solar Photovoltaic Costs Continuing to Fall in 2016
chart of solar pv costs from q4 2009 to q1 2016 NREL U.S. PV system cost benchmarks, from the fourth (NREL). Driving the cost reductions were lower module and inverter prices, increased competition, lower ;The continuing total cost decline of solar PV systems demonstrates the sustained economic
-
PCS: a pallet costing system for wood pallet manufacturers (version 1.0 for Windows®)
A. Jefferson, Jr. Palmer; Cynthia D. West; Bruce G. Hansen; Marshall S. White; Hal L. Mitchell
2002-01-01
The Pallet Costing System (PCS) is a computer-based, Microsoft Windows® application that computes the total and per-unit cost of manufacturing an order of wood pallets. Information about the manufacturing facility, along with the pallet-order requirements provided by the customer, is used in determining production cost. The major cost factors addressed by PCS...
-
NASA Astrophysics Data System (ADS)
Sanaye, Sepehr; Katebi, Arash
2014-02-01
Energy, exergy, economic and environmental (4E) analysis and optimization of a hybrid solid oxide fuel cell and micro gas turbine (SOFC-MGT) system for use as combined generation of heat and power (CHP) is investigated in this paper. The hybrid system is modeled and performance related results are validated using available data in literature. Then a multi-objective optimization approach based on genetic algorithm is incorporated. Eight system design parameters are selected for the optimization procedure. System exergy efficiency and total cost rate (including capital or investment cost, operational cost and penalty cost of environmental emissions) are the two objectives. The effects of fuel unit cost, capital investment and system power output on optimum design parameters are also investigated. It is observed that the most sensitive and important design parameter in the hybrid system is fuel cell current density which has a significant effect on the balance between system cost and efficiency. The selected design point from the Pareto distribution of optimization results indicates a total system exergy efficiency of 60.7%, with estimated electrical energy cost 0.057 kW-1 h-1, and payback period of about 6.3 years for the investment.
-
Internal Logistics System Selection with Total Cost of Ownership Analysis
NASA Astrophysics Data System (ADS)
Araújo, Inês; Pimentel, Carina; Godina, Radu; Matias, João C. O.
2017-06-01
In this paper a methodology was followed in order to support the decision-making of one industrial unit regarding its internal logistics system. The addressed factory was facing issues with their internal logistics approach. Some alternatives were pointed out and a proper total cost of ownership (TCO) analysis was developed. This analysis was taken in order to demonstrate the more cost-effective solution for the internal logistics system. This tool is more and more valued by the companies, due to their willing to reduce the costs that are associated with the way of doing business. Despite the proposal of the best choice for the internal logistics system of the enterprise, this study also intends to present some conclusions about the match between the nature of the industrial unit and the logistics systems that best fit the requirements of those.
-
A Systems Analysis View of the Vietnam War: 1965-1972. Volume 11. Economics: War Costs and Inflation
1975-02-01
Conflict On Great Society Programs Sep 67 4 The Cost Of Bombing North Vietnam Dec 67 8 The Bombing - Its Economic Costs Avnd Benefits To North Vietnam...current DOD program and the one for the peacetime force structure after the war. A third cost concept is reflected in the figures the Defense Department...papers will cover FY 70-71, as soon as those program budgets are ready, and will include AID, GVN, and third country costs . Total Cost . The total cost
-
Code of Federal Regulations, 2010 CFR
2010-10-01
... Section 434.001 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SPECIAL CATEGORIES OF... total acquisition costs (for information technology, life cycle costs) are estimated to be $50 million... Technology Systems Executive. ...
-
The Space Transportation System. [Space Shuttle-Spacelab-Space Tug system
NASA Technical Reports Server (NTRS)
Donlan, C. J.; Brazill, E. J.
1976-01-01
The Space Transportation System, consisting of the Space Shuttle, Spacelab, and the Space Tug, is discussed from the viewpoint of reductions in the cost of space operations. Each of the three vehicles is described along with its mission capabilities, and the time table for system development activities is outlined. Basic attributes of the Space Transportation System are reviewed, all operational modes are considered, and the total cost picture of the system is examined from the standpoint of a mission economic analysis. It is concluded that as the features of the Space Transportation System, especially the Shuttle and the Tug, are put to more efficient use during the maturing-operation phase, the total cost of conducting space missions should be about half of what it would be if any other system were employed.
-
The health system cost of post-abortion care in Uganda
Vlassoff, Michael; Mugisha, Frederick; Sundaram, Aparna; Bankole, Akinrinola; Singh, Susheela; Amanya, Leo; Kiggundu, Charles; Mirembe, Florence
2014-01-01
This article presents estimates based on the research conducted in 2010 of the cost to the Ugandan health system of providing post-abortion care (PAC), filling a gap in knowledge of the cost of unsafe abortion. Thirty-nine public and private health facilities were sampled representing three levels of health care, and data were collected on drugs, supplies, material, personnel time and out-of-pocket expenses. In addition, direct non-medical costs in the form of overhead and capital costs were also measured. Our results show that the average annual PAC cost per client, across five types of abortion complications, was $131. The total cost of PAC nationally, including direct non-medical costs, was estimated to be $13.9 million per year. Satisfying all demand for PAC would raise the national cost to $20.8 million per year. This shows that PAC consumes a substantial portion of the total expenditure in reproductive health in Uganda. Investing more resources in family planning programmes to prevent unwanted and mistimed pregnancies would help reduce health systems costs. PMID:23274438
-
Costs of Fetal Alcohol Spectrum Disorder in the Canadian Criminal Justice System.
Thanh, Nguyen Xuan; Jonsson, Egon
2015-01-01
We reviewed literature to estimate the costs of Fetal Alcohol Spectrum Disorder (FASD) in the Canadian Criminal Justice System (CJS), and to update the total costs of FASD in Canada. The results suggest FASD is costlier than previous estimates. The costs of FASD associated with the CJS are estimated at $3.9 billion a year, with $1.2 billion for police, $0.4 billion for court, $0.5 billion for correctional services, $1.6 billion for victims, and $0.2 billion for third-party. The updated total costs of FASD in Canada are $9.7 billion a year, of which CJS accounts for 40%, healthcare 21%, education 17%, social services 13%, and others 9%.
-
Assessing the Performance of Human-Automation Collaborative Planning Systems
2011-06-01
process- ing and incorporating vast amounts of incoming information into their solutions. How- ever, these algorithms are brittle and unable to account for...planning system, a descriptive Mission Performance measure may address the total travel time on the path or the cost of the path (e.g. total work...minimizing costs or collisions [4, 32, 33]. Error measures for such a path planning system may track how many collisions occur or how much threat
-
Evaluation of the wind pumped hydropower storage integrated flood mitigation system
NASA Astrophysics Data System (ADS)
Safi, Aishah; Basrawi, Firdaus
2018-04-01
As Wind Pumped Hydropower Storage (WPHS) need high cost to construct, it is important to study their impacts on economic and environmental aspects. Thus, this research aims to evaluate their economic and environmental performances. First, Hybrid Optimization Model for Electric Renewable (HOMER) was used to simulate power generation system with and without the flood reservoir. Next, the total amount of emitted air pollutant was used to evaluate the environmental impacts. It was found the wind-diesel with reservoir storage system (A-III) will have much lower NPC than other systems that do not include reservoir for flood mitigation when the cost of flood losses are included in the total Net Present Cost (NPC). The NPC for system A-III was RM 1.52 million and for diesel standalone system (A-I) is RM 10.8 million when the cost of flood losses are included in the total NPC. Between both energy systems, the amount of pollutants emitted by the A-III system was only 408 kg-CO2/year which is much less than the A-I system which is 99, 754 kg of carbon dioxide per year. To conclude, the WPHS integrated with flood mitigation system seems promising in the aspects of economic and environment.
-
Jönsen, Andreas; Hjalte, Frida; Willim, Minna; Carlsson, Katarina Steen; Sjöwall, Christopher; Svenungsson, Elisabet; Leonard, Dag; Bengtsson, Christine; Rantapää-Dahlqvist, Solbritt; Pettersson, Susanne; Gunnarsson, Iva; Zickert, Agneta; Gustafsson, Johanna T; Rönnblom, Lars; Petersson, Ingemar F; Bengtsson, Anders A; Nived, Ola
2016-06-01
The main objectives of this study were to calculate total costs of illness and cost-driving disease features among patients with systemic lupus erythematosus (SLE) in Sweden. Five cohorts of well-defined SLE patients, located in different parts of the country were merged. Incident and prevalent cases from 2003 through 2010 were included. The American College of Rheumatology (ACR) classification criteria was used. From the local cohorts, data on demographics, disease activity (SLEDAI 2K), and organ damage (SDI) were collected. Costs for inpatient care, specialist outpatient care and drugs were retrieved from national registries at the National Board of Health and Welfare. Indirect costs were calculated based on sickness leave and disability pensions from the Swedish Social Insurance Agency. In total, 1029 SLE patients, 88% females, were included, and approximately 75% were below 65 years at the end of follow-up, and thus in working age. The mean number of annual specialist physician visits varied from six to seven; mean annual inpatient days were 3.1-3.6, and mean annual sick leave was 123-148 days, all per patient. The total annual cost was 208,555 SEK ($33,369 = 22,941€), of which direct cost was 63,672kr ($10,188 = 7004€) and the indirect cost was 144,883 SEK ($23,181 = 15,937€), all per patient. The costs for patients with short disease duration were higher. Higher disease activity as measured by a SLEDAI 2K score > 3 was associated with approximately 50% increase in both indirect and direct costs. Damage in the neuropsychiatric and musculoskeletal domains were also linked to higher direct and indirect costs, while organ damage in the renal and ocular systems increased direct costs. Based on this study and an estimate of slightly more than 6000 SLE patients in Sweden, the total annual cost for SLE in the country is estimated at $188 million (=129.5 million €). Both direct (30%) and indirect costs (70%) are substantial. Medication accounts for less than 10% of the total cost. The tax paid national systems for health care and social security in Sweden ensure equal access to health care, sick leave reimbursements, and disability pensions nationwide. Our extrapolated annual costs for SLE in Sweden are therefore the best supported estimations thus far, and they clearly underline the importance of improved management, especially to reduce the indirect costs. Copyright © 2016 Elsevier Inc. All rights reserved.
-
Fischer, Sebastian; Meyer, Georg; Kramer, Axel
2012-01-01
In preparation for implementation of a central water processing system at a dental department, we analyzed the costs of conventional decentralized disinfection of dental units against a central water treatment concept based on electrochemical disinfection. The cost evaluation included only the costs of annually required antimicrobial consumables and additional water usage of a decentralize conventional maintenance system for dental water lines build in the respective dental units and the central electrochemical water disinfection system, BLUE SAFETY™ Technologies. In total, analysis of costs of 6 dental departments reviled additional annual costs for hygienic preventive measures of € 4,448.37. For the BLUE SAFETY™ Technology, the additional annual total agent consumption costs were € 2.18, accounting for approximately 0.05% of the annual total agent consumption costs of the conventional maintenance system. For both water processing concepts, the additional costs for energy could not be calculated, since the required data was not obtainable from the manufacturers. For both concepts, the investment and maintenance costs were not calculated due to lack of manufacturer's data. Therefore, the results indicate the difference of costs for the required consumables only. Aside of the significantly lower annual costs for required consumables and disinfectants; a second advantage for the BLUE SAFETY™ Technology is its constant and automatic operation, which does not require additional staff resources. This not only safety human resources, but add additionally to cost saving. Since the antimicrobial disinfection capacity of the BLUE SAFETY™ was demonstrated previously and is well known, this technology, which is comparable or even superior in its non-corrosive effect, may be regarded as method of choice for continuous disinfection and prevention of biofilm formation in dental units' water lines.
-
Fischer, Sebastian; Meyer, Georg; Kramer, Axel
2012-01-01
Background: In preparation for implementation of a central water processing system at a dental department, we analyzed the costs of conventional decentralized disinfection of dental units against a central water treatment concept based on electrochemical disinfection. Methods: The cost evaluation included only the costs of annually required antimicrobial consumables and additional water usage of a decentralize conventional maintenance system for dental water lines build in the respective dental units and the central electrochemical water disinfection system, BLUE SAFETY™ Technologies. Results: In total, analysis of costs of 6 dental departments reviled additional annual costs for hygienic preventive measures of € 4,448.37. For the BLUE SAFETY™ Technology, the additional annual total agent consumption costs were € 2.18, accounting for approximately 0.05% of the annual total agent consumption costs of the conventional maintenance system. For both water processing concepts, the additional costs for energy could not be calculated, since the required data was not obtainable from the manufacturers. Discussion: For both concepts, the investment and maintenance costs were not calculated due to lack of manufacturer's data. Therefore, the results indicate the difference of costs for the required consumables only. Aside of the significantly lower annual costs for required consumables and disinfectants; a second advantage for the BLUE SAFETY™ Technology is its constant and automatic operation, which does not require additional staff resources. This not only safety human resources, but add additionally to cost saving. Conclusion: Since the antimicrobial disinfection capacity of the BLUE SAFETY™ was demonstrated previously and is well known, this technology, which is comparable or even superior in its non-corrosive effect, may be regarded as method of choice for continuous disinfection and prevention of biofilm formation in dental units’ water lines. PMID:22558042
-
NASA Technical Reports Server (NTRS)
Deyoung, R. J.; Walker, G. H.; Williams, M. D.; Schuster, G. L.; Conway, E. J.
1987-01-01
A preliminary conceptual design of a space-based solar pumped iodide laser emitting 1 megawatt of laser power for space-to-space power transmission is described. A near parabolic solar collector focuses sunlight onto the t-C4F9I (perfluoro-t butyl iodide) lasant within a transverse flow optical cavity. Using waste heat, a thermal system was designed to supply compressor and auxiliary power. System components were designed with weight and cost estimates assigned. Although cost is very approximate, the cost comparison of individual system components leads to valuable insights for future research. In particular, it was found that laser efficiency was not a dominant cost or weight factor, the dominant factor being the laser cavity and laser transmission optics. The manufacturing cost was approx. two thirds of the total cost with transportation to orbit the remainder. The flowing nonrenewable lasant comprised 20% of the total life cycle cost of the system and thus was not a major cost factor. The station mass was 92,000 kg without lasant, requiring approx. four shuttle flights to low Earth orbit where an orbital transfer vehicle will transport it to the final altitude of 6378 km.
-
Optimum Repair Level Analysis (ORLA) for the Space Transportation System (STS)
NASA Technical Reports Server (NTRS)
Henry, W. R.
1979-01-01
A repair level analysis method applied to a space shuttle scenario is presented. A determination of the most cost effective level of repair for reparable hardware, the location for the repair, and a system which will accrue minimum total support costs within operational and technical constraints over the system design are defined. The method includes cost equations for comparison of selected costs to completion for assumed repair alternates.
-
Impact of a hospitalist system on length of stay and cost for children with common conditions.
Srivastava, Rajendu; Landrigan, Christopher P; Ross-Degnan, Dennis; Soumerai, Stephen B; Homer, Charles J; Goldmann, Donald A; Muret-Wagstaff, Sharon
2007-08-01
This study examined mechanisms of efficiency in a managed care hospitalist system on length of stay and total costs for common pediatric conditions. We conducted a retrospective cohort study (October 1993 to July 1998) of patients in a not-for-profit staff model (HMO 1) and a non-staff-model (HMO 2) managed care organization at a freestanding children's hospital. HMO 1 introduced a hospitalist system for patients in October 1996. Patients were included if they had 1 of 3 common diagnoses: asthma, dehydration, or viral illness. Linear regression models examining length-of-stay-specific costs for prehospitalist and posthospitalist systems were built. Distribution of length of stay for each diagnosis before and after the system change in both study groups was calculated. Interrupted time series analysis tested whether changes in the trends of length of stay and total costs occurred after implementation of the hospitalist system by HMO1 (HMO 2 as comparison group) for all 3 diagnoses combined. A total of 1970 patients with 1 of the 3 study conditions were cared for in HMO 1, and 1001 in HMO 2. After the hospitalist system was introduced in HMO 1, length of stay was reduced by 0.23 days (13%) for asthma and 0.19 days (11%) for dehydration; there was no difference for patients with viral illness. The largest relative reduction in length of stay occurred in patients with a shorter length of stay whose hospitalizations were reduced from 2 days to 1 day. This shift resulted in an average cost-per-case reduction of $105.51 (9.3%) for patients with asthma and $86.22 (7.8%) for patients with dehydration. During the same period, length of stay and total cost rose in HMO 2. Introduction of a hospitalist system in one health maintenance organization resulted in earlier discharges and reduced costs for children with asthma and dehydration compared with another one, with the largest reductions occurring in reducing some 2-day hospitalizations to 1 day. These findings suggest that hospitalists can increase efficiency and reduce costs for children with common pediatric conditions.
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Dongxiao Yang; Zhi Wang; Jixiao Wang
2009-09-15
In order to restrict greenhouse gases emissions, CO{sub 2} should be captured from the postcombustion gas for further treatment, for example, geosequestration. In this work, the separation performance of the two-stage membrane system with a recycle stream was investigated using the cross-flow model. For larger CO{sub 2}/N{sub 2} selectivities that can be achieved in the lab, for example, selectivity of 52, the separation target of CO{sub 2} purity >95% and CO{sub 2} recovery >90% can be fulfilled by the two-stage system. The process cost of the two-stage membrane process was investigated. There is an optimum pressure ratio with which themore » capital cost and the energy cost can be balanced to minimize the total cost. Using the optimum pressure ratios and efficient membranes, the total cost of the two-stage system can be reduced to a range that is competitive with the process cost of the traditional chemical absorption method. For example, with feed compression applied, the total cost of the two-stage membrane system using the membrane with CO{sub 2}/N{sub 2} selectivity of 52 and CO{sub 2} permeance of 3.12 x 10{sup -3} m{sup 3} (STP) m{sup -2} s{sup -1} MPa{sup -1} is estimated to be $47.9/(ton CO{sub 2} recovered). 22 refs., 11 figs., 3 tabs.« less
-
Provider continuity in family medicine: does it make a difference for total health care costs?
De Maeseneer, Jan M; De Prins, Lutgarde; Gosset, Christiane; Heyerick, Jozef
2003-01-01
International comparisons of health care systems have shown a relationship at the macro level between a well-structured primary health care plan and lower total health care costs. The objective of this study was to assess whether provider continuity with a family physician is related to lower health care costs using the individual patient as the unit of analysis. We undertook a study of a stratified sample of patients (age, sex, region, insurance company) for which 2 cohorts were constructed based on the patients' utilization pattern of family medicine (provider continuity or not). Patient utilization patterns were observed for 2 years. The setting was the Belgian health care system. The participants were 4,134 members of the 2 largest health insurance companies in 2 regions (Aalst and Liège). The main outcome measures were the total health care costs of patients with and without provider continuity with a family physician, controlling for variables known to influence health care utilization (need factors, predisposing factors, enabling factors). Bivariate analyses showed that patients who were visiting the same family physician had a lower total cost for medical care. A multivariate linear regression showed that provider continuity with a family physician was one of the most important explanatory variables related to the total health care cost. Provider continuity with a family physician is related to lower total health care costs. This finding brings evidence to the debate on the importance of structured primary health care (with high continuity for family practice) for a cost-effective health policy.
-
48 CFR 16.304 - Cost-plus-incentive-fee contracts.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-plus-incentive-fee...-incentive-fee contracts. A cost-plus-incentive-fee contract is a cost-reimbursement contract that provides... allowable costs to total target costs. Cost-plus-incentive-fee contracts are covered in subpart 16.4...
-
[Assessing the economic impact of adverse events in Spanish hospitals by using administrative data].
Allué, Natalia; Chiarello, Pietro; Bernal Delgado, Enrique; Castells, Xavier; Giraldo, Priscila; Martínez, Natalia; Sarsanedas, Eugenia; Cots, Francesc
2014-01-01
To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010. A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project. This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure. Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.
-
Upton, J; Murphy, M; Shalloo, L; Groot Koerkamp, P W G; De Boer, I J M
2014-01-01
Our objective was to define and demonstrate a mechanistic model that enables dairy farmers to explore the impact of a technical or managerial innovation on electricity consumption, associated CO2 emissions, and electricity costs. We, therefore, (1) defined a model for electricity consumption on dairy farms (MECD) capable of simulating total electricity consumption along with related CO2 emissions and electricity costs on dairy farms on a monthly basis; (2) validated the MECD using empirical data of 1yr on commercial spring calving, grass-based dairy farms with 45, 88, and 195 milking cows; and (3) demonstrated the functionality of the model by applying 2 electricity tariffs to the electricity consumption data and examining the effect on total dairy farm electricity costs. The MECD was developed using a mechanistic modeling approach and required the key inputs of milk production, cow number, and details relating to the milk-cooling system, milking machine system, water-heating system, lighting systems, water pump systems, and the winter housing facilities as well as details relating to the management of the farm (e.g., season of calving). Model validation showed an overall relative prediction error (RPE) of less than 10% for total electricity consumption. More than 87% of the mean square prediction error of total electricity consumption was accounted for by random variation. The RPE values of the milk-cooling systems, water-heating systems, and milking machine systems were less than 20%. The RPE values for automatic scraper systems, lighting systems, and water pump systems varied from 18 to 113%, indicating a poor prediction for these metrics. However, automatic scrapers, lighting, and water pumps made up only 14% of total electricity consumption across all farms, reducing the overall impact of these poor predictions. Demonstration of the model showed that total farm electricity costs increased by between 29 and 38% by moving from a day and night tariff to a flat tariff. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
-
Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction.
Thomas, Andrew; Alt, Jeremiah; Gale, Craig; Vijayakumar, Sathya; Padia, Reema; Peters, Matthew; Champagne, Trevor; Meier, Jeremy D
2016-10-01
Septoplasty and turbinate reduction (STR) is a common procedure for which cost reduction efforts may improve value. The purpose of this study was to identify sources of variation in medical facility and surgeon costs associated with STR, and whether these costs correlated with short-term complications. An observational cohort study was performed in a multifacility network using a standardized cost-accounting system to determine costs associated with adult STR from January 1, 2008 to July 31, 2015. A total of 4007 cases, performed at 21 facilities, by 72 different surgeons were included in the study. Total costs, variable costs, operating room (OR) time, and 30-day complications (eg, epistaxis) were compared among surgeons, facilities, and specialties. Total procedure cost: (mean ± standard deviation [SD]) $2503 ± $790 (range, $852 to $10,559). Mean total variable cost: $1147 ± $423 (range, $400 to $5,081). Intersurgeon and interfacility variability was significant for total cost (p < 0.0001) and OR time (p < 0.0001). Intersurgeon OR supply cost variability was also significant (p < 0.0001). Otolaryngologists had less total cost (p < 0.0001), OR time/cost (p < 0.0001), and complications (p = 0.0164), but greater supply cost (p < 0.0001), than other specialties. There is wide variation in cost associated with STR. Significant variance in OR time and supply cost between surgeons suggests these are potential areas for cost reduction. Although no increased 30-day complications were seen with faster and less costly surgeries, further research is needed to evaluate how time and cost relate to quality of care. © 2016 ARS-AAOA, LLC.
-
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
-
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.
-
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
-
1986-09-01
source of the module/system. Source options are; battery, gas, cartridge, valve , and miscellaneous costs. NAMELIST OPERAT is used to compile the...hardware costs allocated to transportation for packing. TF1 = Initial transportation factor. WEIGHT = Shipping weight of total system. XSUM = System float...CD(6,I)+CD(9,I). . AROC(7,I) - Replenishment spares by year. CD(4,I) - Valve replacement cost by year. CD(5,I) = Cartridge replacement cost by year
-
Code of Federal Regulations, 2011 CFR
2011-10-01
... total acquisition costs (for information technology, life cycle costs) are estimated to be $50 million or more, or (b) The system, regardless of estimated acquisition or life cycle costs, has been...
-
Code of Federal Regulations, 2014 CFR
2014-10-01
... total acquisition costs (for information technology, life cycle costs) are estimated to be $50 million or more, or (b) The system, regardless of estimated acquisition or life cycle costs, has been...
-
Code of Federal Regulations, 2013 CFR
2013-10-01
... total acquisition costs (for information technology, life cycle costs) are estimated to be $50 million or more, or (b) The system, regardless of estimated acquisition or life cycle costs, has been...
-
Code of Federal Regulations, 2012 CFR
2012-10-01
... total acquisition costs (for information technology, life cycle costs) are estimated to be $50 million or more, or (b) The system, regardless of estimated acquisition or life cycle costs, has been...
-
Metsemakers, Willem-Jan; Smeets, Bart; Nijs, Stefaan; Hoekstra, Harm
2017-06-01
One of the most challenging complications in musculoskeletal trauma surgery is the development of infection after fracture fixation (IAFF). It can delay healing, lead to permanent functional loss, or even amputation of the affected limb. The main goal of this study was to investigate the total healthcare costs and length-of-stay (LOS) related to the surgical treatment of tibia fractures and furthermore identify the subset of clinical variables driving these costs within the Belgian healthcare system. The hypothesis was that deep infection would be the most important driver for total healthcare costs. Overall, 358 patients treated operatively for AO/OTA type 41, 42, and 43 tibia fractures between January 1, 2009 and January 1, 2014 were included in this study. A total of 26 clinical and process variables were defined. Calculated costs were limited to hospital care covered by the Belgian healthcare financing system. The five main cost categories studied were: honoraria, materials, hospitalization, day care admission, and pharmaceuticals. Multivariate analysis showed that deep infection was the most significant characteristic driving total healthcare costs and LOS related to the surgical treatment of tibia fractures. Furthermore, this complication resulted in the highest overall increase in total healthcare costs and LOS. Treatment costs were approximately 6.5-times higher compared to uninfected patients. This study shows the enormous hospital-related healthcare costs associated with IAFF of the tibia. Treatment costs for patients with deep infection are higher than previously mentioned in the literature. Therefore, future research should focus more on prevention rather than treatment strategies, not only to reduce patient morbidity but also to reduce the socio-economic impact. Copyright © 2017 Elsevier Ltd. All rights reserved.
-
Hoekman, Daniël R; Rutten, Juliette M T M; Vlieger, Arine M; Benninga, Marc A; Dijkgraaf, Marcel G W
2015-11-01
To estimate annual medical and nonmedical costs of care for children diagnosed with irritable bowel syndrome (IBS) or functional abdominal pain (syndrome; FAP/FAPS). Baseline data from children with IBS or FAP/FAPS who were included in a multicenter trial (NTR2725) in The Netherlands were analyzed. Patients' parents completed a questionnaire concerning usage of healthcare resources, travel costs, out-of-pocket expenses, productivity loss of parents, and supportive measures at school. Use of abdominal pain related prescription medication was derived from case reports forms. Total annual costs per patient were calculated as the sum of direct and indirect medical and nonmedical costs. Costs of initial diagnostic investigations were not included. A total of 258 children, mean age 13.4 years (±5.5), were included, and 183 (70.9%) were female. Total annual costs per patient were estimated to be €2512.31. Inpatient and outpatient healthcare use were major cost drivers, accounting for 22.5% and 35.2% of total annual costs, respectively. Parental productivity loss accounted for 22.2% of total annual costs. No difference was found in total costs between children with IBS or FAP/FAPS. Pediatric abdominal pain related functional gastrointestinal disorders impose a large economic burden on patients' families and healthcare systems. More than one-half of total annual costs of IBS and FAP/FAPS consist of inpatient and outpatient healthcare use. Netherlands Trial Registry: NTR2725. Copyright © 2015 Elsevier Inc. All rights reserved.
-
NASA Technical Reports Server (NTRS)
Caluori, V. A.; Conrad, R. T.; Jenkins, J. C.
1980-01-01
Technologies including accelerated technology that are critical to performance and/or provide cost advantages for future space transportation systems are identified. Mission models are scoped and include priority missions, and cargo missions. Summary data, providing primary design concepts and features, are given for the SSTO, HLLV, POTV, and LCOTV vehicles. Significant system costs and total system costs in terms of life cycle costs in both discounted and undiscounted dollars are summarized for each of the vehicles.
-
NASA Technical Reports Server (NTRS)
1982-01-01
Primary and automatic flight controls are combined for a total flight control reliability and maintenance cost data base using information from two previous reports and additional cost data gathered from a major airline. A comparison of the current B-747 flight control system effects on reliability and operating cost with that of a B-747 designed for an active control wing load alleviation system is provided.
-
The financial implications of endovascular aneurysm repair in the cost containment era.
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.
-
Health Cost Containment, Wellness, and the 1990s.
ERIC Educational Resources Information Center
Stasica, Edward R.
Virtually every employer has it in their power to reduce their employee health care costs by 10-20 percent or more. The solution to the rising health care costs problem is a total health care system. Most cost savings potential will be centered in three areas: control of wasteful and often harmful use of the health care system; provider price…
-
How much is the cost of multiple sclerosis--systematic literature review.
Kolasa, Katarzyna
2013-01-01
In Poland, a data on MS costs is lacking. The systematic review of cost of illness studies was conducted to estimate the average annual cost of MS patient and its breakdown. The PubMed database was searched for relevant literature. Following search criteria were used: "multiple sclerosis", "costs", "cost of illness" and "disease burden". Articles written in English including total costs published 2002-2012 were included. In total 17 studies were classified. The costs were re-calculated into USD Purchasing Power Parity (PPP). The available approach from the literature was used for the cost breakdown presentation. The average patient was 47 years old with EDSS equals 4 and 13 years from the date of diagnosis. The average annual cost was 41 133 US$ PPP. The direct costs did not exceed 70% of total costs in any study. The pharmaceutical expenses were one of the most important contributors to the direct costs. Only 40% of patients were active on the labor market what translated into the loss of productivity and consequently an increase in total costs. The preformed systematic review revealed that multiple sclerosis imposes a huge economic burden on the healthcare system and society. It happens due to productivity loss and caregiver burden.
-
Cost savings of patients with a MACIS score lower than 6 when radioactive iodine is not given.
Pace-Asciak, Pia Z; Payne, Richard J; Eski, Spiro J; Walfish, Paul; Damani, Manzur; Freeman, Jeremy L
2007-09-01
To assess the cost savings if the current policy of treating patients with a MACIS (metastases, age, completeness of resection, invasion, and size) score lower than 6 using radioactive iodine (RAI) was changed to reflect the findings of recent studies. Retrospective medical record review. Mount Sinai Hospital, Toronto, Ontario. Between January 1, 2002, and July 1, 2005, 199 consecutive patients with a MACIS score lower than 6 who received RAI treatment after total thyroidectomy. Patient demographics were analyzed. Costs for the dose of RAI, hospital stay, and health insurance claims were included in the calculations. For 199 consecutive patients, the cost for sodium iodide 131 treatment totaled Can$161 588, and the required 2-day stay in isolation totaled Can$764 558. The overall cost to the health care system was Can$934 106, which translates into approximately Can$4694 per patient. By following the recommendations of recent evidence-based studies and by ceasing to treat patients with a MACIS score lower than 6 after total thyroidectomy using RAI, cost savings can be accrued for health care systems involved in the treatment of thyroid cancer. Alternate strategies, such as treating patients who need RAI therapy on an outpatient basis and reducing the dose of RAI, can lower costs as well.
-
CAI System Costs: Present and Future.
ERIC Educational Resources Information Center
Pressman, Israel; Rosenbloom, Bruce
1984-01-01
Discusses costs related to providing computer assisted instruction (CAI), considering hardware, software, user training, maintenance, and installation. Provides an example of the total cost of CAI broken down into these categories, giving an adjusted yearly cost. Projects future trends and costs of CAI as well as cost savings possibilities. (JM)
-
Evaluation of solar sludge drying alternatives by costs and area requirements.
Kurt, Mayıs; Aksoy, Ayşegül; Sanin, F Dilek
2015-10-01
Thermal drying is a common method to reach above 90% dry solids content (DS) in sludge. However, thermal drying requires high amount of energy and can be expensive. A greenhouse solar dryer (GSD) can be a cost-effective substitute if the drying performance, which is typically 70% DS, can be increased by additional heat. In this study feasibility of GSD supported with solar panels is evaluated as an alternative to thermal dryers to reach 90% DS. Evaluations are based on capital and O&M costs as well as area requirements for 37 wastewater treatment plants (WWTPs) with various sludge production rates. Costs for the supported GSD system are compared to that of conventional and co-generation thermal dryers. To calculate the optimal costs associated with the drying system, an optimization model was developed in which area limitation was a constraint. Results showed that total cost was minimum when the DS in the GSD (DS(m,i)) was equal to the maximum attainable value (70% DS). On average, 58% of the total cost and 38% of total required area were associated with the GSD. Variations in costs for 37 WWTPs were due to differences in initial DS (DS(i,i)) and sludge production rates, indicating the importance of dewatering to lower drying costs. For large plants, GSD supported with solar panels provided savings in total costs especially in long term when compared to conventional and co-generation thermal dryers. Copyright © 2015 Elsevier Ltd. All rights reserved.
-
Global Economic Burden of Norovirus Gastroenteritis
Bartsch, Sarah M.; Lopman, Benjamin A.; Ozawa, Sachiko; Hall, Aron J.; Lee, Bruce Y.
2016-01-01
Background Despite accounting for approximately one fifth of all acute gastroenteritis illnesses, norovirus has received comparatively less attention than other infectious pathogens. With several candidate vaccines under development, characterizing the global economic burden of norovirus could help funders, policy makers, public health officials, and product developers determine how much attention and resources to allocate to advancing these technologies to prevent and control norovirus. Methods We developed a computational simulation model to estimate the economic burden of norovirus in every country/area (233 total) stratified by WHO region and globally, from the health system and societal perspectives. We considered direct costs of illness (e.g., clinic visits and hospitalization) and productivity losses. Results Globally, norovirus resulted in a total of $4.2 billion (95% UI: $3.2–5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4–83.4 billion) in societal costs per year. Disease amongst children <5 years cost society $39.8 billion, compared to $20.4 billion for all other age groups combined. Costs per norovirus illness varied by both region and age and was highest among adults ≥55 years. Productivity losses represented 84–99% of total costs varying by region. While low and middle income countries and high income countries had similar disease incidence (10,148 vs. 9,935 illness per 100,000 persons), high income countries generated 62% of global health system costs. In sensitivity analysis, the probability of hospitalization had the largest impact on health system cost estimates ($2.8 billion globally, assuming no hospitalization costs), while the probability of missing productive days had the largest impact on societal cost estimates ($35.9 billion globally, with a 25% probability of missing productive days). Conclusions The total economic burden is greatest in young children but the highest cost per illness is among older age groups in some regions. These large costs overwhelmingly are from productivity losses resulting from acute illness. Low, middle, and high income countries all have a considerable economic burden, suggesting that norovirus gastroenteritis is a truly global economic problem. Our findings can help identify which age group(s) and/or geographic regions may benefit the most from interventions. PMID:27115736
-
Global Economic Burden of Norovirus Gastroenteritis.
Bartsch, Sarah M; Lopman, Benjamin A; Ozawa, Sachiko; Hall, Aron J; Lee, Bruce Y
2016-01-01
Despite accounting for approximately one fifth of all acute gastroenteritis illnesses, norovirus has received comparatively less attention than other infectious pathogens. With several candidate vaccines under development, characterizing the global economic burden of norovirus could help funders, policy makers, public health officials, and product developers determine how much attention and resources to allocate to advancing these technologies to prevent and control norovirus. We developed a computational simulation model to estimate the economic burden of norovirus in every country/area (233 total) stratified by WHO region and globally, from the health system and societal perspectives. We considered direct costs of illness (e.g., clinic visits and hospitalization) and productivity losses. Globally, norovirus resulted in a total of $4.2 billion (95% UI: $3.2-5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4-83.4 billion) in societal costs per year. Disease amongst children <5 years cost society $39.8 billion, compared to $20.4 billion for all other age groups combined. Costs per norovirus illness varied by both region and age and was highest among adults ≥55 years. Productivity losses represented 84-99% of total costs varying by region. While low and middle income countries and high income countries had similar disease incidence (10,148 vs. 9,935 illness per 100,000 persons), high income countries generated 62% of global health system costs. In sensitivity analysis, the probability of hospitalization had the largest impact on health system cost estimates ($2.8 billion globally, assuming no hospitalization costs), while the probability of missing productive days had the largest impact on societal cost estimates ($35.9 billion globally, with a 25% probability of missing productive days). The total economic burden is greatest in young children but the highest cost per illness is among older age groups in some regions. These large costs overwhelmingly are from productivity losses resulting from acute illness. Low, middle, and high income countries all have a considerable economic burden, suggesting that norovirus gastroenteritis is a truly global economic problem. Our findings can help identify which age group(s) and/or geographic regions may benefit the most from interventions.
-
Analysis of Costs and Performance
ERIC Educational Resources Information Center
Duchesne, Roderick M.
1973-01-01
This article outlines a library management information system concerned with total library costs and performance. The system is essentially an adaptation of well-proven industrial and commercial management accounting techniques to the library context. (24 references) (Author)
-
Poli, Anna; Di Matteo, Sergio; Bruno, Giacomo M; Fornai, Enrica; Valentino, Maria Chiara; Colombo, Giorgio L
2015-01-01
Despite the awareness about the increasing rates of Clostridium difficile infection (CDI) and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation), few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication. We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI. We enrolled 69 patients (19 males and 50 females), with a mean age of 82.16 years (minimum 46 to maximum 98). The total number of hospitalization days observed was 886 (12.8 per patient on average). The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature. The economic impact of CDI is most evident in the extension of the duration of hospitalization and emergency recurrences requiring new therapeutic options with the need to develop and implement new diagnostic and therapeutic algorithms in clinical practice.
-
Poli, Anna; Di Matteo, Sergio; Bruno, Giacomo M; Fornai, Enrica; Valentino, Maria Chiara; Colombo, Giorgio L
2015-01-01
Introduction Despite the awareness about the increasing rates of Clostridium difficile infection (CDI) and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation), few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication. Methods We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI. Results We enrolled 69 patients (19 males and 50 females), with a mean age of 82.16 years (minimum 46 to maximum 98). The total number of hospitalization days observed was 886 (12.8 per patient on average). The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature. Conclusion The economic impact of CDI is most evident in the extension of the duration of hospitalization and emergency recurrences requiring new therapeutic options with the need to develop and implement new diagnostic and therapeutic algorithms in clinical practice. PMID:26604846
-
Cieza, Alarcos; Baldwin, David S.
2017-01-01
Development of payment systems for mental health services has been hindered by limited evidence for the utility of diagnosis or symptoms in predicting costs of care. We investigated the utility of functioning information in predicting costs for patients with mood and anxiety disorders. This was a prospective cohort study involving 102 adult patients attending a tertiary referral specialist clinic for mood and anxiety disorders. The main outcome was total costs, calculated by applying unit costs to healthcare use data. After adjusting for covariates, a significant total costs association was yielded for functioning (eβ=1.02; 95% confidence interval: 1.01–1.03), but not depressive symptom severity or anxiety symptom severity. When we accounted for the correlations between the main independent variables by constructing an abridged functioning metric, a significant total costs association was again yielded for functioning (eβ=1.04; 95% confidence interval: 1.01–1.09), but not symptom severity. The utility of functioning in predicting costs for patients with mood and anxiety disorders was supported. Functioning information could be useful within mental health payment systems. PMID:28383309
-
Cost effectiveness analysis of a smoke alarm giveaway program in Oklahoma City, Oklahoma.
Haddix, A C; Mallonee, S; Waxweiler, R; Douglas, M R
2001-12-01
To estimate the cost effectiveness of the Lifesavers Residential Fire and Injury Prevention Program (LRFIPP), a smoke alarm giveaway program. In 1990, the LRFIPP distributed over 10,000 smoke alarms in an area of Oklahoma City at high risk for residential fire injuries. The program also included fire prevention education and battery replacement components. A cost effectiveness analysis was conducted from the societal and health care systems perspectives. The study compared program costs with the total costs of medical treatment and productivity losses averted over a five year period. Fatal and non-fatal residential fire related injuries prevented were estimated from surveillance data. Medical costs were obtained from chart reviews of patients with fire related injuries that occurred during the pre-intervention period. During the five years post-intervention, it is estimated that the LRFIPP prevented 20 fatal and 24 non-fatal injuries. From the societal perspective, the total discounted cost of the program was $531,000. Total discounted net savings exceeded $15 million. From the health care system perspective, the total discounted net savings were almost $1 million and would have a net saving even if program effectiveness was reduced by 64%. The program was effective in reducing fatal and non-fatal residential fire related injuries and was cost saving. Similar programs in other high risk areas would be good investments even if program effectiveness was lower than that achieved by the LRFIPP.
-
Activity-based costing in radiology. Application in a pediatric radiological unit.
Laurila, J; Suramo, I; Brommels, M; Tolppanen, E M; Koivukangas, P; Lanning, P; Standertskjöld-Nordenstam, G
2000-03-01
To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.
-
The health system cost of post-abortion care in Rwanda
Vlassoff, Michael; Musange, Sabine F; Kalisa, Ina R; Ngabo, Fidele; Sayinzoga, Felix; Singh, Susheela; Bankole, Akinrinola
2015-01-01
Based on research conducted in 2012, we estimate the cost to the Rwandan health-care system of providing post-abortion care (PAC) due to unsafe abortions, a subject of policy importance not studied before at the national level. Thirty-nine public and private health facilities representing three levels of health care were randomly selected for data collection from key care providers and administrators for all five regions. Using an ingredients approach to costing, data were gathered on drugs, supplies, material, personnel time and hospitalization. Additionally, direct non-medical costs such as overhead and capital costs were also measured. We found that the average annual PAC cost per client, across five types of abortion complications, was $93. The total cost of PAC nationally was estimated to be $1.7 million per year, 49% of which was expended on direct non-medical costs. Satisfying all demands for PAC would raise the national cost to $2.5 million per year. PAC comprises a significant share of total expenditure in reproductive health in Rwanda. Investing more resources in provision of contraceptive services to prevent unwanted or mistimed pregnancies would likely reduce health systems costs. PMID:24548846
-
Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital
Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud
2016-01-01
Background: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. Objective: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. Methods: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. Results: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. Conclusion: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department. PMID:26234974
-
Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.
Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud
2015-05-17
Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.
-
The cost of pressure ulcers in the UK.
Bennett, Gerry; Dealey, Carol; Posnett, John
2004-05-01
To estimate the annual cost of treating pressure ulcers in the UK. Costs were derived from a bottom-up methodology, based on the daily resources required to deliver protocols of care reflecting good clinical practice. Health and social care system in the UK. Patients developing a pressure ulcer. A bottom-up costing approach is used to estimate treatment cost per episode of care and per patient for ulcers of different grades and level of complications. Also, total treatment cost to the health and social care system in the UK. The cost of treating a pressure ulcer varies from pound 1,064 (Grade 1) to pound 10,551 (Grade 4). Costs increase with ulcer grade because the time to heal is longer and because the incidence of complications is higher in more severe cases. The total cost in the UK is pound 1.4- pound 2.1 billion annually (4% of total NHS expenditure). Most of this cost is nurse time. Pressure ulcers represent a very significant cost burden in the UK. Without concerted effort this cost is likely to increase in the future as the population ages. To the extent that pressure ulcers are avoidable, pressure damage may be indicative of clinical negligence and there is evidence that litigation could soon become a significant threat to healthcare providers in the UK, as it is in the USA.
-
Feasibility analysis of a hydrogen backup power system for Russian telecom market
NASA Astrophysics Data System (ADS)
Borzenko, V. I.; Dunikov, D. O.
2017-11-01
We performed feasibility analysis of 10 kW hydrogen backup power system (H2BS) consisting of a water electrolyzer, a metal hydride hydrogen storage and a fuel cell. Capital investments in H2BS are mostly determined by the costs of the PEM electrolyzer, the fuel cell and solid state hydrogen storage materials, for single unit or small series manufacture the cost of AB5-type intermetallic compound can reach 50% of total system cost. Today the capital investments in H2BS are 3 times higher than in conventional lead-acid system of the same capacity. Wide distribution of fuel cell hydrogen vehicles, development of hydrogen infrastructure, and mass production of hydrogen power systems will for sure lower capital investments in fuel cell backup power. Operational expenditures for H2BS is only 15% from the expenditures for lead acid systems, and after 4-5 years of exploitation the total cost of ownership will become lower than for batteries.
-
Low cost miniature data collection platform
NASA Technical Reports Server (NTRS)
1977-01-01
The development of the RF elements of a telecommunications package involved detailed study and analysis of concepts and techniques followed by laboratory testing and evaluation of designs. The design goals for a complete telecommunications package excluding antenna were a total weight of 300 grams, in a total volume of 400 cu cm with a capability of unattended operation for a period of six months. Of utmost importance is extremely low cost when produced in lots of 10,000. Early in the program it became apparent that a single Miniature Data Collection Platform would not satisfy all users. A single high efficiency system would not satisfy a user who had available a large battery capacity but required a low cost system. Conversely, the low cost system would not satisfy the end user who had a very limited battery capacity. A system design to satisfy these varied requirements was implemented by designing several versions of the system building blocks and then constructing three systems from these building blocks.
-
NASA Astrophysics Data System (ADS)
Chaianong, A.; Bangviwat, A.; Menke, C.
2017-07-01
Driven by decreasing PV and energy storage prices, increasing electricity costs and policy supports from Thai government (self-consumption era), rooftop PV and energy storage systems are going to be deployed in the country rapidly that may disrupt existing business models structure of Thai distribution utilities due to revenue erosion and lost earnings opportunities. The retail rates that directly affect ratepayers (non-solar customers) are expected to increase. This paper focuses on a framework for evaluating impacts of PV with and without energy storage systems on Thai distribution utilities and ratepayers by using cost-benefit analysis (CBA). Prior to calculation of cost/benefit components, changes in energy sales need to be addressed. Government policies for the support of PV generation will also help in accelerating the rooftop PV installation. Benefit components include avoided costs due to transmission losses and deferring distribution capacity with appropriate PV penetration level, while cost components consist of losses in revenue, program costs, integration costs and unrecovered fixed costs. It is necessary for Thailand to compare total costs and total benefits of rooftop PV and energy storage systems in order to adopt policy supports and mitigation approaches, such as business model innovation and regulatory reform, effectively.
-
Özyapıcı, Hasan; Tanış, Veyis Naci
2017-05-01
Objective The aim of the present study was to explore the differences between resource consumption accounting (RCA) and time-driven activity-based costing (TDABC) systems in determining the costs of services of a healthcare setting. Methods A case study was conducted to calculate the unit costs of open and laparoscopic gall bladder surgeries using TDABC and RCA. Results The RCA system assigns a higher cost both to open and laparoscopic gall bladder surgeries than TDABC. The total cost of unused capacity under the TDABC system is also double that in RCA. Conclusion Unlike TDABC, RCA calculates lower costs for unused capacities but higher costs for products or services in a healthcare setting in which fixed costs make up a high proportion of total costs. What is known about the topic? TDABC is a revision of the activity-based costing (ABC) system. RCA is also a new costing system that includes both the theoretical advantages of ABC and the practical advantages of German costing. However, little is known about the differences arising from application of TDABC and RCA. What does this paper add? There is no study comparing both TDABC and RCA in a single case study based on a real-world healthcare setting. Thus, the present study fills this gap in the literature and it is unique in the sense that it is the first case study comparing TDABC and RCA for open and laparoscopic gall bladder surgeries in a healthcare setting. What are the implications for practitioners? This study provides several interesting results for managers and cost accounting researchers. Thus, it will contribute to the spread of RCA studies in healthcare settings. It will also help the implementers of TDABC to revise data concerning the cost of unused capacity. In addition, by separating costs into fixed and variable, the paper will help managers to create a blended (combined) system that can improve both short- and long-term decisions.
-
ERIC Educational Resources Information Center
Densmore, Glen; Bourne, Charles
This study was conducted to determine what fraction of the total cost of the Stanford University library system can properly be charged to each of the four major groups of users: undergraduate students, graduate students, faculty and staff, and non-Stanford users. Eight separate cost elements were developed for each of the library's cost centers…
-
[Cost of mother-child care in Morelos State].
Cahuana-Hurtado, Lucero; Sosa-Rubí, Sandra; Bertozzi, Stefano
2004-01-01
To compare the cost of maternal and child health care (current model) to that of the WHO Mother-Baby Package if it were implemented. A pilot cross-sectional case study was conducted in September 2001 in Sanitary District No. III, Morelos State, Mexico. Two rural health centers, an urban health center, and a general hospital, all managed by the Ministry of Health, were selected for the study. The Mother-Baby Package Costing Spreadsheet was used to estimate the total cost and cost per intervention for the current model and for the Mother-Baby Package model. The total cost of the Mother-Baby Package was twice the cost of the current model. Of the 18 interventions evaluated, the highest proportion of total costs corresponded to antenatal care and normal delivery. Personnel costs represented more than half of the total costs. The Mother-Baby Package Costing Spreadsheet is a practical tool to estimate and compare costs and is useful to guide the distribution of financial resources allocated to maternal and child healthcare. However, this model has limited application unless it is adapted to the structure of each healthcare system. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
-
Martinson, Melissa; Bharmi, Rupinder; Dalal, Nirav; Abraham, William T; Adamson, Philip B
2017-05-01
Haemodynamic-guided heart failure (HF) management effectively reduces decompensation events and need for hospitalizations. The economic benefit of clinical improvement requires further study. An estimate of the cost-effectiveness of haemodynamic-guided HF management was made based on observations published in the randomized, prospective single-blinded CHAMPION trial. A comprehensive analysis was performed including healthcare utilization event rates, survival, and quality of life demonstrated in the randomized portion of the trial (18 months). Markov modelling with Monte Carlo simulation was used to approximate comprehensive costs and quality-adjusted life years (QALYs) from a payer perspective. Unit costs were estimated using the Truven Health MarketScan database from April 2008 to March 2013. Over a 5-year horizon, patients in the Treatment group had average QALYs of 2.56 with a total cost of US$56 974; patients in the Control group had QALYs of 2.16 with a total cost of US$52 149. The incremental cost-effectiveness ratio (ICER) was US$12 262 per QALY. Using comprehensive cost modelling, including all anticipated costs of HF and non-HF hospitalizations, physician visits, prescription drugs, long-term care, and outpatient hospital visits over 5 years, the Treatment group had a total cost of US$212 004 and the Control group had a total cost of US$200 360. The ICER was US$29 593 per QALY. Standard economic modelling suggests that pulmonary artery pressure-guided management of HF using the CardioMEMS™ HF System is cost-effective from the US-payer perspective. This analysis provides the background for further modelling in specific country healthcare systems and cost structures. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
-
Estimating the Life Cycle Cost of Space Systems
NASA Technical Reports Server (NTRS)
Jones, Harry W.
2015-01-01
A space system's Life Cycle Cost (LCC) includes design and development, launch and emplacement, and operations and maintenance. Each of these cost factors is usually estimated separately. NASA uses three different parametric models for the design and development cost of crewed space systems; the commercial PRICE-H space hardware cost model, the NASA-Air Force Cost Model (NAFCOM), and the Advanced Missions Cost Model (AMCM). System mass is an important parameter in all three models. System mass also determines the launch and emplacement cost, which directly depends on the cost per kilogram to launch mass to Low Earth Orbit (LEO). The launch and emplacement cost is the cost to launch to LEO the system itself and also the rockets, propellant, and lander needed to emplace it. The ratio of the total launch mass to payload mass depends on the mission scenario and destination. The operations and maintenance costs include any material and spares provided, the ground control crew, and sustaining engineering. The Mission Operations Cost Model (MOCM) estimates these costs as a percentage of the system development cost per year.
-
Ding, Yan; Fei, Yang; Xu, Biao; Yang, Jun; Yan, Weirong; Diwan, Vinod K; Sauerborn, Rainer; Dong, Hengjin
2015-07-25
Studies into the costs of syndromic surveillance systems are rare, especially for estimating the direct costs involved in implementing and maintaining these systems. An Integrated Surveillance System in rural China (ISSC project), with the aim of providing an early warning system for outbreaks, was implemented; village clinics were the main surveillance units. Village doctors expressed their willingness to join in the surveillance if a proper subsidy was provided. This study aims to measure the costs of data collection by village clinics to provide a reference regarding the subsidy level required for village clinics to participate in data collection. We conducted a cross-sectional survey with a village clinic questionnaire and a staff questionnaire using a purposive sampling strategy. We tracked reported events using the ISSC internal database. Cost data included staff time, and the annual depreciation and opportunity costs of computers. We measured the village doctors' time costs for data collection by multiplying the number of full time employment equivalents devoted to the surveillance by the village doctors' annual salaries and benefits, which equaled their net incomes. We estimated the depreciation and opportunity costs of computers by calculating the equivalent annual computer cost and then allocating this to the surveillance based on the percentage usage. The estimated total annual cost of collecting data was 1,423 Chinese Renminbi (RMB) in 2012 (P25 = 857, P75 = 3284), including 1,250 RMB (P25 = 656, P75 = 3000) staff time costs and 134 RMB (P25 = 101, P75 = 335) depreciation and opportunity costs of computers. The total costs of collecting data from the village clinics for the syndromic surveillance system was calculated to be low compared with the individual net income in County A.
-
Zarogoulidou, Vasiliki; Panagopoulou, Efharis; Papakosta, Despina; Petridis, Dimitris; Porpodis, Konstantinos; Zarogoulidis, Konstantinos; Zarogoulidis, Paul; Arvanitidou, Malamatenia
2015-02-01
Lung cancer (LC) is a disease with high morbidity and mortality while the prevention and treatment constitutes a significant financial burden. This economic burden has an increasing trend, with hospitalization being the highest cost factor in most studies, while the patients' quality of life (QoL) and response to treatment is not proven to be positively affected. To evaluate the direct and indirect cost of managing patients with LC in Greece according to stage and histological type of cancer, total chemotherapy cycles, age, gender, smoking habit, overall survival (OS), treatment outcome (TO) and QoL. One hundred thirteen of 128 consecutive patients met the inclusion criteria and were included in this prospective study. Patient enrolment started in August 2011 and ended in November 2011. The duration of the patient follow up was 32 months after diagnosis until end of registry. Total direct cost included diagnosis and treatment cost. Indirect cost constituted of patient's and family caregivers lost days of productivity. QoL was assessed with EORTC-QLQ-30 and Lung Cancer Symptom Scale (LCSS) questionnaires before treatment and every three months. Total direct cost was €1,853,984 and chemotherapy drugs was the highest cost factor (€1,216,421). Total indirect cost was 28,774 days of which 27,293 were related to patients. Total direct cost was significantly related to the increased number of total chemotherapy cycles, longer OS, histological type of adenocarcinoma, female gender and younger patients. No relation was found between total indirect cost and the above factors. When the association between total direct/indirect cost and QoL was examined no significant results were drawn. The burden of LC on health care systems remains very high and was associated with the increased number of total chemotherapy cycles, longer OS, adenocarcinoma histological type of cancer, female gender and younger patients. Chemotherapy drugs constituted the higher factor of total direct cost. Indirect cost was considerably higher for patients than family caregivers and did not significantly differ in relation to the above factors. No significant conclusion was drawn regarding QoL and total direct/indirect cost.
-
Life-Cycle-Cost Analysis of the Microwave Landing System Ground and Airborne Systems
1981-10-01
constant 1980 dollars, with a production rate variability. Table S-3 presents the life-cycle costs by MLS configuration and total system implementation... PRODUCTION RATE VARIABILITY OVER A THREE-YEAR PFODUCTXION RUN (MILLIONS OF CONSTANT 1980 DOLLARS) Pruduction (Juantitl•e and Costs system Typ 75...Implementation strategies * Production schedules for MLS equipment The LCC was determined to be relatively insensitive to changes in MTBF. This was expected
-
Estimating two indirect logging costs caused by accelerated erosion.
Glen O. Klock
1976-01-01
In forest areas where high soil erosion potential exists, a comparative yarding cost estimate, including the indirect costs determined by methods proposed here, shows that the total cost of using "advanced" logging methods may be less than that of "traditional" systems.
-
[Costs of maternal-infant care in an institutionalized health care system].
Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L
1998-01-01
Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.
-
NASA Astrophysics Data System (ADS)
Olivia, G.; Santoso, A.; Prayogo, D. N.
2017-11-01
Nowadays, the level of competition between supply chains is getting tighter and a good coordination system between supply chains members is very crucial in solving the issue. This paper focused on a model development of coordination system between single supplier and buyers in a supply chain as a solution. Proposed optimization model was designed to determine the optimal number of deliveries from a supplier to buyers in order to minimize the total cost over a planning horizon. Components of the total supply chain cost consist of transportation costs, handling costs of supplier and buyers and also stock out costs. In the proposed optimization model, the supplier can supply various types of items to retailers whose item demand patterns are probabilistic. Sensitivity analysis of the proposed model was conducted to test the effect of changes in transport costs, handling costs and production capacities of the supplier. The results of the sensitivity analysis showed a significant influence on the changes in the transportation cost, handling costs and production capacity to the decisions of the optimal numbers of product delivery for each item to the buyers.
-
Impact Of Health Care Delivery System Innovations On Total Cost Of Care.
Smith, Kevin W; Bir, Anupa; Freeman, Nikki L B; Koethe, Benjamin C; Cohen, Julia; Day, Timothy J
2017-03-01
Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings. Project HOPE—The People-to-People Health Foundation, Inc.
-
The economics of time shared computing: Congestion, user costs and capacity
NASA Technical Reports Server (NTRS)
Agnew, C. E.
1982-01-01
Time shared systems permit the fixed costs of computing resources to be spread over large numbers of users. However, bottleneck results in the theory of closed queueing networks can be used to show that this economy of scale will be offset by the increased congestion that results as more users are added to the system. If one considers the total costs, including the congestion cost, there is an optimal number of users for a system which equals the saturation value usually used to define system capacity.
-
Balogh, Orsolya; Brodszky, Valentin; Gulácsi, László; Herédi, Emese; Herszényi, Krisztina; Jókai, Hajnalka; Kárpáti, Sarolta; Baji, Petra; Remenyik, Éva; Szegedi, Andrea; Holló, Péter
2014-05-01
Despite the widespread availability of biological drugs in psoriasis, there is a shortage of disease burden studies. To assess the cost-of-illness and quality of life of patients with moderate to severe psoriasis in Hungary. Consecutive patients with Psoriasis Area and Severity Index (PASI) > 10 and Dermatology Life Quality Index (DLQI) > 10, or treated with traditional systemic (TST) or biological systemic treatment (BST) were included. Demographic data, clinical characteristics, psoriasis related medication, health care utilizations and employment status in the previous 12 months were recorded. Costing was performed from the societal perspective applying the human capital approach. Quality of life was assessed using DLQI and EQ-5D measures. Two-hundred patients were involved (females 32%) with a mean age of 51 (SD 13) years, 103 (52%) patients were on BST. Mean PASI, DLQI and EQ-5D scores were 8 (SD 10), 6 (SD 7) and 0.69 (SD 0.3), respectively. The mean total cost was €9,254/patient/year (SD 8,502) with direct costs accounting for 86%. The main cost driver was BST (mean €7,339/patient/year). Total costs differed significantly across treatment subgroups, mean (SD): no systemic therapy €2,186 (4,165), TST €2,388 (4,106) and BST €15,790 (6,016) (p < 0,001). Patients with BST had better PASI and DLQI scores (p < 0.01) than the other two subgroups. Patients with biological treatment have a significantly better quality of life and higher total costs than patients with or without traditional systemic treatment. Our study is the largest in Europe and the first in the CEE region that provides cost-of-illness data in psoriasis involving patients with BST.
-
Final Report - Stationary and Emerging Market Fuel Cell System Cost Assessment
DOE Office of Scientific and Technical Information (OSTI.GOV)
Contini, Vince; Heinrichs, Mike; George, Paul
The U.S. Department of Energy (DOE) is focused on providing a portfolio of technology solutions to meet energy security challenges of the future. Fuel cells are a part of this portfolio of technology offerings. To help meet these challenges and supplement the understanding of the current research, Battelle has executed a five-year program that evaluated the total system costs and total ownership costs of two technologies: (1) an ~80 °C polymer electrolyte membrane fuel cell (PEMFC) technology and (2) a solid oxide fuel cell (SOFC) technology, operating with hydrogen or reformate for different applications. Previous research conducted by Battelle, andmore » more recently by other research institutes, suggests that fuel cells can offer customers significant fuel and emission savings along with other benefits compared to incumbent alternatives. For this project, Battelle has applied a proven cost assessment approach to assist the DOE Fuel Cell Technologies Program in making decisions regarding research and development, scale-up, and deployment of fuel cell technology. The cost studies and subsequent reports provide accurate projections of current system costs and the cost impact of state-of-the-art technologies in manufacturing, increases in production volume, and changes to system design on system cost and life cycle cost for several near-term and emerging fuel cell markets. The studies also provide information on types of manufacturing processes that must be developed to commercialize fuel cells and also provide insights into the optimization needed for use of off-the-shelf components in fuel cell systems. Battelle’s analysis is intended to help DOE prioritize investments in research and development of components to reduce the costs of fuel cell systems while considering systems optimization.« less
-
A feasibility study on solar utility total energy system /SUTES/
NASA Astrophysics Data System (ADS)
Bilgen, E.
1980-11-01
A fully dedicated central receiver solar utility (CRSU) designed to meet domestic energy requirements for space heating and hot water has been synthesized and assessed at the conceptual level. The solar utility total energy system (SUTES) integrates (1) a central receiver solar utility (CRSU), (2) an electrical power generating system (EPGS), (3) a hydrogen production plant (HPP), (4) a water chilling system for cooling, heat pump system (HPS), (5) necessary thermal energy storage systems (TES), (6) a district heating and cooling system (DH&CS). All subsystems are close-coupled. Using consistent costing bases, it has been found that the SUTES concept provides energy costs which are lower than those provided by a CRSU. Representative costs are $3.14/GJ versus $8.56/GJ for 10 percent recovery factor and $12.55/GJ versus $13.47/GJ for 17.5 percent recovery factor.
-
Costs and quality of life of patients with ankylosing spondylitis in Hong Kong.
Zhu, T Y; Tam, L-S; Lee, V W-Y; Hwang, W W; Li, T K; Lee, K K; Li, E K
2008-09-01
To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants. A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36). The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs. There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.
-
Policy interactions and underperforming emission trading markets in China.
Zhang, Bing; Zhang, Hui; Liu, Beibei; Bi, Jun
2013-07-02
Emission trading is considered to be cost-effective environmental economic instrument for pollution control. However, the ex post analysis of emission trading program found that cost savings have been smaller and the trades fewer than might have been expected at the outset of the program. Besides policy design issues, pre-existing environmental regulations were considered to have a significant impact on the performance of the emission trading market in China. Taking the Jiangsu sulfur dioxide (SO2) market as a case study, this research examined the impact of policy interactions on the performance of the emission trading market. The results showed that cost savings associated with the Jiangsu SO2 emission trading market in the absence of any policy interactions were CNY 549 million or 12.5% of total pollution control costs. However, policy interactions generally had significant impacts on the emission trading system; the lone exception was current pollution levy system. When the model accounted for all four kinds of policy interactions, the total pollution control cost savings from the emission trading market fell to CNY 39.7 million or 1.36% of total pollution control costs. The impact of policy interactions would reduce 92.8% of cost savings brought by emission trading program.
-
Assessing the Utilization of Total Ankle Replacement in the United States.
Reddy, Sudheer; Koenig, Lane; Demiralp, Berna; Nguyen, Jennifer T; Zhang, Qian
2017-06-01
Total ankle arthroplasty (TAR) has been shown to be a cost-effective procedure relative to conservative management and ankle arthrodesis. Although its use has grown considerably over the last 2 decades, it is less common than arthrodesis. The purpose of this investigation was to analyze the cost and utilization of TAR across hospitals. Our analytical sample consisted of Medicare claims data from 2011 and 2012 for Inpatient Prospective Payment System hospitals. Outcome variables of interest were the likelihood of a hospital performing TAR, the volume of TAR cases, TAR hospital costs, and hospital profit margins. Data from the 2010 Cost Report and Medicare inpatient claims were utilized to compute average margins for TAR cases and overall hospital margins. TAR cost was calculated based on the all payer cost-to-charge ratio for each hospital in the Cost Report. Nationwide Inpatient Sample data were used to generate descriptive statistics on all TAR patients across payers. Medicare participants accounted for 47.5% of the overall population of TAR patients. Average implant cost was $13 034, accounting for approximately 70% of the total all-payer cost. Approximately, one-third of hospitals were profitable with respect to primary TAR. Profitable hospitals had lower total costs and higher payments leading to a difference in profit of approximately $11 000 from TAR surgeries between profitable and nonprofitable hospitals. No difference was noted with respect to length of stay or number of cases performed between profitable and nonprofitable hospitals. TAR surgeries were more likely to take place in large and major teaching hospitals. Among hospitals performing at least 1 TAR, the margin on TAR cases was positively associated with the total number of TARs performed by a hospital. There is an overall significant financial burden associated with performing TAR with many health systems failing to demonstrate profitability despite its increased utilization. While additional factors such as improved patient outcomes may be driving utilization of TAR, financial barriers may exist that can affect utilization of TAR across health systems. Level III, comparative study.
-
Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.
Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J
2015-07-15
Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle replacement is preferred over ankle fusion; total ankle replacement is cost-saving when indirect costs are considered and demonstrates increasing cost-effectiveness in younger patients. As indications for and utilization of total ankle replacement increase, continued research is needed to define appropriate subgroups of patients who would likely derive the greatest clinical benefit from that procedure. Economic and decision analysis Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
-
Regenerating an Arsenic Removal Iron-Based Adsorptive Media System, Part 2: Performance and Cost
The replacement of exhausted, adsorptive media used to remove arsenic from drinking water accounts for approximately 80% of the total operational and maintenance (O/M) costs of this commonly used small system technology. The results of three, full scale system studies of an on-s...
-
Plantation thinning systems in the Southern United States
Bryce J. Stokes; William F. Watson
1996-01-01
This paper reviews southern pine management and thinning practices, describes three harvesting systems for thinning, and presents production and cost estimates, and utilization rates. The costs and product recoveries were developed from published sources using a spreadsheet analysis. Systems included tree-length, flail/chip, and cut-to-length. The estimated total...
-
de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes
2015-01-01
Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.
-
Total systems design analysis of high performance structures
NASA Technical Reports Server (NTRS)
Verderaime, V.
1993-01-01
Designer-control parameters were identified at interdiscipline interfaces to optimize structural systems performance and downstream development and operations with reliability and least life-cycle cost. Interface tasks and iterations are tracked through a matrix of performance disciplines integration versus manufacturing, verification, and operations interactions for a total system design analysis. Performance integration tasks include shapes, sizes, environments, and materials. Integrity integrating tasks are reliability and recurring structural costs. Significant interface designer control parameters were noted as shapes, dimensions, probability range factors, and cost. Structural failure concept is presented, and first-order reliability and deterministic methods, benefits, and limitations are discussed. A deterministic reliability technique combining benefits of both is proposed for static structures which is also timely and economically verifiable. Though launch vehicle environments were primarily considered, the system design process is applicable to any surface system using its own unique filed environments.
-
Highlights of recent balance of system research and evaluation
NASA Astrophysics Data System (ADS)
Thomas, M. G.; Stevens, J. W.
The cost of most photovoltaic (PV) systems is more a function of the balance of system (BOS) components than the collectors. The exception to this rule is the grid-tied system whose cost is related more directly to the collectors, and secondarily to the inverter/controls. In fact, recent procurements throughout the country document that collector costs for roof-mounted, utility-tied systems (Russell, PV Systems Workshop, 7/94) represent 60% to 70% of the system cost. This contrasts with the current market for packaged stand-alone all PV or PV-hybrid systems where collectors represent only 25% to 35% of the total. Not only are the BOS components the cost drivers in the current cost-effective PV system market place, they are also the least reliable components. This paper discusses the impact that BOS issues have on component performance, system performance, and system cost and reliability. We will also look at recent recommended changes in system design based upon performance evaluations of fielded PV systems.
-
Systems design analysis applied to launch vehicle configuration
NASA Technical Reports Server (NTRS)
Ryan, R.; Verderaime, V.
1993-01-01
As emphasis shifts from optimum-performance aerospace systems to least lift-cycle costs, systems designs must seek, adapt, and innovate cost improvement techniques in design through operations. The systems design process of concept, definition, and design was assessed for the types and flow of total quality management techniques that may be applicable in a launch vehicle systems design analysis. Techniques discussed are task ordering, quality leverage, concurrent engineering, Pareto's principle, robustness, quality function deployment, criteria, and others. These cost oriented techniques are as applicable to aerospace systems design analysis as to any large commercial system.
-
Yu, Mo; Guerriere, Denise N; Coyte, Peter C
2015-11-01
In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00 CDN = $1.00 USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of costs borne by different stakeholders. © 2014 John Wiley & Sons Ltd.
-
Russo, S; Mariani, T T; Migliorini, R; Marcellusi, A; Mennini, F S
2015-09-16
The aim of the study is to estimate the pension costs incurred for patients with musculoskeletal disorders (MDs) and specifically with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in Italy between 2009 and 2012. We analyzed the database of the Italian National Social Security Institute (Istituto Nazionale Previdenza Sociale i.e. INPS) to estimate the total costs of three types of social security benefits granted to patients with MDs, RA and AS: disability benefits (for people with reduced working ability), disability pensions (for people who cannot qualify as workers) and incapacity pensions (for people without working ability). We developed a probabilistic model with a Monte Carlo simulation to estimate the total costs for each type of benefit associated with MDs, RA and AS. We also estimated the productivity loss resulting from RA in 2013. From 2009 to 2012 about 393 thousand treatments were paid for a total of approximately €2.7 billion. The annual number of treatments was on average 98 thousand and cost in total €674 million per year. In particular, the total pension burden was about €99 million for RA and €26 million for AS. The productivity loss for AR in 2013 was equal to €707,425,191 due to 9,174,221 working days lost. Our study is the fi rst to estimate the burden of social security pensions for MDs based on data of both approved claims and benefits paid by the national security system. From 2009 to 2012, in Italy, the highest indirect costs were associated with disability pensions (54% of the total indirect cost), followed by disability benefits (44.1% of cost) and incapacity pensions (1.8% of cost). In conclusion, MDs are chronic and highly debilitating diseases with a strong female predominance and very significant economic and social costs that are set to increase due to the aging of the population.
-
Cost-identification analysis of total laryngectomy: an itemized approach to hospital costs.
Dedhia, Raj C; Smith, Kenneth J; Weissfeld, Joel L; Saul, Melissa I; Lee, Steve C; Myers, Eugene N; Johnson, Jonas T
2011-02-01
To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Case series with chart review. Large tertiary care teaching hospital system. Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Mean total hospital costs were $29,563 (range, $10,915 to $120,345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6-43), and median Charlson comorbidity index score was 8 (2-16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46,831 vs $24,601, P < .01). The authors found no significant cost differences with stratification based on previous radiation therapy ($27,598 vs $29,915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29,483 vs $29,609 without readmission, P = .97). This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers.
-
Manpower Mix for Health Services
Shuman, Larry J.; Young, John P.; Naddor, Eliezer
1971-01-01
A model is formulated to determine the mix of manpower and technology needed to provide health services of acceptable quality at a minimum total cost to the community. Total costs include both the direct costs associated with providing the services and with developing additional manpower and the indirect costs (shortage costs) resulting from not providing needed services. The model is applied to a hypothetical neighborhood health center, and its sensitivity to alternative policies is investigated by cost-benefit analyses. Possible extensions of the model to include dynamic elements in health delivery systems are discussed, as is its adaptation for use in hospital planning, with a changed objective function. PMID:5095652
-
The health system cost of post-abortion care in Rwanda.
Vlassoff, Michael; Musange, Sabine F; Kalisa, Ina R; Ngabo, Fidele; Sayinzoga, Felix; Singh, Susheela; Bankole, Akinrinola
2015-03-01
Based on research conducted in 2012, we estimate the cost to the Rwandan health-care system of providing post-abortion care (PAC) due to unsafe abortions, a subject of policy importance not studied before at the national level. Thirty-nine public and private health facilities representing three levels of health care were randomly selected for data collection from key care providers and administrators for all five regions. Using an ingredients approach to costing, data were gathered on drugs, supplies, material, personnel time and hospitalization. Additionally, direct non-medical costs such as overhead and capital costs were also measured. We found that the average annual PAC cost per client, across five types of abortion complications, was $93. The total cost of PAC nationally was estimated to be $1.7 million per year, 49% of which was expended on direct non-medical costs. Satisfying all demands for PAC would raise the national cost to $2.5 million per year. PAC comprises a significant share of total expenditure in reproductive health in Rwanda. Investing more resources in provision of contraceptive services to prevent unwanted or mistimed pregnancies would likely reduce health systems costs. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014.
-
NASA Astrophysics Data System (ADS)
Jatzeck, Bernhard Michael
2000-10-01
The application of the Luus-Jaakola direct search method to the optimization of stand-alone hybrid energy systems consisting of wind turbine generators (WTG's), photovoltaic (PV) modules, batteries, and an auxiliary generator was examined. The loads for these systems were for agricultural applications, with the optimization conducted on the basis of minimum capital, operating, and maintenance costs. Five systems were considered: two near Edmonton, Alberta, and one each near Lethbridge, Alberta, Victoria, British Columbia, and Delta, British Columbia. The optimization algorithm used hourly data for the load demand, WTG output power/area, and PV module output power. These hourly data were in two sets: seasonal (summer and winter values separated) and total (summer and winter values combined). The costs for the WTG's, PV modules, batteries, and auxiliary generator fuel were full market values. To examine the effects of price discounts or tax incentives, these values were lowered to 25% of the full costs for the energy sources and two-thirds of the full cost for agricultural fuel. Annual costs for a renewable energy system depended upon the load, location, component costs, and which data set (seasonal or total) was used. For one Edmonton load, the cost for a renewable energy system consisting of 27.01 m2 of WTG area, 14 PV modules, and 18 batteries (full price, total data set) was 6873/year. For Lethbridge, a system with 22.85 m2 of WTG area, 47 PV modules, and 5 batteries (reduced prices, seasonal data set) cost 2913/year. The performance of renewable energy systems based on the obtained results was tested in a simulation using load and weather data for selected days. Test results for one Edmonton load showed that the simulations for most of the systems examined ran for at least 17 hours per day before failing due to either an excessive load on the auxiliary generator or a battery constraint being violated. Additional testing indicated that increasing the generator capacity and reducing the maximum allowed battery charge current during the time of the day at which these failures occurred allowed the simulation to successfully operate.
-
Carel, R S
1982-04-01
The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."
-
Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique
Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan
2015-01-01
Background: Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. Objectives: The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). Materials and Methods: We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Results: Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. Conclusion: As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs. PMID:26715979
-
Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique.
Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan
2015-10-01
Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs.
-
Budgeting in health care systems.
Maynard, A
1984-01-01
During the last decade there has been a recognition that all health care systems, public and private, are characterised by perverse incentives (especially moral hazard and third party pays) which generate inefficiency in the use of scarce economic resources. Inefficiency is unethical: doctors who use resources inefficiently deprive potential patients of care from which they could benefit. To eradicate unethical and inefficient practices two economic rules have to be followed: (i) no service should be provided if its total costs exceed its total benefits; (ii) if total benefits exceed total costs, the level of provision should be at that level at which the additional input cost (marginal cost) is equal to the additional benefits (marginal benefit). This efficiency test can be applied to health care systems, their component parts and the individuals (especially doctors) who control resource allocation within them. Unfortunately, all health care systems neither generate this relevant decision making data nor are they flexible enough to use it to affect health care decisions. There are two basic varieties of budgeting system: resource based and production targeted. The former generates obsession with cash limits and too little regard of the benefits, particularly at the margins, of alternative patterns of resource allocation. The latter generates undue attention to the production of processes of care and scant regard for costs, especially at the margins. Consequently, one set of budget rules may lead to cost containment regardless of benefits and the other set of budget rules may lead to output maximization regardless of costs. To close this circle of inefficiency it is necessary to evolve market-like structures. To do this a system of client group (defined broadly across all existing activities public and private) budgets is advocated with an identification of the budget holder who has the capacity to shift resources and seek out cost effective policies. Negotiated output targets with defined budgets and incentives for decision makers to economise in their use of resources are being incorporated into experiments in the health care systems of Western Europe and the United States. Undue optimism about the success of these experiments must be avoided because these problems have existed in the West and in the Soviet bloc for decades and efficient solutions are noticeable by their absence.
-
NASA Technical Reports Server (NTRS)
Summers, Geoffrey P.; Walters, Robert J.; Messenger, Scott R.; Burke, Edward A.
1995-01-01
An analysis embodied in a PC computer program is presented which quantitatively demonstrates how the availability of radiation hard solar cells can minimize the cost of a global satellite communication system. The chief distinction between the currently proposed systems, such as Iridium Odyssey and Ellipsat, is the number of satellites employed and their operating altitudes. Analysis of the major costs associated with implementing these systems shows that operation within the earth's radiation belts can reduce the total system cost by as much as a factor of two, so long as radiation hard components including solar cells, can be used. A detailed evaluation of several types of planar solar cells is given, including commercially available Si and GaAs/Ge cells, and InP/Si cells which are under development. The computer program calculates the end of life (EOL) power density of solar arrays taking into account the cell geometry, coverglass thickness, support frame, electrical interconnects, etc. The EOL power density can be determined for any altitude from low earth orbit (LEO) to geosynchronous (GEO) and for equatorial to polar planes of inclination. The mission duration can be varied over the entire range planned for the proposed satellite systems. An algorithm is included in the program for determining the degradation of cell efficiency for different cell technologies due to proton and electron irradiation. The program can be used to determine the optimum configuration for any cell technology for a particular orbit and for a specified mission life. Several examples of applying the program are presented, in which it is shown that the EOL power density of different technologies can vary by an order of magnitude for certain missions. Therefore, although a relatively radiation soft technology can be made to provide the required EOL power by simply increasing the size of the array, the impact on the total system budget could be unacceptable, due to increased launch and hardware costs. In aggregate these factors can account for more than a 10% increase in the total system cost. Since the estimated total costs of proposed global coverage systems range from $1 Billion to $9 Billion, the availability of radiation hard solar cells could make a decisive difference in the selection of a particular constellation architecture.
-
Saronga, Happiness Pius; Dalaba, Maxwell Ayindenaba; Dong, Hengjin; Leshabari, Melkizedeck; Sauerborn, Rainer; Sukums, Felix; Blank, Antje; Kaltschmidt, Jens; Loukanova, Svetla
2015-04-02
Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a "know-do gap" where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal health care. This study aimed at assessing the cost of installing and operating the system in the health centers. This retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software, transport, personnel, training, supplies and communication. These were grouped into installation and operation cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and economic cost implications. We also conducted a sensitivity analysis on the estimations. Total financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in the installation phase and included all the activities in preparation for the actual operation of the system for client care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost) followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset useful life and input cost variations. Our study presents financial and economic cost estimates of installing and operating an electronic CDSS for maternal health care in six rural health centres. From these findings one can understand exactly what goes into a similar investment and thus determine sorts of input modification needed to fit their context.
-
System engineering of complex optical systems for mission assurance and affordability
NASA Astrophysics Data System (ADS)
Ahmad, Anees
2017-08-01
Affordability and reliability are equally important as the performance and development time for many optical systems for military, space and commercial applications. These characteristics are even more important for the systems meant for space and military applications where total lifecycle costs must be affordable. Most customers are looking for high performance optical systems that are not only affordable but are designed with "no doubt" mission assurance, reliability and maintainability in mind. Both US military and commercial customers are now demanding an optimum balance between performance, reliability and affordability. Therefore, it is important to employ a disciplined systems design approach for meeting the performance, cost and schedule targets while keeping affordability and reliability in mind. The US Missile Defense Agency (MDA) now requires all of their systems to be engineered, tested and produced according to the Mission Assurance Provisions (MAP). These provisions or requirements are meant to ensure complex and expensive military systems are designed, integrated, tested and produced with the reliability and total lifecycle costs in mind. This paper describes a system design approach based on the MAP document for developing sophisticated optical systems that are not only cost-effective but also deliver superior and reliable performance during their intended missions.
-
48 CFR 852.236-82 - Payments under fixed-price construction contracts (without NAS).
Code of Federal Regulations, 2013 CFR
2013-10-01
... “Network Analysis System (NAS).” Payments Under Fixed-Price Construction Contracts (APR 1984) The clause..., as applied to each branch, shall equal the total cost of such branch. The total cost of all branches... readily available for inspection and inventory by the resident engineer. (4) Such materials and/or...
-
48 CFR 852.236-82 - Payments under fixed-price construction contracts (without NAS).
Code of Federal Regulations, 2011 CFR
2011-10-01
... “Network Analysis System (NAS).” Payments Under Fixed-Price Construction Contracts (APR 1984) The clause..., as applied to each branch, shall equal the total cost of such branch. The total cost of all branches... readily available for inspection and inventory by the resident engineer. (4) Such materials and/or...
-
48 CFR 852.236-82 - Payments under fixed-price construction contracts (without NAS).
Code of Federal Regulations, 2012 CFR
2012-10-01
... “Network Analysis System (NAS).” Payments Under Fixed-Price Construction Contracts (APR 1984) The clause..., as applied to each branch, shall equal the total cost of such branch. The total cost of all branches... readily available for inspection and inventory by the resident engineer. (4) Such materials and/or...
-
48 CFR 852.236-82 - Payments under fixed-price construction contracts (without NAS).
Code of Federal Regulations, 2014 CFR
2014-10-01
... “Network Analysis System (NAS).” Payments Under Fixed-Price Construction Contracts (APR 1984) The clause..., as applied to each branch, shall equal the total cost of such branch. The total cost of all branches... readily available for inspection and inventory by the resident engineer. (4) Such materials and/or...
-
Analysing biomass torrefaction supply chain costs.
Svanberg, Martin; Olofsson, Ingemar; Flodén, Jonas; Nordin, Anders
2013-08-01
The objective of the present work was to develop a techno-economic system model to evaluate how logistics and production parameters affect the torrefaction supply chain costs under Swedish conditions. The model consists of four sub-models: (1) supply system, (2) a complete energy and mass balance of drying, torrefaction and densification, (3) investment and operating costs of a green field, stand-alone torrefaction pellet plant, and (4) distribution system to the gate of an end user. The results show that the torrefaction supply chain reaps significant economies of scale up to a plant size of about 150-200 kiloton dry substance per year (ktonDS/year), for which the total supply chain costs accounts to 31.8 euro per megawatt hour based on lower heating value (€/MWhLHV). Important parameters affecting total cost are amount of available biomass, biomass premium, logistics equipment, biomass moisture content, drying technology, torrefaction mass yield and torrefaction plant capital expenditures (CAPEX). Copyright © 2013 Elsevier Ltd. All rights reserved.
-
Reliability and cost: A sensitivity analysis
NASA Technical Reports Server (NTRS)
Suich, Ronald C.; Patterson, Richard L.
1991-01-01
In the design phase of a system, how a design engineer or manager choose between a subsystem with .990 reliability and a more costly subsystem with .995 reliability is examined, along with the justification of the increased cost. High reliability is not necessarily an end in itself but may be desirable in order to reduce the expected cost due to subsystem failure. However, this may not be the wisest use of funds since the expected cost due to subsystem failure is not the only cost involved. The subsystem itself may be very costly. The cost of the subsystem nor the expected cost due to subsystem failure should not be considered separately but the total of the two costs should be maximized, i.e., the total of the cost of the subsystem plus the expected cost due to subsystem failure.
-
Modular socket system versus traditionally laminated socket: a cost analysis.
Normann, Elna; Olsson, Anna; Brodtkorb, Thor-Henrik
2011-03-01
Using the new modular socket system (MSS) to produce a prosthetic socket directly on the patient has the potential of being easier and quicker to manufacture but also incurring higher costs. The purpose of the study was to compare the costs of manufacturing a transtibial prosthetic socket using either a MSS or a standard laminated socket (PC). Concurrent controlled trial. A total of 20 patients at two orthopaedic facilities were followed with regards to the cost of manufacturing a prosthetic socket using either MSS or PC. Time aspects and material costs were considered in the cost analysis. Other factors studied include delivery time and number of visits. For the cost analysis, only direct costs pertaining to the prosthetic socket were considered. The total cost of MSS was found to be significantly higher (p < 0.01) compared to PC. However, the production and time cost was significantly lower. Delivery time to the patient was 1 day for MSS compared to 17 days for PC. Our study shows that the direct prosthetic cost of treating a patient using MSS is significantly higher than treating a patient using PC. However, the MSS prosthesis can be delivered significantly faster and with fewer visits. Further studies taking the full societal costs of MSS into account should therefore be performed. This study shows that the direct prosthetic cost of treating a patient with Modular Socket System is significantly higher than treating a patient with plastercasting with standard laminated socket. However, the Modular Socket System prosthesis can be delivered significantly faster and with fewer visits.
-
NASA Astrophysics Data System (ADS)
Pine, G. D.; Christian, J. E.; Mixon, W. R.; Jackson, W. L.
1980-07-01
The procedures and data sources used to develop an energy consumption and system cost data base for use in predicting the market penetration of phosphoric acid fuel cell total energy systems in the nonindustrial building market are described. A computer program was used to simulate the hourly energy requirements of six types of buildings; office buildings; retail stores; hotels and motels; schools; hospitals; and multifamily residences. The simulations were done by using hourly weather tapes for one city in each of the ten Department of Energy administrative regions. Two types of building construction were considered, one for existing buildings and one for new buildings. A fuel cell system combined with electrically driven heat pumps and one combined with a gas boiler and an electrically driven chiller were compared with similar conventional systems. The methods of system simulation, component sizing, and system cost estimation are described for each system.
-
Developing a dashboard to help measure and achieve the triple aim: a population-based cohort study.
Seow, Hsien-Yeang; Sibley, Lyn M
2014-08-30
Health system planners aim to pursue the three goals of Triple Aim: 1) reduce health care costs; 2) improve population health; and 3) improve the care experience. Moreover, they also need measures that can reliably predict future health care needs in order to manage effectively the health system performance. Yet few measures exist to assess Triple Aim and predict future needs at a health system level. The purpose of this study is to explore the novel application of a case-mix adjustment method in order to measure and help improve the Triple Aim of health system performance. We applied a case-mix adjustment method to a population-based analysis to assess its usefulness as a measure of health system performance and Triple Aim. The study design was a retrospective, cohort study of adults from Ontario, Canada using administrative databases: individuals were assigned a predicted illness burden score using a case-mix adjustment system from diagnoses and health utilization data in 2008, and then followed forward to assess the actual health care utilization and costs in the following year (2009). We applied the Johns Hopkins Adjusted Clinical Group (ACG) Case-Mix System to categorize individuals into 60 levels of healthcare need, called ACGs. The outcomes were: 1) Number of individuals per ACG; 2) Total system costs per ACG; and 3) Mean cost per person per ACG, which together formed a health system "dashboard". We identified 11.4 million adults. 16.1% were aged 65 or older, 3.2 million (28%) did not use health care services that year, and 45,000 (0.4%) were in the highest acuity ACG category using 12 times more than an average adult. The sickest 1%, 5% and 15% of the population use about 10%, 30% and 50% of total health system costs respectively. The dashboard measures 2 dimensions of Triple Aim: 1) reduced costs: when total system costs per ACG or when average costs per person is reduced; and 2) improved population health: when more people move into healthier rather than sicker ACGs. It can help to achieve the third aim, improved care experience, when ACG utilization predictions are reported to providers to proactively develop care plans. The dashboard, developed via case-mix methods, measures 2 of the Triple Aim goals and can help health system planners better manage their health delivery systems.
-
Dávila, Javier A; Rosenberg, Moshe; Cardona, Carlos A
2017-01-01
This work investigated a model biorefinery for producing phenolic compounds extract, ethanol and xylitol from spent blackberry pulp (SBP). The biorefinery was investigated according to four potential scenarios including mass and heat integrations as well as cogeneration system for supplying part of the energy requirements in the biorefinery. The investigated SBP had 61.54% holocellulose; its total phenolic compounds was equivalent to 2700mg of gallic acid/100g SBP, its anthocyanins content was 126.41mg/kg of SBP and its total antioxidant activity was 174.8μmol TE/g of SBP. The economic analysis revealed that the level of integration in the biorefinery significantly affected the total production cost. The sale-to-total-production-cost ratio indicated that both, mass and heat integrations are of importance relevance. The cost of supplies (enzymes and reagents) had the most significant impact on the total production cost and accounted between 46.72 and 58.95% of the total cost of the biorefinery. Copyright © 2016 Elsevier Ltd. All rights reserved.
-
Eggimann, Sven; Truffer, Bernhard; Maurer, Max
2016-10-15
To determine the optimal connection rate (CR) for regional waste water treatment is a challenge that has recently gained the attention of academia and professional circles throughout the world. We contribute to this debate by proposing a framework for a total cost assessment of sanitation infrastructures in a given region for the whole range of possible CRs. The total costs comprise the treatment and transportation costs of centralised and on-site waste water management systems relative to specific CRs. We can then identify optimal CRs that either deliver waste water services at the lowest overall regional cost, or alternatively, CRs that result from households freely choosing whether they want to connect or not. We apply the framework to a Swiss region, derive a typology for regional cost curves and discuss whether and by how much the empirically observed CRs differ from the two optimal ones. Both optimal CRs may be reached by introducing specific regulatory incentive structures. Copyright © 2016 Elsevier Ltd. All rights reserved.
-
National Costs Of The Medical Liability System
Mello, Michelle M.; Chandra, Amitabh; Gawande, Atul A.; Studdert, David M.
2011-01-01
Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending. PMID:20820010
-
1994-04-01
engineering and con- struction management services for both military and civil works programs. In FY93, the cost of those programs exceeded $10 billion and...A related issue was to explore the USACE costs , benefits, and barriers to implementing a single Class VI system software package for both the military...provide information in useful ways, track utilization information, I A Class HI system is defined in AR 25-3. It is a system whose total program costs are
-
Controlling costs without compromising quality: paying hospitals for total knee replacement.
Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J
2010-10-01
Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P < 0.001; χ) and 9.9% lower risk-adjusted total costs ($12,773-$11,512; P < 0.001; t test) than all study hospitals. Inefficiency accounted for 96% of excess costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.
-
Mobile app self-care versus in-office care for stress reduction: a cost minimization analysis.
Luxton, David D; Hansen, Ryan N; Stanfill, Katherine
2014-12-01
We calculated the cost of providing stress reduction care with a mobile phone app (Breathe2Relax) in comparison with normal in-person care, the standard method for managing stress in military and civilian populations. We conducted a cost-minimization analysis. The total cost to the military healthcare system of treating 1000 patients with the app was $106,397. Treating 1000 patients with in-office care cost $68,820. Treatment using the app became less expensive than in-office treatment at approximately 1600 users. From the perspective of the civilian healthcare system, treatment using the app became less expensive than in-office treatment at approximately 1500 users. An online tool was used to obtain data about the number of app downloads and usage sessions. A total of 47,000 users had accessed the app for 10-30 min sessions in the 2.5 years since the release of the app. Assuming that all 47,000 users were military beneficiaries, the savings to the military healthcare system would be $2.7 million; if the 47,000 users were civilian, the savings to the civilian healthcare system would be $2.9 million. Because of the large number of potential users, the total societal savings resulting from self-care using the app may be considerable. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
-
Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up.
Bitsaki, Marina; Koutras, George; Heep, Hansjoerg; Koutras, Christos
2017-01-01
Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.
-
Systems Engineering-Based Tool for Identifying Critical Research Systems
ERIC Educational Resources Information Center
Abbott, Rodman P.; Stracener, Jerrell
2016-01-01
This study investigates the relationship between the designated research project system independent variables of Labor, Travel, Equipment, and Contract total annual costs and the dependent variables of both the associated matching research project total annual academic publication output and thesis/dissertation number output. The Mahalanobis…
-
Spinal surgery: variations in health care costs and implications for episode-based bundled payments.
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.
-
Constellation Program Life-cycle Cost Analysis Model (LCAM)
NASA Technical Reports Server (NTRS)
Prince, Andy; Rose, Heidi; Wood, James
2008-01-01
The Constellation Program (CxP) is NASA's effort to replace the Space Shuttle, return humans to the moon, and prepare for a human mission to Mars. The major elements of the Constellation Lunar sortie design reference mission architecture are shown. Unlike the Apollo Program of the 1960's, affordability is a major concern of United States policy makers and NASA management. To measure Constellation affordability, a total ownership cost life-cycle parametric cost estimating capability is required. This capability is being developed by the Constellation Systems Engineering and Integration (SE&I) Directorate, and is called the Lifecycle Cost Analysis Model (LCAM). The requirements for LCAM are based on the need to have a parametric estimating capability in order to do top-level program analysis, evaluate design alternatives, and explore options for future systems. By estimating the total cost of ownership within the context of the planned Constellation budget, LCAM can provide Program and NASA management with the cost data necessary to identify the most affordable alternatives. LCAM is also a key component of the Integrated Program Model (IPM), an SE&I developed capability that combines parametric sizing tools with cost, schedule, and risk models to perform program analysis. LCAM is used in the generation of cost estimates for system level trades and analyses. It draws upon the legacy of previous architecture level cost models, such as the Exploration Systems Mission Directorate (ESMD) Architecture Cost Model (ARCOM) developed for Simulation Based Acquisition (SBA), and ATLAS. LCAM is used to support requirements and design trade studies by calculating changes in cost relative to a baseline option cost. Estimated costs are generally low fidelity to accommodate available input data and available cost estimating relationships (CERs). LCAM is capable of interfacing with the Integrated Program Model to provide the cost estimating capability for that suite of tools.
-
The evolution of a teledentistry system within the Department of Defense.
Rocca, M. A.; Kudryk, V. L.; Pajak, J. C.; Morris, T.
1999-01-01
Total Dental Access (TDA) is the teledentistry project within the Department of Defense. This project enables referring dentists from the US Armed Forces to consult with specialists on the status of a patient. TDA focuses on three areas of dentistry: patient care, continuing education and dentist-laboratory communications. One of the goals of this project is to increase patient access to quality dental care. The other goal is to establish a cost effective telemedicine system. This paper describes the evolution of a teledentistry system, the main features of POTS-based, ISDN-based and Web-based systems used, advantages, disadvantages and cost-effectiveness of these systems. Data has been collected on the frequency of use, technical problems occurred, avoided patient or specialist travel and the total number of consults. A cost-effectiveness analysis has been conducted on the data collected. The results of this analysis will be presented. PMID:10566495
-
The evolution of a teledentistry system within the Department of Defense.
Rocca, M A; Kudryk, V L; Pajak, J C; Morris, T
1999-01-01
Total Dental Access (TDA) is the teledentistry project within the Department of Defense. This project enables referring dentists from the US Armed Forces to consult with specialists on the status of a patient. TDA focuses on three areas of dentistry: patient care, continuing education and dentist-laboratory communications. One of the goals of this project is to increase patient access to quality dental care. The other goal is to establish a cost effective telemedicine system. This paper describes the evolution of a teledentistry system, the main features of POTS-based, ISDN-based and Web-based systems used, advantages, disadvantages and cost-effectiveness of these systems. Data has been collected on the frequency of use, technical problems occurred, avoided patient or specialist travel and the total number of consults. A cost-effectiveness analysis has been conducted on the data collected. The results of this analysis will be presented.
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
University of California, Berkeley; Wei, Max; Lipman, Timothy
2014-06-23
A total cost of ownership model is described for low temperature proton exchange membrane stationary fuel cell systems for combined heat and power (CHP) applications from 1-250kW and backup power applications from 1-50kW. System designs and functional specifications for these two applications were developed across the range of system power levels. Bottom-up cost estimates were made for balance of plant costs, and detailed direct cost estimates for key fuel cell stack components were derived using design-for-manufacturing-and-assembly techniques. The development of high throughput, automated processes achieving high yield are projected to reduce the cost for fuel cell stacks to the $300/kWmore » level at an annual production volume of 100 MW. Several promising combinations of building types and geographical location in the U.S. were identified for installation of fuel cell CHP systems based on the LBNL modelling tool DER CAM. Life-cycle modelling and externality assessment were done for hotels and hospitals. Reduced electricity demand charges, heating credits and carbon credits can reduce the effective cost of electricity ($/kWhe) by 26-44percent in locations such as Minneapolis, where high carbon intensity electricity from the grid is displaces by a fuel cell system operating on reformate fuel. This project extends the scope of existing cost studies to include externalities and ancillary financial benefits and thus provides a more comprehensive picture of fuel cell system benefits, consistent with a policy and incentive environment that increasingly values these ancillary benefits. The project provides a critical, new modelling capacity and should aid a broad range of policy makers in assessing the integrated costs and benefits of fuel cell systems versus other distributed generation technologies.« less
-
The cost of colorectal cancer according to the TNM stage.
Mar, Javier; Errasti, Jose; Soto-Gordoa, Myriam; Mar-Barrutia, Gilen; Martinez-Llorente, José Miguel; Domínguez, Severina; García-Albás, Juan José; Arrospide, Arantzazu
2017-02-01
The aim of this study was to measure the cost of treatment of colorectal cancer in the Basque public health system according to the clinical stage. We retrospectively collected demographic data, clinical data and resource use of a sample of 529 patients. For stagesi toiii the initial and follow-up costs were measured. The calculation of cost for stageiv combined generalized linear models to relate the cost to the duration of follow-up based on parametric survival analysis. Unit costs were obtained from the analytical accounting system of the Basque Health Service. The sample included 110 patients with stagei, 171 with stageii, 158 with stageiii and 90 with stageiv colorectal cancer. The initial total cost per patient was 8,644€ for stagei, 12,675€ for stageii and 13,034€ for stageiii. The main component was hospitalization cost. Calculated by extrapolation for stageiv mean survival was 1.27years. Its average annual cost was 22,403€, and 24,509€ to death. The total annual cost for colorectal cancer extrapolated to the whole Spanish health system was 623.9million€. The economic burden of colorectal cancer is important and should be taken into account in decision-making. The combination of generalized linear models and survival analysis allows estimation of the cost of metastatic stage. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
-
Selby, Luke V; Gennarelli, Renee L; Schnorr, Geoffrey C; Solomon, Stephen B; Schattner, Mark A; Elkin, Elena B; Bach, Peter B; Strong, Vivian E
2017-10-01
Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016. Ninety-day normalized postoperative costs. Hospital accounting system costs were normalized to reflect Medicare reimbursement levels using the ratio of hospital costs to Medicare reimbursement and categorized into major cost categories. Differences between costs in Medicare proportional dollars (MP $) can be interpreted as the amount that would be reimbursed to an average hospital by Medicare if it paid differentially based on types and extent of postoperative complications. In total, 120 patients underwent curative-intent total gastrectomy for stage I through III gastric adenocarcinoma between 2009 and 2012. Of these, 79 patients (65.8%) were men, and the median (interquartile range) age was 64 (52-70) years. The 51 patients (42.5%) who underwent an uncomplicated total gastrectomy had a mean (SD) normalized cost of MP $12 330 (MP $2500), predominantly owing to the cost of surgical care (mean [SD] cost, MP $6830 [MP $1600]). The 34 patients (28.3%) who had a major complication had a mean (SD) normalized cost of MP $37 700 (MP $28 090). Surgical care was more expensive in these patients (mean [SD] cost, MP $8970 [MP $2750]) but was a smaller contributor to total cost (24%) owing to increased costs from room and board (mean [SD] cost, MP $11 940 [MP $8820]), consultations (mean [SD] cost, MP $3530 [MP $2410]), and intensive care unit care (mean [SD] cost, MP $7770 [MP $14 310]). Major complications were associated with tripled normalized costs following curative-intent total gastrectomy. Most of the excess costs were related to the treatment of complications. Interventions that decrease the number or severity of postoperative complications could result in substantial cost savings.
-
Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty.
Bilgili, Mustafa Gökhan; Erçin, Ersin; Peker, Gökhan; Kural, Cemal; Başaran, Serdar Hakan; Duramaz, Altuğ; Avkan, Cevdet
2014-06-01
Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Retrospective comparative study. Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.
-
Zhou, Xiuru; Ye, Weili; Zhang, Bing
2016-03-01
Transaction costs and uncertainty are considered to be significant obstacles in the emissions trading market, especially for including nonpoint source in water quality trading. This study develops a nonlinear programming model to simulate how uncertainty and transaction costs affect the performance of point/nonpoint source (PS/NPS) water quality trading in the Lake Tai watershed, China. The results demonstrate that PS/NPS water quality trading is a highly cost-effective instrument for emissions abatement in the Lake Tai watershed, which can save 89.33% on pollution abatement costs compared to trading only between nonpoint sources. However, uncertainty can significantly reduce the cost-effectiveness by reducing trading volume. In addition, transaction costs from bargaining and decision making raise total pollution abatement costs directly and cause the offset system to deviate from the optimal state. While proper investment in monitoring and measuring of nonpoint emissions can decrease uncertainty and save on the total abatement costs. Finally, we show that the dispersed ownership of China's farmland will bring high uncertainty and transaction costs into the PS/NPS offset system, even if the pollution abatement cost is lower than for point sources. Copyright © 2015 Elsevier Ltd. All rights reserved.
-
Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?
Melnikow, Joy; Xing, Guibo; Cox, Ginger; Leigh, Paul; Mills, Lisa; Miglioretti, Diana L; Moghadassi, Michelle; Smith-Bindman, Rebecca
2016-04-01
Decreasing the use of high-cost tests may reduce health care costs. To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests. Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician. A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male. All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers. Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (P<0.0001). Total costs were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239. Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.
-
Cost-Identification Analysis of Total Laryngectomy: An Itemized Approach to Hospital Costs
Dedhia, Raj C.; Smith, Kenneth J.; Weissfeld, Joel L.; Saul, Melissa I.; Lee, Steve C.; Myers, Eugene N.; Johnson, Jonas T.
2012-01-01
Objectives To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Study Design Case series with chart review. Setting Large tertiary care teaching hospital system. Subjects and Methods Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Results Mean total hospital costs were $29 563 (range, $10 915 to $120 345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6–43), and median Charlson comorbidity index score was 8 (2–16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46 831 vs $24 601, P < .01). The authors found no significant cost differences with stratification based on previous radiation therapy ($27 598 vs $29 915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29 483 vs $29 609 without readmission, P = .97). Conclusion This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers. PMID:21493420
-
Simulation and Analysis of the AFLC Bulk Data Network Using Abstract Data Types.
1981-12-01
performs. Simulation is more expensive than queueing, but it is often ə the only way to study complex funtional relationships in a large system. Unlike... relationship between through- put, response and cost is shown in Figure 2. At a given cost level, additional throughput can be obtained at the expense...improved by adding resources, but this increases the total cost of the system. Network models are used to study the relationship between cost
-
Predicting Cost/Performance Trade-Offs for Whitney: A Commodity Computing Cluster
NASA Technical Reports Server (NTRS)
Becker, Jeffrey C.; Nitzberg, Bill; VanderWijngaart, Rob F.; Kutler, Paul (Technical Monitor)
1997-01-01
Recent advances in low-end processor and network technology have made it possible to build a "supercomputer" out of commodity components. We develop simple models of the NAS Parallel Benchmarks version 2 (NPB 2) to explore the cost/performance trade-offs involved in building a balanced parallel computer supporting a scientific workload. We develop closed form expressions detailing the number and size of messages sent by each benchmark. Coupling these with measured single processor performance, network latency, and network bandwidth, our models predict benchmark performance to within 30%. A comparison based on total system cost reveals that current commodity technology (200 MHz Pentium Pros with 100baseT Ethernet) is well balanced for the NPBs up to a total system cost of around $1,000,000.
-
The Impact of Mission Duration on a Mars Orbital Mission
NASA Technical Reports Server (NTRS)
Arney, Dale; Earle, Kevin; Cirillo, Bill; Jones, Christopher; Klovstad, Jordan; Grande, Melanie; Stromgren, Chel
2017-01-01
Performance alone is insufficient to assess the total impact of changing mission parameters on a space mission concept, architecture, or campaign; the benefit, cost, and risk must also be understood. This paper examines the impact to benefit, cost, and risk of changing the total mission duration of a human Mars orbital mission. The changes in the sizing of the crew habitat, including consumables and spares, was assessed as a function of duration, including trades of different life support strategies; this was used to assess the impact on transportation system requirements. The impact to benefit is minimal, while the impact on cost is dominated by the increases in transportation costs to achieve shorter total durations. The risk is expected to be reduced by decreasing total mission duration; however, large uncertainty exists around the magnitude of that reduction.
-
Game Theory and Risk-Based Levee System Design
NASA Astrophysics Data System (ADS)
Hui, R.; Lund, J. R.; Madani, K.
2014-12-01
Risk-based analysis has been developed for optimal levee design for economic efficiency. Along many rivers, two levees on opposite riverbanks act as a simple levee system. Being rational and self-interested, land owners on each river bank would tend to independently optimize their levees with risk-based analysis, resulting in a Pareto-inefficient levee system design from the social planner's perspective. Game theory is applied in this study to analyze decision making process in a simple levee system in which the land owners on each river bank develop their design strategies using risk-based economic optimization. For each land owner, the annual expected total cost includes expected annual damage cost and annualized construction cost. The non-cooperative Nash equilibrium is identified and compared to the social planner's optimal distribution of flood risk and damage cost throughout the system which results in the minimum total flood cost for the system. The social planner's optimal solution is not feasible without appropriate level of compensation for the transferred flood risk to guarantee and improve conditions for all parties. Therefore, cooperative game theory is then employed to develop an economically optimal design that can be implemented in practice. By examining the game in the reversible and irreversible decision making modes, the cost of decision making myopia is calculated to underline the significance of considering the externalities and evolution path of dynamic water resource problems for optimal decision making.
-
The determinants of nursing home costs in Nebraska's proprietary nursing homes.
Palm, D W; Nelson, S
1984-01-01
In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.
-
Cost decomposition of linear systems with application to model reduction
NASA Technical Reports Server (NTRS)
Skelton, R. E.
1980-01-01
A means is provided to assess the value or 'cst' of each component of a large scale system, when the total cost is a quadratic function. Such a 'cost decomposition' of the system has several important uses. When the components represent physical subsystems which can fail, the 'component cost' is useful in failure mode analysis. When the components represent mathematical equations which may be truncated, the 'component cost' becomes a criterion for model truncation. In this latter event component costs provide a mechanism by which the specific control objectives dictate which components should be retained in the model reduction process. This information can be valuable in model reduction and decentralized control problems.
-
Cost-of-Illness Analysis of Type 2 Diabetes Mellitus in Iran
Javanbakht, Mehdi; Baradaran, Hamid R.; Mashayekhi, Atefeh; Haghdoost, Ali Akbar; Khamseh, Mohammad E.; Kharazmi, Erfan; Sadeghi, Aboozar
2011-01-01
Introduction Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year. Methods This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups. Results The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million). Conclusions T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority. PMID:22066013
-
Lo, Yuan-Ting C; Wahlqvist, Mark L; Huang, Yi-Chen; Lee, Meei-Shyuan
2016-03-14
A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated with lower risks of all-cause-, cancer- and CVD-related mortalities. However, the association between consumption patterns and medical costs remains unclear. The effects of various food group costs on medical service utilisation and costs were investigated. The study cohort was recruited through the Elderly Nutrition and Health Survey in Taiwan between 1999 and 2000 and followed-up for 8 years until 2006. It comprised free-living elderly participants who provided a 24-h dietary recall. Daily energy-adjusted food group costs were estimated. Annual medical service utilisation and costs for 1445 participants aged 65-79 years were calculated from the National Health Insurance claim data. Generalised linear models were used to appraise the associations between the food group costs and medical service utilisation and costs. Older adults with the highest F&V cost tertile had significantly fewer hospital days (30%) and total medical costs (19%), whereas those in the highest animal-derived group had a higher number of hospital days (28%) and costs (83%) as well as total medical costs (38%). Participants in the high F&V and low animal-derived cost groups had the shortest annual hospitalisation stays (5·78 d) and lowest costs (NT$38,600) as well as the lowest total medical costs (NT$75,800), a mean annual saving of NT$45 200/person. Older adults who spend more on F&V and less on animal-derived foods have a reduced medical-care system burden. This provides opportunities for nutritionally related healthcare system investment strategies.
-
Chen, Kevin K; Harty, Jonathan H; Bosco, Joseph A
2017-06-01
The increasing cost of our country's healthcare is not sustainable. To address this crisis, the federal government is transiting healthcare reimbursement from the traditional volume-based system to a value-based system. As such, increasing healthcare value has become an essential point of discussion for all healthcare stakeholders. The purpose of this study is to discuss the importance of healthcare value as a means to achieve this goal of value-based medicine and 3 methods to create value in total joint arthroplasty. These methods are to: (1) improve outcomes greater than the increased costs to achieve this improvement, (2) decrease costs without affecting outcomes, and (3) decrease costs while simultaneously improving outcomes. Following these guidelines will help practitioners thrive in a bundled care environment. Copyright © 2017 Elsevier Inc. All rights reserved.
-
Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden.
Virta, Lena; Joranger, Pål; Brox, Jens Ivar; Eriksson, Rikard
2012-02-10
Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. 204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.
-
Federal Register 2010, 2011, 2012, 2013, 2014
2011-07-06
..., you should comment and provide your total capital and startup cost components or annual operation... cost factors, including system and technology acquisition, expected useful life of capital equipment, discount rate(s), and the period over which you incur costs. Capital and startup costs include, among other...
-
1989-07-31
Information System (OSMIS). The long-range objective is to develop methods to determine total operating and support (O&S) costs within life-cycle cost...objective was to assess the feasibility of developing cost estimating relationships (CERs) based on data from the Army Operating and Support Management
-
Thomas, Leena S; Manning, Arthur; Holmes, Charles B; Naidoo, Shan; van der Linde, Frans; Gray, Glenda E; Martinson, Neil A
2007-12-01
HIV/AIDS creates a massive burden of care for health systems. A better understanding of the impact of HIV infection on health care utilization and costs may enable better use of limited resources. We compared public sector inpatient costs of HIV-infected versus uninfected adults and children at a large hospital in Soweto, South Africa. Daily hotel costs estimated from hospital financial data and total patient visits were combined with utilization, abstracted from patients' charts, and costed using government price lists to estimate total inpatient costs. A total of 1185 eligible records were included over a 6-week period in 2005. Eight hundred twelve were from HIV-infected patients, and of these, 77 were on antiretroviral (ARV) therapy. The mean length of stay (LOS) and mean drug and intravenous fluid utilization of HIV-infected adults not on ARVs was greater than those of uninfected adults, resulting in a $200 higher total average admission cost. Patients on ARVs had longer LOS and incurred a total average admission cost of $750 more than HIV-infected adults not on ARVs. Inpatient costs were greater for this selected group of HIV-infected adults, and even higher for the small proportion of individuals receiving ARVs. Budget allocations should incorporate case mix by HIV and ARV status as a key determinant of hospital expenditure.
-
Paying a Premium: How Patient Complexity Affects Costs and Profit Margins
Taheri, Paul A.; Butz, David A.; Greenfield, Lazar J.
1999-01-01
Objective and Background Tertiary medical centers continue to be under extreme pressure to deliver high-complexity care, but paradoxically there is considerable pressure within these institutions to reduce their emphasis on tertiary care and refocus their efforts to develop a more community-like practice. The genesis of this pressure is the perceived profitability of routine surgical activity when compared with more complex care. The purpose of this study is to assess how the total cost and profit (loss) margin can vary for an entire trauma service. The authors also evaluate payments for specific trauma-related diagnostic-related groups (DRGs) and analyze how hospital margins were affected based on mortality outcome. Materials and Methods The authors analyzed the actual cost of all trauma discharges (n = 692) at their level I trauma center for fiscal year 1997. Data were obtained from the trauma registry and the hospital cost accounting system. Total cost was defined as the sum of the variable, fixed, and indirect costs associated with each patient. Margin was defined as expected payments minus total cost. The entire population and all DRGs with 10 or more patients were stratified based on survival outcome, Injury Severity Score, insurance status, and length of stay. The mean total costs for survivors and nonsurvivors within these various categories and their margins were evaluated. Results The profit margin on nonsurvivors was $5898 greater than for survivors, even though the mean total cost for nonsurvivors was $28,821 greater. Within the fixed fee arrangement, approximately 44% of transfers had a negative margin. Both survivors and nonsurvivors become increasingly profitable out to 20 days and subsequently become unprofitable beyond 21 days, but nonsurvivors were more profitable than survivors. Conclusions There is a wide variance in both the costs and margins within trauma-related DRGs. The DRG payment system disproportionately reimburses providers for nonsurvivors, even though on average they are more costly. Because payers are likely to engage in portfolio management, patients can be transferred between hospitals based on the contractual relationship between the payer and the provider. This payment system potentially allows payers to act strategically, sending relatively low-cost patients to hospitals where they use fee-for-service reimbursement and high-cost patients to hospitals where their reimbursement is contractually capped. Although specific to the authors’ trauma center and its payer mix, these data demonstrate the profitability of maintaining a level I trauma center and preserving the mission of delivering care to the severely injured. PMID:10363894
-
Kawalec, Paweł P; Malinowski, Krzysztof P
2015-01-01
Systemic lupus erythematosus, systemic sclerosis and sarcoidosis are three different autoimmune systemic diseases that generate a significant burden to society due to treatment costs and also those caused by a work disability or absenteeism among patients. Relevant 2012 data referring to the three components of absenteeism produced by autoimmune systemic diseases, sick leave, short-term and long-term work disability, were obtained from the Social Insurance Institution in Poland (PSII). By applying the Human Capital Approach using gross domestic product per capita, gross value added per worker and gross income per worker in 2012, total indirect costs for the diseases were calculated. All costs were presented in euros and were valid for 2012. The PSII recorded 1600 patients with systemic lupus erythematosus, 500 patients with systemic sclerosis and 2700 patients with sarcoidosis in the 2012 - total indirect costs were as high as 7,260,595, 2,268,571 and 4,027,575 EUR, respectively. Costs were estimated using gross domestic product per capita; 17,485,412, 5,463,312 and 9,699,455 EUR, accordingly, calculated using gross value added per worker and 5,346,933, 1,670,648 and 2,966,034 EUR estimated using gross income per worker, respectively. Considering only data on absenteeism gathered by the PSII we can conclude that the three autoimmune systemic diseases bore great indirect costs. Their social burden for Poland could be even greater when considering presenteeism as well as other components of absenteeism such as loss of unpaid work, a gray economy or loss of leisure time.
-
Code of Federal Regulations, 2010 CFR
2010-10-01
... that involve redesign of systems or subsystems. Life-cycle cost means the total cost to the Government... included, at the most appropriate time in the acquisition cycle, in solicitations and resulting contracts...
-
Code of Federal Regulations, 2012 CFR
2012-10-01
... that involve redesign of systems or subsystems. Life-cycle cost means the total cost to the Government... included, at the most appropriate time in the acquisition cycle, in solicitations and resulting contracts...
-
Code of Federal Regulations, 2014 CFR
2014-10-01
... that involve redesign of systems or subsystems. Life-cycle cost means the total cost to the Government... included, at the most appropriate time in the acquisition cycle, in solicitations and resulting contracts...
-
Unaffordable or cost-effective?: introducing an emergency referral system in rural Niger.
Bossyns, Paul; Abache, Ranaou; Abdoulaye, Mahaman Sani; Lerberghe, Wim Van
2005-09-01
An important investment was made in two health districts in Niger to organize an emergency referral system. This study estimates its impact and cost-effectiveness in relation with external determinants. After installing a solar radio network in the health centres, emergency calls and related data were monitored over 7 years and investment and recurrent costs for the system were estimated. The number of emergency calls increased significantly in both districts. In 2003, the total yearly cost for the district amounted to US dollars 14,147, the cost per useful and successful call was US dollars 49 and the cost per inhabitant and per year was about US dollars 0.06. The impressive and immediate impact on the health system, the relatively low recurrent cost and the minimal management requirements for the health service make the investment very worthwhile. Organizing emergency evacuation systems should be a priority for any health district in the world.
-
Boronat, F; Barrachina, I; Budia, A; Vivas Consuelo, D; Criado, M C
The health care system has management tools available in hospitals that facilitate the assessment of efficiency through the study of costs and management control in order to make a better use of the resources. The aim of the study was the calculation and analysis of the total cost of a urology department, including ambulatory, hospitalization and surgery activity and the drafting of an income statement where service costs are compared with income earned from the Government fees during 2014. From the information recorded by the Economic Information System of the Department of Health, ABC and top-down method of cost calculation was applied by process care activity. The cost results obtained were compared with the rates established for ambulatory and hospital production in the Tax Law of the Generalitat Valenciana. The production was structured into outpatient (external and technical consultations) and hospital stays and surgeries (inpatient). A total of 32,510 outpatient consultations, 7,527 techniques, 2,860 interventions and 4,855 hospital stays were made during 2014. The total cost was 7,579,327€; the cost for outpatient consultations was 1,748,145€, 1,229,836 Euros for technical consultations, 2,621,036€ for surgery procedures and 1,980,310€ for hospital admissions. Considered as income the current rates applied in 2014 (a total of 15,035,843€), the difference between income and expenditure was 7,456,516€. The economic balance was positive with savings over 50% and a mean adjusted hospitalization stay rate (IEMAC) rate of 0.67 (33% better than the standard). CMA had a favorable impact on cost control. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
-
NASA Technical Reports Server (NTRS)
1972-01-01
The study has concluded that there are very large space program cost savings to be obtained by use of low cost, refurbishable, and standard spacecraft in conjunction with the shuttle transportation system. The range of space program cost savings for three different groups of programs are shown in quantitative terms. The total savings for the 91 programs will range from $13.4 billion to $18.0 billion depending on the degree of hardware standardization. These savings, principally resulting from payload cost reductions, tangibly support the development costs of the shuttle system.
-
Efficiency of an emissions payment system for nitrogen in sewage treatment plants - a case study.
Malmaeus, J Mikael; Ek, Mats; Åmand, Linda; Roth, Susanna; Baresel, Christian; Olshammar, Mikael
2015-05-01
An emissions payment system for nitrogen in Swedish sewage treatment plants (STPs) was evaluated using a semi-empirical approach. The system was based on a tariff levied on each unit of nitrogen emitted by STPs, and profitable measures to reduce nitrogen emissions were identified for twenty municipal STPs. This was done through direct involvement with the plant personnel and the results were scaled up to cover all treatment plants larger than 2000 person equivalents in the Swedish tributary areas of the Kattegat and the Baltic Proper. The sum of costs and nitrogen reductions were compared with an assumed command-and-control regulation requiring all STPs to obtain 80% total nitrogen reduction in their effluents. Costs for the latter case were estimated using a database containing standard estimates for reduction costs by six specified measures. For both cases a total reduction target of 3000 tonnes of nitrogen was set. We did not find that the emissions payment system was more efficient in terms of total reduction costs, although some practical and administrative advantages could be identified. Our results emphasize the need to evaluate the performance of policy instruments on a case-by-case basis since the theoretical efficiency is not always reflected in practice. Copyright © 2015 Elsevier Ltd. All rights reserved.
-
Cost analysis of robotic versus laparoscopic general surgery procedures.
Higgins, Rana M; Frelich, Matthew J; Bosler, Matthew E; Gould, Jon C
2017-01-01
Robotic surgical systems have been used at a rapidly increasing rate in general surgery. Many of these procedures have been performed laparoscopically for years. In a surgical encounter, a significant portion of the total costs is associated with consumable supplies. Our hospital system has invested in a software program that can track the costs of consumable surgical supplies. We sought to determine the differences in cost of consumables with elective laparoscopic and robotic procedures for our health care organization. De-identified procedural cost and equipment utilization data were collected from the Surgical Profitability Compass Procedure Cost Manager System (The Advisory Board Company, Washington, DC) for our health care system for laparoscopic and robotic cholecystectomy, fundoplication, and inguinal hernia between the years 2013 and 2015. Outcomes were length of stay, case duration, and supply cost. Statistical analysis was performed using a t-test for continuous variables, and statistical significance was defined as p < 0.05. The total cost of consumable surgical supplies was significantly greater for all robotic procedures. Length of stay did not differ for fundoplication or cholecystectomy. Length of stay was greater for robotic inguinal hernia repair. Case duration was similar for cholecystectomy (84.3 robotic and 75.5 min laparoscopic, p = 0.08), but significantly longer for robotic fundoplication (197.2 robotic and 162.1 min laparoscopic, p = 0.01) and inguinal hernia repair (124.0 robotic and 84.4 min laparoscopic, p = ≪0.01). We found a significantly increased cost of general surgery procedures for our health care system when cases commonly performed laparoscopically are instead performed robotically. Our analysis is limited by the fact that we only included costs associated with consumable surgical supplies. The initial acquisition cost (over $1 million for robotic surgical system), depreciation, and service contract for the robotic and laparoscopic systems were not included in this analysis.
-
Muto, Hiroshi; Tani, Yuji; Suzuki, Shigemasa; Yokooka, Yuki; Abe, Tamotsu; Sase, Yuji; Terashita, Takayoshi; Ogasawara, Katsuhiko
2011-09-30
Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC) method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views), knee (three views), wrist (two views), and other. Indirect costs were allocated to cost objects using the ABC method. The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.
-
2011-01-01
Background Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC) method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. Methods We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views), knee (three views), wrist (two views), and other. Indirect costs were allocated to cost objects using the ABC method. Results The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. Conclusions The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients. PMID:21961846
-
Azar, Nabih; Leblond, Veronique; Ouzegdouh, Maya; Button, Paul
2017-12-01
The Pitié Salpêtrière Hospital Hemobiotherapy Department, Paris, France, has been providing extracorporeal photopheresis (ECP) since November 2011, and started using the Therakos ® CELLEX ® fully integrated system in 2012. This report summarizes our single-center experience of transitioning from the use of multi-step ECP procedures to the fully integrated ECP system, considering the capacity and cost implications. The total number of ECP procedures performed 2011-2015 was derived from department records. The time taken to complete a single ECP treatment using a multi-step technique and the fully integrated system at our department was assessed. Resource costs (2014€) were obtained for materials and calculated for personnel time required. Time-driven activity-based costing methods were applied to provide a cost comparison. The number of ECP treatments per year increased from 225 (2012) to 727 (2015). The single multi-step procedure took 270 min compared to 120 min for the fully integrated system. The total calculated per-session cost of performing ECP using the multi-step procedure was greater than with the CELLEX ® system (€1,429.37 and €1,264.70 per treatment, respectively). For hospitals considering a transition from multi-step procedures to fully integrated methods for ECP where cost may be a barrier, time-driven activity-based costing should be utilized to gain a more comprehensive understanding the full benefit that such a transition offers. The example from our department confirmed that there were not just cost and time savings, but that the time efficiencies gained with CELLEX ® allow for more patient treatments per year. © 2017 The Authors Journal of Clinical Apheresis Published by Wiley Periodicals, Inc.
-
Leblond, Veronique; Ouzegdouh, Maya; Button, Paul
2017-01-01
Abstract Introduction The Pitié Salpêtrière Hospital Hemobiotherapy Department, Paris, France, has been providing extracorporeal photopheresis (ECP) since November 2011, and started using the Therakos® CELLEX® fully integrated system in 2012. This report summarizes our single‐center experience of transitioning from the use of multi‐step ECP procedures to the fully integrated ECP system, considering the capacity and cost implications. Materials and Methods The total number of ECP procedures performed 2011–2015 was derived from department records. The time taken to complete a single ECP treatment using a multi‐step technique and the fully integrated system at our department was assessed. Resource costs (2014€) were obtained for materials and calculated for personnel time required. Time‐driven activity‐based costing methods were applied to provide a cost comparison. Results The number of ECP treatments per year increased from 225 (2012) to 727 (2015). The single multi‐step procedure took 270 min compared to 120 min for the fully integrated system. The total calculated per‐session cost of performing ECP using the multi‐step procedure was greater than with the CELLEX® system (€1,429.37 and €1,264.70 per treatment, respectively). Conclusions For hospitals considering a transition from multi‐step procedures to fully integrated methods for ECP where cost may be a barrier, time‐driven activity‐based costing should be utilized to gain a more comprehensive understanding the full benefit that such a transition offers. The example from our department confirmed that there were not just cost and time savings, but that the time efficiencies gained with CELLEX® allow for more patient treatments per year. PMID:28419561
-
The effects of patient cost sharing on inpatient utilization, cost, and outcome.
Xu, Yuan; Li, Ning; Lu, Mingshan; Dixon, Elijah; Myers, Robert P; Jelley, Rachel J; Quan, Hude
2017-01-01
Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases. We measured patient cost-sharing using actual reimbursement ratio (RR) which is allowed us to better capture financial incentive than using type of health insurance. A rigorous risk adjustment method was employed with both comorbidities and disease severity measures acting as risk adjustors. Associations between RR and health use, costs and outcome were analyzed by multivariate analyses. After risk adjustment, patients with more generous health insurance coverage (higher RR) were found to have longer hospital stay, higher total cost, higher medication cost, and higher ratio of medication to total cost, as well as higher number and likelihood that specific procedures were performed. Our study implied that patient cost-sharing affects health care services use and cost. This reflects how patients and physicians respond to financial incentives in the current healthcare system in China, and the responses could be a joint effect of both demand and supply side moral hazard. In order to contain cost and improve efficiency in the system, reforming provide payment and insurance scheme is urgently needed.
-
A Policy-Based Approach to Technology Systems
ERIC Educational Resources Information Center
Kuhn, Robert M.; Brookes, Kimberly H.; Bellos, Nephellie
2008-01-01
Discussions with a central IT organization about integration with existing systems on campus, support costs for the new implementation, and total cost of ownership frequently become adversarial. Simmons College, a small college in Boston with an enrollment of approximately 1,900 undergraduate and 2,800 graduate students, reframed these issues in…
-
Cost-effectiveness Analysis for Technology Acquisition.
Chakravarty, A; Naware, S S
2008-01-01
In a developing country with limited resources, it is important to utilize the total cost visibility approach over the entire life-cycle of the technology and then analyse alternative options for acquiring technology. The present study analysed cost-effectiveness of an "In-house" magnetic resonance imaging (MRI) scan facility of a large service hospital against outsourcing possibilities. Cost per unit scan was calculated by operating costing method and break-even volume was calculated. Then life-cycle cost analysis was performed to enable total cost visibility of the MRI scan in both "In-house" and "outsourcing of facility" configuration. Finally, cost-effectiveness analysis was performed to identify the more acceptable decision option. Total cost for performing unit MRI scan was found to be Rs 3,875 for scans without contrast and Rs 4,129 with contrast. On life-cycle cost analysis, net present value (NPV) of the "In-house" configuration was found to be Rs-(4,09,06,265) while that of "outsourcing of facility" configuration was Rs-(5,70,23,315). Subsequently, cost-effectiveness analysis across eight Figures of Merit showed the "In-house" facility to be the more acceptable option for the system. Every decision for acquiring high-end technology must be subjected to life-cycle cost analysis.
-
[The planning of resource support of secondary medical care in hospital].
Kungurov, N V; Zil'berberg, N V
2010-01-01
The Ural Institute of dermatovenerology and immunopathology developed and implemented the software concerning the personalized total recording of medical services and pharmaceuticals. The Institute also presents such software as listing of medical services, software module of calculation of financial costs of implementing full standards of secondary medical care in case of chronic dermatopathy, reference book of standards of direct specific costs on laboratory and physiotherapy services, reference book of pharmaceuticals, testing systems and consumables. The unified information system of management recording is a good technique to substantiate the costs of the implementation of standards of medical care, including high-tech care with taking into account the results of total calculation of provided medical services.
-
1980-06-01
43 3000 TYPICAL MID-1978 COSTS, all overhead included 2000- Type of System: Double alkali flue gas desulfurization plus baghouse particulate removal...Figures 5, 6, and 8 also provide cost estimating data for oil- and natural gas -fired steam turbine systems. Figure 5 shows the steam- generating station of...to the ownership and operation of the system. For systems burning oil or natural gas , fuel will typically constitute 65-90% of the total life cycle
-
Rutten, Niels; Gonzales, José L.; Elbers, Armin R. W.; Velthuis, Annet G. J.
2012-01-01
Background As low pathogenic avian influenza viruses can mutate into high pathogenic viruses the Dutch poultry sector implemented a surveillance system for low pathogenic avian influenza (LPAI) based on blood samples. It has been suggested that egg yolk samples could be sampled instead of blood samples to survey egg layer farms. To support future decision making about AI surveillance economic criteria are important. Therefore a cost analysis is performed on systems that use either blood or eggs as sampled material. Methodology/Principal Findings The effectiveness of surveillance using egg or blood samples was evaluated using scenario tree models. Then an economic model was developed that calculates the total costs for eight surveillance systems that have equal effectiveness. The model considers costs for sampling, sample preparation, sample transport, testing, communication of test results and for the confirmation test on false positive results. The surveillance systems varied in sampled material (eggs or blood), sampling location (farm or packing station) and location of sample preparation (laboratory or packing station). It is shown that a hypothetical system in which eggs are sampled at the packing station and samples prepared in a laboratory had the lowest total costs (i.e. € 273,393) a year. Compared to this a hypothetical system in which eggs are sampled at the farm and samples prepared at a laboratory, and the currently implemented system in which blood is sampled at the farm and samples prepared at a laboratory have 6% and 39% higher costs respectively. Conclusions/Significance This study shows that surveillance for avian influenza on egg yolk samples can be done at lower costs than surveillance based on blood samples. The model can be used in future comparison of surveillance systems for different pathogens and hazards. PMID:22523543
-
[Cost analysis of treatment for severe rheumatoid arthritis in a city in southern Brazil].
Buendgens, Fabíola Bagatini; Blatt, Carine Raquel; Marasciulo, Antônio Carlos Estima; Leite, Silvana Nair; Farias, Mareni Rocha
2013-11-01
Treatment of rheumatoid arthritis involves the use of medicines, non-pharmaceutical therapies, medical appointments, and complimentary tests, among other procedures. Based on sources of payment, this article presents the direct medical costs related to treatment of rheumatoid arthritis. The cost analysis included 103 patients with severe rheumatoid arthritis treated at the Specialized Division of Pharmaceutical Care in Florianopolis, Santa Catarina State, Brazil. Total annual direct cost was R$ 2,045,596.55 (approximately one million US dollars), or R$ 19,860.16 per patient/year (slightly less than ten thousand US dollars). Total cost breakdown was as follows: 90.8% for medicines, 2.5% for hospitalizations, 2.2% for complimentary tests, 2.1% for medical appointments, and 2.4% for all other costs. The public sector accounted for 73.6% of the total direct medical costs and 79.3% of the cost of medicines. The cost analysis provided a profile of how a group of individuals with a chronic non-communicable disease that requires resources circulates in the public-private mix that characterizes the Brazilian health system.
-
Ha, Yong-Chan; Kim, Ha-Young; Jang, Sunmee; Lee, Young-Kyun; Kim, Tae-Young
2017-12-01
The purpose of this study was to estimate the current economic burden of osteoporosis in South Korea using national claim data of the Korean National Health Insurance Service (KNHIS) from 2008 to 2011. Patients aged 50 years or older were identified from KNHIS nationwide database for all records of outpatient visits or hospital admissions. Healthcare costs for osteoporotic patients included direct medical costs for hospitalization, outpatient care, and prescription drugs for the year after discharge. Healthcare costs were estimated based on the perspective of KNHIS, and calculated using a bottom-up approach. Between 2008 and 2011, total healthcare costs for osteoporotic patients increased from 3976 million USD to 5126 million USD, with an annual increase of 9.2% which accounted for one-sixth (16.7%) of national healthcare expenditure. Healthcare cost for hospitalization was the highest ($1903 million, 40.0% of total healthcare cost), followed by cost for outpatient care ($1474 million, 31.0%) and cost for prescription drugs ($1379 million, 29.0%). Although total healthcare cost for osteoporotic men was 6 times lower than that for osteoporotic women, the cost per person was 1.5 times higher than that for women. Total healthcare cost for osteoporotic patients without fractures was higher than that for osteoporotic patients with fractures. However, cost per person was the opposite. Osteoporosis entails substantial epidemiologic and economic burden in South Korea. This study provides information about the total healthcare burden, which could be important when determining what attention and awareness osteoporosis should be given in the public health system.
-
Usuf, E; Mackenzie, G; Lowe-Jallow, Y; Boye, B; Atherly, D; Suraratdecha, C; Griffiths, U K
2014-04-07
The Gambia introduced seven-valent pneumococcal conjugate vaccine (PCV) in August 2009 and switched to 13-valent PCV in April 2011. In April 2009 monovalent hepatitis B and combined Diphtheria-Tetanus-Pertussis and Haemophilus influenzae type b vaccines were transitioned to a combined pentavalent vaccine. The current schedule offers three doses of PCV and pentavalent, and continues to give children monovalent hepatitis B vaccine at birth. We estimated the overall costs of the Gambian immunisation programme and the incremental costs of introducing pentavalent and the seven-valent PCV. Twenty health facilities out of a total of 56 were surveyed. Data collected included number of vaccine doses delivered, staff time spent on vaccine delivery, distance travelled to collect vaccines, and cold chain expansion due to new vaccine introduction. National level data were collected from key informant interviews. Annualised costs were calculated in 2009 US$. With a PCV price of US$7 per dose, the incremental costs of introducing PCV was US$1.6 million, equivalent to US$25 per fully immunised child, with systems costs accounting for US$1.90. The switch to pentavalent vaccine resulted in cost savings of US$0.45 per fully immunised child. Total annual costs increased by 45% after the introduction of the new vaccines, amounting to US$ 3.0 million, or US$45 per fully immunised child. Vaccine prices were the most important determinant of total incremental costs and cold chain expansion the biggest cost component of systems costs. Copyright © 2014 Elsevier Ltd. All rights reserved.
-
1988-03-01
Accounting and Budgeting Reporting (SABR) system, a joint Headquarters, U. S . Marine Corps and Marine Corps Finance Center financial system. The Naval...be retyped because of changes to the content. Even though information production costs account for a small percentage of the total business costs ... COSTS $16,580.11 ** Z-248s were procured by HQMC *155 * S .*5’ ~ ~ p~--J .~-~ J".*II 9 ~ ,1 *’Jb ~ S ~ ~ 9 Facilities Management Hardware Requirements Qty
-
Optimal inventories for overhaul of repairable redundant systems - A Markov decision model
NASA Technical Reports Server (NTRS)
Schaefer, M. K.
1984-01-01
A Markovian decision model was developed to calculate the optimal inventory of repairable spare parts for an avionics control system for commercial aircraft. Total expected shortage costs, repair costs, and holding costs are minimized for a machine containing a single system of redundant parts. Transition probabilities are calculated for each repair state and repair rate, and optimal spare parts inventory and repair strategies are determined through linear programming. The linear programming solutions are given in a table.
-
Launch vehicle systems design analysis
NASA Technical Reports Server (NTRS)
Ryan, Robert; Verderaime, V.
1993-01-01
Current launch vehicle design emphasis is on low life-cycle cost. This paper applies total quality management (TQM) principles to a conventional systems design analysis process to provide low-cost, high-reliability designs. Suggested TQM techniques include Steward's systems information flow matrix method, quality leverage principle, quality through robustness and function deployment, Pareto's principle, Pugh's selection and enhancement criteria, and other design process procedures. TQM quality performance at least-cost can be realized through competent concurrent engineering teams and brilliance of their technical leadership.
-
Landolina, Maurizio; Morani, Giovanni; Curnis, Antonio; Vado, Antonello; D'Onofrio, Antonio; Bianchi, Valter; Stabile, Giuseppe; Crosato, Martino; Petracci, Barbara; Ceriotti, Carlo; Bontempi, Luca; Morosato, Martina; Ballari, Gian Paolo; Gasparini, Maurizio
2017-08-01
Patients receiving cardiac resynchronization therapy defibrillators (CRT-Ds) are likely to undergo one or more device replacements, mainly for battery depletion. We assessed the economic impact of battery depletion on the overall cost of CRT-D treatment from the perspectives of the healthcare system and the hospital. We also compared devices of different generations and from different manufacturers in terms of therapy cost. We analysed data on 1792 CRT-Ds implanted in 1399 patients in 9 Italian centres. We calculated the replacement probability and the total therapy cost over 6 years, stratified by device generation and manufacturer. Public tariffs from diagnosis-related groups were used together with device prices and hospitalization costs. Generators were from 3 manufacturers: Boston Scientific (667, 37%), Medtronic (973, 54%), and St Jude Medical (152, 9%). The replacement probability at 6 years was 83 and 68% for earlier- and recent-generation devices, respectively. The need for replacement increased total therapy costs by more than 50% over the initial implantation cost for hospitals and by more than 30% for healthcare system. The improved longevity of recent-generation CRT-Ds reduced the therapy cost by ∼6% in both perspectives. Among recent-generation CRT-Ds, the replacement probability of devices from different manufacturers ranged from 12 to 70%. Consequently, the maximum difference in therapy cost between manufacturers was 40% for hospitals and 19% for the healthcare system. Differences in CRT-D longevity strongly affect the overall therapy cost. While the use of recent-generation devices has reduced the cost, significant differences exist among currently available systems. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.
-
Total joint Perioperative Surgical Home: an observational financial review.
Raphael, Darren R; Cannesson, Maxime; Schwarzkopf, Ran; Garson, Leslie M; Vakharia, Shermeen B; Gupta, Ranjan; Kain, Zeev N
2014-01-01
The numbers of people requiring total arthroplasty is expected to increase substantially over the next two decades. However, increasing costs and new payment models in the USA have created a sustainability gap. Ad hoc interventions have reported marginal cost reduction, but it has become clear that sustainability lies only in complete restructuring of care delivery. The Perioperative Surgical Home (PSH) model, a patient-centered and physician-led multidisciplinary system of coordinated care, was implemented at UC Irvine Health in 2012 for patients undergoing primary elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). This observational study examines the costs associated with this initiative. The direct cost of materials and services (excluding professional fees and implants) for a random index sample following the Total Joint-PSH pathway was used to calculate per diem cost. Cost of orthopedic implants was calculated based on audit-verified direct cost data. Operating room and post-anesthesia care unit time-based costs were calculated for each case and analyzed for variation. Benchmark cost data were obtained from literature search. Data are presented as mean ± SD (coefficient of variation) where possible. Total per diem cost was $10,042 ± 1,305 (13%) for TKA and $9,952 ± 1,294 (13%) for THA. Literature-reported benchmark per diem cost was $17,588 for TKA and $16,267 for THA. Implant cost was $7,482 ± 4,050 (54%) for TKA and $9869 ± 1,549 (16%) for THA. Total hospital cost was $17,894 ± 4,270 (24%) for TKA and $20,281 ± 2,057 (10%) for THA. In-room to incision time cost was $1,263 ± 100 (8%) for TKA and $1,341 ± 145 (11%) for THA. Surgery time cost was $1,558 ± 290 (19%) for TKA and $1,930 ± 374 (19%) for THA. Post-anesthesia care unit time cost was $507 ± 187 (36%) for TKA and $557 ± 302 (54%) for THA. Direct hospital costs were driven substantially below USA benchmark levels using the Total Joint-PSH pathway. The incremental benefit of each step in the coordinated care pathway is manifested as a lower average length of stay. We identified excessive variation in the cost of implants and post-anesthesia care.
-
Total joint Perioperative Surgical Home: an observational financial review
2014-01-01
Background The numbers of people requiring total arthroplasty is expected to increase substantially over the next two decades. However, increasing costs and new payment models in the USA have created a sustainability gap. Ad hoc interventions have reported marginal cost reduction, but it has become clear that sustainability lies only in complete restructuring of care delivery. The Perioperative Surgical Home (PSH) model, a patient-centered and physician-led multidisciplinary system of coordinated care, was implemented at UC Irvine Health in 2012 for patients undergoing primary elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). This observational study examines the costs associated with this initiative. Methods The direct cost of materials and services (excluding professional fees and implants) for a random index sample following the Total Joint-PSH pathway was used to calculate per diem cost. Cost of orthopedic implants was calculated based on audit-verified direct cost data. Operating room and post-anesthesia care unit time-based costs were calculated for each case and analyzed for variation. Benchmark cost data were obtained from literature search. Data are presented as mean ± SD (coefficient of variation) where possible. Results Total per diem cost was $10,042 ± 1,305 (13%) for TKA and $9,952 ± 1,294 (13%) for THA. Literature-reported benchmark per diem cost was $17,588 for TKA and $16,267 for THA. Implant cost was $7,482 ± 4,050 (54%) for TKA and $9869 ± 1,549 (16%) for THA. Total hospital cost was $17,894 ± 4,270 (24%) for TKA and $20,281 ± 2,057 (10%) for THA. In-room to incision time cost was $1,263 ± 100 (8%) for TKA and $1,341 ± 145 (11%) for THA. Surgery time cost was $1,558 ± 290 (19%) for TKA and $1,930 ± 374 (19%) for THA. Post-anesthesia care unit time cost was $507 ± 187 (36%) for TKA and $557 ± 302 (54%) for THA. Conclusions Direct hospital costs were driven substantially below USA benchmark levels using the Total Joint-PSH pathway. The incremental benefit of each step in the coordinated care pathway is manifested as a lower average length of stay. We identified excessive variation in the cost of implants and post-anesthesia care. PMID:25177486
-
Sari, Nazmi; Rotter, Thomas; Goodridge, Donna; Harrison, Liz; Kinsman, Leigh
2017-08-03
The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada. In order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses. The total cost for implementation of Lean over two years (2012-2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources. Recognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation.
-
ERIC Educational Resources Information Center
Bohl, Alex A.; Phelan, Elizabeth A.; Fishman, Paul A.; Harris, Jeffrey R.
2012-01-01
Purpose of the Study: To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity. Design and Methods: We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual…
-
Update on Multi-Variable Parametric Cost Models for Ground and Space Telescopes
NASA Technical Reports Server (NTRS)
Stahl, H. Philip; Henrichs, Todd; Luedtke, Alexander; West, Miranda
2012-01-01
Parametric cost models can be used by designers and project managers to perform relative cost comparisons between major architectural cost drivers and allow high-level design trades; enable cost-benefit analysis for technology development investment; and, provide a basis for estimating total project cost between related concepts. This paper reports on recent revisions and improvements to our ground telescope cost model and refinements of our understanding of space telescope cost models. One interesting observation is that while space telescopes are 50X to 100X more expensive than ground telescopes, their respective scaling relationships are similar. Another interesting speculation is that the role of technology development may be different between ground and space telescopes. For ground telescopes, the data indicates that technology development tends to reduce cost by approximately 50% every 20 years. But for space telescopes, there appears to be no such cost reduction because we do not tend to re-fly similar systems. Thus, instead of reducing cost, 20 years of technology development may be required to enable a doubling of space telescope capability. Other findings include: mass should not be used to estimate cost; spacecraft and science instrument costs account for approximately 50% of total mission cost; and, integration and testing accounts for only about 10% of total mission cost.
-
A comparative cost analysis of robot-assisted versus traditional laparoscopic partial nephrectomy.
Hyams, Elias; Pierorazio, Philip; Mullins, Jeffrey K; Ward, Maryann; Allaf, Mohamad
2012-07-01
Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as proliferation of robotic systems and patient demand for robot-assisted surgery. We sought to quantify the costs associated with the use of robotics for minimally invasive partial nephrectomy. A cost analysis was performed for 20 consecutive robot-assisted partial nephrectomy (RPN) and LPN patients at our institution from 2009 to 2010. Data included actual perioperative and hospitalization costs as well as professional fees. Capital costs were estimated using purchase costs and amortization of two robotic systems from 2001 to 2009, as well as maintenance contract costs. The estimated cost/case was obtained using total robotic surgical volume during this period. Total estimated costs were compared between groups. A separate analysis was performed assuming "ideal" robotic utilization during a comparable period. RALPN had a cost premium of +$1066/case compared with LPN, assuming actual robot utilization from 2001 to 2009. Assuming "ideal" utilization during a comparable period, this premium decreased to +$334; capital costs per case decreased from $1907 to $1175. Tumor size, operative time, and length of stay were comparable between groups. RALPN is associated with a small to moderate cost premium depending on assumptions regarding robotic surgical volume. Saturated utilization of robotic systems decreases attributable capital costs and makes comparison with laparoscopy more favorable. Purported clinical benefits of RPN (eg, decreased warm ischemia time, increased utilization of nephron-sparing surgery) need further study, because these may have cost implications.
-
Health Care Costs for Patients With Chronic Spinal Cord Injury in the Veterans Health Administration
French, Dustin D; Campbell, Robert R; Sabharwal, Sunil; Nelson, Audrey L; Palacios, Polly A; Gavin-Dreschnack, Deborah
2007-01-01
Background/Objective: Recurring annual costs of caring for patients with chronic spinal cord injury (SCI) is a large economic burden on health care systems, but information on costs of SCI care beyond the acute and initial postacute phase is sparse. The objective of this study was to establish a frame of reference and estimate of the annual direct medical costs associated with health care for a sample of patients with chronic SCI (ie, >2 years after injury). Methods: Patients were recruited from 3 Veterans Health Administration (VHA) SCI facilities; baseline patient information was cross-referenced to the Decision Support System (DSS) National Data Extracts (NDE) to obtain patient-specific health care costs in VHA. Descriptive statistical analysis of annual DSS-NDE cost of patients with SCI (N = 675) for fiscal year (FY) 2005 by level and completeness of injury was conducted. Results: Total (inpatient and outpatient) annual (FY 2005) direct medical costs for 675 patients with SCI exceeded $14.47 million or $21,450 per patient. Average annual total costs varied from $28,334 for cervical complete SCI to $16,792 for thoracic incomplete SCI. Two hundred thirty-three of the 675 patients with SCI who were hospitalized over the study period accounted for a total of 378 hospital discharges, costing in excess of $7.19 million. This approximated a cost of outpatient care received of $7.28 million for our entire sample. Conclusions: The comprehensive nature of health care delivery and related cost capture for people with chronic SCI in the VHA provided us the opportunity to accurately determine health care costs for this population. Future SCI postacute care cost analyses should consider case-mix adjusting patients at high risk for rehospitalization. PMID:18092564
-
Soárez, Patricia Coelho de; Lara, Amanda Nazareth; Sartori, Ana Marli Christovam; Abdala, Edson; Haddad, Luciana Bertocco de Paiva; D'Albuquerque, Luiz Augusto Carneiro; Novaes, Hillegonda Maria Dutilh
2015-01-01
Data on the costs of outpatient follow-up after liver transplantation are scarce in Brazil. The purpose of the present study was to estimate the direct medical costs of the outpatient follow-up after liver transplantation, from the first outpatient visit after transplantation to five years after transplantation. Cost description study conducted in a university hospital in São Paulo, Brazil. Cost data were available for 20 adults who underwent liver transplantation due to acute liver failure (ALF) from 2005 to 2009. The data were retrospectively retrieved from medical records and the hospital accounting information system from December 2010 to January 2011. Mean cost per patient/year was R$ 13,569 (US$ 5,824). The first year of follow-up was the most expensive (R$ 32,546 or US$ 13,968), and medication was the main driver of total costs, accounting for 85% of the total costs over the five-year period and 71.9% of the first-year total costs. In the second year after transplantation, the mean total costs were about half of the amount of the first-year costs (R$ 15,165 or US$ 6,509). Medication was the largest contributor to the costs followed by hospitalization, over the five-year period. In the fourth year, the costs of diagnostic tests exceeded the hospitalization costs. This analysis provides significant insight into the costs of outpatient follow-up after liver transplantation due to ALF and the participation of each cost component in the Brazilian setting.
-
Acute pediatric stroke: contributors to institutional cost.
Turney, Colin M; Wang, Wei; Seiber, Eric; Lo, Warren
2011-11-01
Recent studies examined the overall cost of pediatric stroke, but there are little data regarding the sources of these costs. We examined an administrative database that collected charges from 24 US children's hospitals to determine the sources of costs for acute hospital care of stroke. We used International Classification of Diseases, 9th Revision codes to search the Pediatric Health Information System. From 2003 to 2009 there were 1667 patients who had a primary diagnosis of stroke, 703 of which were hemorrhagic and 964 were ischemic. Individual costs, excluding physician charges, were gathered under 7 categories that were ranked to determine which contributed the most to total cost. Individual costs were ranked within their categories. We analyzed costs based on stroke type. Total costs were adjusted using the US Consumer Price Index to compare increases with the rate of inflation. Median total cost for any stroke was $19,548 (interquartile range, $10,764-$40,721). The category "other/nursing" contributed the most to hospital costs followed by imaging, laboratory, and pharmacy. Brain MRI and CT contributed the most to imaging costs. Hemorrhagic strokes (median $24,843) were more expensive than ischemic strokes (median $16,954). Total cost increased from 2003 to 2009, but no overall annual trend emerged after controlling for gender, age, race, and hospital. This is the first in-depth analysis of cost for pediatric stroke care. The highest cost categories are potential targets for cost containment but are also crucial for effective diagnosis and treatment. Necessary yet prudent use of imaging technologies and inpatient stays may be strategies for cost containment.
-
[Financial impact of introducing filmless CRT diagnosis].
Kusakabe, Yukihiro
2002-09-01
There has been a great deal of discussion as to the cost and benefit of introducing filmless CRT diagnosis for radiological exams. Although the various advantages of the filmless system tend to be highlighted, very few studies have attempted to provide a quantitative estimate of the degree of impact. We analyzed the potential financial impact on the cost of film management (film development, maintenance, and transportation) if CRT diagnosis were to be introduced in Seirei Hamamatsu Hospital. In conducting this analysis, we assumed that CRT diagnosis initially would be limited to CT and MR. The analysis demonstrated that the actual yearly cost of managing films amounts to about 240 million yen. As individual items, the cost of film materials, labor, and depreciation of assets were the three largest cost sectors, with the cost of film accounting for more than 30% of the total. The expense attributable to CT and MR exams was roughly half of the total cost. Against this level of expense, the expected savings in the first year after shifting to the filmless system would be 100 million yen, or a 36% reduction in current expenses. This savings reflects various effects of system change, including lack of need for related materials, reduction in staff workload, elimination of unnecessary equipment, etc. Under the simulation we conducted, 70% of savings occurred in the area of variable costs and 30% in the area of fixed costs.
-
Cow-specific treatment of clinical mastitis: an economic approach.
Steeneveld, W; van Werven, T; Barkema, H W; Hogeveen, H
2011-01-01
Under Dutch circumstances, most clinical mastitis (CM) cases of cows on dairy farms are treated with a standard intramammary antimicrobial treatment. Several antimicrobial treatments are available for CM, differing in antimicrobial compound, route of application, duration, and cost. Because cow factors (e.g., parity, stage of lactation, and somatic cell count history) and the causal pathogen influence the probability of cure, cow-specific treatment of CM is often recommended. The objective of this study was to determine if cow-specific treatment of CM is economically beneficial. Using a stochastic Monte Carlo simulation model, 20,000 CM cases were simulated. These CM cases were caused by Streptococcus uberis and Streptococcus dysgalactiae (40%), Staphylococcus aureus (30%), or Escherichia coli (30%). For each simulated CM case, the consequences of using different antimicrobial treatment regimens (standard 3-d intramammary, extended 5-d intramammary, combination 3-d intramammary+systemic, combination 3-d intramammary+systemic+1-d nonsteroidal antiinflammatory drugs, and combination extended 5-d intramammary+systemic) were simulated simultaneously. Finally, total costs of the 5 antimicrobial treatment regimens were compared. Some inputs for the model were based on literature information and assumptions made by the authors were used if no information was available. Bacteriological cure for each individual cow depended on the antimicrobial treatment regimen, the causal pathogen, and the cow factors parity, stage of lactation, somatic cell count history, CM history, and whether the cow was systemically ill. Total costs for each case depended on treatment costs for the initial CM case (including costs for antibiotics, milk withdrawal, and labor), treatment costs for follow-up CM cases, costs for milk production losses, and costs for culling. Average total costs for CM using the 5 treatments were (US) $224, $247, $253, $260, and $275, respectively. Average probabilities of bacteriological cure for the 5 treatments were 0.53, 0.65, 0.65, 0.68, and 0.75, respectively. For all different simulated CM cases, the standard 3-d intramammary antimicrobial treatment had the lowest total costs. The benefits of lower costs for milk production losses and culling for cases treated with the intensive treatments did not outweigh the higher treatment costs. The stochastic model was developed using information from the literature and assumptions made by the authors. Using these information sources resulted in a difference in effectiveness of different antimicrobial treatments for CM. Based on our assumptions, cow-specific treatment of CM was not economically beneficial. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
-
Electricity system based on 100% renewable energy for India and SAARC.
Gulagi, Ashish; Choudhary, Piyush; Bogdanov, Dmitrii; Breyer, Christian
2017-01-01
The developing region of SAARC (South Asian Association for Regional Cooperation) is home to a large number of people living below the poverty line. In future, providing affordable, universally accessible, reliable, low to zero carbon electricity in this region will be the main aim. A cost optimal 100% renewable energy system is simulated for SAARC for the year 2030 on an hourly resolved basis. The region was divided into 16 sub-regions and three different scenarios were set up based on the level of high voltage direct current (HVDC) grid connections. The results obtained for a total system levelised cost of electricity (LCOE) showed a decrease from 71.6 €/MWh in a decentralized to 67.2 €/MWh for a centralized grid connected scenario. An additional scenario was simulated to show the benefits of integrating industrial gas production and seawater reverse osmosis desalination demand, and showed the system cost decreased by 5% and total electricity generation decreased by 1%. The results show that a 100% renewable energy system could be a reality in the SAARC region with the cost assumptions used in this research and it may be more cost competitive than nuclear and fossil carbon capture and storage (CCS) alternatives. One of the limitations of this study is the cost of land for installation of renewables which is not included in the LCOE calculations, but regarded as a minor contribution.
-
Electricity system based on 100% renewable energy for India and SAARC
Gulagi, Ashish; Choudhary, Piyush; Bogdanov, Dmitrii; Breyer, Christian
2017-01-01
The developing region of SAARC (South Asian Association for Regional Cooperation) is home to a large number of people living below the poverty line. In future, providing affordable, universally accessible, reliable, low to zero carbon electricity in this region will be the main aim. A cost optimal 100% renewable energy system is simulated for SAARC for the year 2030 on an hourly resolved basis. The region was divided into 16 sub-regions and three different scenarios were set up based on the level of high voltage direct current (HVDC) grid connections. The results obtained for a total system levelised cost of electricity (LCOE) showed a decrease from 71.6 €/MWh in a decentralized to 67.2 €/MWh for a centralized grid connected scenario. An additional scenario was simulated to show the benefits of integrating industrial gas production and seawater reverse osmosis desalination demand, and showed the system cost decreased by 5% and total electricity generation decreased by 1%. The results show that a 100% renewable energy system could be a reality in the SAARC region with the cost assumptions used in this research and it may be more cost competitive than nuclear and fossil carbon capture and storage (CCS) alternatives. One of the limitations of this study is the cost of land for installation of renewables which is not included in the LCOE calculations, but regarded as a minor contribution. PMID:28723937
-
Mburu, Njenga; Tebitendwa, Sylvie M; van Bruggen, Johan J A; Rousseau, Diederik P L; Lens, Piet N L
2013-10-15
The performance, effluent quality, land area requirement, investment and operation costs of a full-scale waste stabilization pond (WSP) and a pilot scale horizontal subsurface flow constructed wetland (HSSF-CW) at Jomo Kenyatta University of Agriculture and Technology (JKUAT) were investigated between November 2010 to January 2011. Both systems gave comparable medium to high levels of organic matter and suspended solids removal. However, the WSP showed a better removal for Total Phosphorus (TP) and Ammonium (NH4(+)-N). Based on the population equivalent calculations, the land area requirement per person equivalent of the WSP system was 3 times the area that would be required for the HSSF-CW to treat the same amount of wastewater. The total annual cost estimates consisting of capital, operation and maintenance (O&M) costs were comparable for both systems. However, the evaluation of the capital cost of either system showed that it is largely influenced by the size of the population served, local cost of land and the construction materials involved. Hence, one can select either system in terms of treatment efficiency. When land is available other factor including the volume of wastewater or the investment, and O&M costs determine the technology selection. Copyright © 2013 Elsevier Ltd. All rights reserved.
-
Ebola in the Netherlands, 2014-2015: costs of preparedness and response.
Suijkerbuijk, Anita W M; Swaan, Corien M; Mangen, Marie-Josee J; Polder, Johan J; Timen, Aura; Ruijs, Wilhelmina L M
2017-11-17
The recent epidemic of Ebola virus disease (EVD) resulted in countries worldwide to prepare for the possibility of having an EVD patient. In this study, we estimate the costs of Ebola preparedness and response borne by the Dutch health system. An activity-based costing method was used, in which the cost of staff time spent in preparedness and response activities was calculated based on a time-recording system and interviews with key professionals at the healthcare organizations involved. In addition, the organizations provided cost information on patient days of hospitalization, laboratory tests, personal protective equipment (PPE), as well as the additional cleaning and disinfection required. The estimated total costs averaged €12.6 million, ranging from €6.7 to €22.5 million. The main cost drivers were PPE expenditures and preparedness activities of personnel, especially those associated with ambulance services and hospitals. There were 13 possible cases clinically evaluated and one confirmed case admitted to hospital. The estimated total cost of EVD preparedness and response in the Netherlands was substantial. Future costs might be reduced and efficiency increased by designating one ambulance service for transportation and fewer hospitals for the assessment of possible patients with a highly infectious disease of high consequences.
-
[An evaluation of costs in nephrology by means of analytical accounting system].
Hernández-Jaras, J; García Pérez, H; Pons, R; Calvo, C
2005-01-01
The analytical accounting is a countable technique directed to the evaluation, by means of pre-established criteria of distribution, of the internal economy of the hospital, in order to know the effectiveness and efficiency of Clinical Units. The aim of this study was to analyze the activity and costs of the Nephrology Department of General Hospital of Castellón. Activity of Hospitalization and Ambulatory Care, during 2003 was analysed. Hospitalization discharges were grouped in DGR and the costs per DGR were determinated. Total costs Hospitalisation and Ambulatory Care were 560.434,9 and 146.317,8 Euros, respectively. And the costs of one stay, one first outpatient visit and maintenance visit were 200, 63, and 31,6 Euros, respectively. Eighty per cent of the discharges were grouped in 9 DGR and DRG number 316 (Renal Failure) represented 30% of the total productivity. Costs of DGR 316 were 3.178,2 Euros and 16% represented laboratory cost and costs of diagnostic or therapeutic procedures. With introduction of analytical accounting and DGR system, the Nephrology Departments can acquire more full information on the results and costs of treatment. These techniques permits to improve the financial and economic performance.
-
Low-cost flywheel demonstration program
NASA Astrophysics Data System (ADS)
Rabenhorst, D. W.; Small, T. R.; Wilkinson, W. O.
1980-04-01
All primary objectives were successfully achieved as follows: demonstration of a full-size, 1 kWh flywheel having an estimated cost in large-volume production of approximately $50/kWh; development of a ball-bearing system having losses comparable to the losses in a totally magnetic suspension system; successful and repeated demonstration of the low-cost flywheel in a complete flywheel energy-storage system based on the use of ordinary house voltage and frequency; and application of the experience gained in the hardware program to project the system design into a complete, full-scale, 30 kWh home-type flywheel energy-storage system.
-
Economic impact of medication non-adherence by disease groups: a systematic review
Fernandez-Llimos, Fernando; Frommer, Michael; Benrimoj, Charlie; Garcia-Cardenas, Victoria
2018-01-01
Objective To determine the economic impact of medication non-adherence across multiple disease groups. Design Systematic review. Evidence review A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist. Results Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to ‘all causes’ non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents. Conclusion Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required. PROSPERO registration number CRD42015027338. PMID:29358417
-
Development of a solar-powered residential air conditioner: Economic analysis
NASA Technical Reports Server (NTRS)
1975-01-01
The results of investigations aimed at the development of cost models to be used in the economic assessment of Rankine-powered air conditioning systems for residential application are summarized. The rationale used in the development of the cost model was to: (1) collect cost data on complete systems and on the major equipment used in these systems; (2) reduce these data and establish relationships between cost and other engineering parameters such as weight, size, power level, etc; and (3) derive simple correlations from which cost-to-the-user can be calculated from performance requirements. The equipment considered in the survey included heat exchangers, fans, motors, and turbocompressors. This kind of hardware represents more than 2/3 of the total cost of conventional air conditioners.
-
Clinical process cost analysis.
Marrin, C A; Johnson, L C; Beggs, V L; Batalden, P B
1997-09-01
New systems of reimbursement are exerting enormous pressure on clinicians and hospitals to reduce costs. Using cheaper supplies or reducing the length of stay may be a satisfactory short-term solution, but the best strategy for long-term success is radical reduction of costs by reengineering the processes of care. However, few clinicians or institutions know the actual costs of medical care; nor do they understand, in detail, the activities involved in the delivery of care. Finally, there is no accepted method for linking the two. Clinical process cost analysis begins with the construction of a detailed flow diagram incorporating each activity in the process of care. The cost of each activity is then calculated, and the two are linked. This technique was applied to Diagnosis Related Group 75 to analyze the real costs of the operative treatment of lung cancer at one institution. Total costs varied between $6,400 and $7,700. The major driver of costs was personnel time, which accounted for 55% of the total. Forty percent of the total cost was incurred in the operating room. The cost of care decreased progressively during hospitalization. Clinical process cost analysis provides detailed information about the costs and processes of care. The insights thus obtained may be used to reduce costs by reengineering the process.
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Al-Karaghouli, Ali; Kazmerski, L.L.
2010-04-15
This paper addresses the need for electricity of rural areas in southern Iraq and proposes a photovoltaic (PV) solar system to power a health clinic in that region. The total daily health clinic load is 31.6 kW h and detailed loads are listed. The National Renewable Energy Laboratory (NREL) optimization computer model for distributed power, ''HOMER,'' is used to estimate the system size and its life-cycle cost. The analysis shows that the optimal system's initial cost, net present cost, and electricity cost is US$ 50,700, US$ 60,375, and US$ 0.238/kW h, respectively. These values for the PV system are comparedmore » with those of a generator alone used to supply the load. We found that the initial cost, net present cost of the generator system, and electricity cost are US$ 4500, US$ 352,303, and US$ 1.332/kW h, respectively. We conclude that using the PV system is justified on humanitarian, technical, and economic grounds. (author)« less
-
Efficient distribution of toy products using ant colony optimization algorithm
NASA Astrophysics Data System (ADS)
Hidayat, S.; Nurpraja, C. A.
2017-12-01
CV Atham Toys (CVAT) produces wooden toys and furniture, comprises 13 small and medium industries. CVAT always attempt to deliver customer orders on time but delivery costs are high. This is because of inadequate infrastructure such that delivery routes are long, car maintenance costs are high, while fuel subsidy by the government is still temporary. This study seeks to minimize the cost of product distribution based on the shortest route using one of five Ant Colony Optimization (ACO) algorithms to solve the Vehicle Routing Problem (VRP). This study concludes that the best of the five is the Ant Colony System (ACS) algorithm. The best route in 1st week gave a total distance of 124.11 km at a cost of Rp 66,703.75. The 2nd week route gave a total distance of 132.27 km at a cost of Rp 71,095.13. The 3rd week best route gave a total distance of 122.70 km with a cost of Rp 65,951.25. While the 4th week gave a total distance of 132.27 km at a cost of Rp 74,083.63. Prior to this study there was no effort to calculate these figures.
-
Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals
Cortada, Aline Pinheiro dos Santos; da Silva, Telma Gomes; da Silva, André Campos; Golmia, Ricardo Prado; Guerra, Renata Leborato; Takemoto, Maíra Libertad Soligo; Monteiro, Roberta Dyonisio Canaveira; Scheinberg, Morton Aaron
2015-01-01
Objective To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system. Methods A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization). Results A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively. Conclusion Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio. PMID:26313439
-
Bloom, Joan R; Wang, Huihui; Kang, Soo Hyang; Wallace, Neal T; Hyun, Jenny K; Hu, Teh-wei
2011-02-01
Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs. Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995-1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates. Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reductions in cost per user for both outpatient services and total services. In the not-for-profit programs, there were no significant changes in cost per user for total services; a significant reduction in cost per user for outpatient services was found only in the first two years, 1995 and 1996). The evidence suggests that different strategies were used by the not-for-profit and for-profit programs to control expenditures and utilization and that the for-profit programs were more successful in reducing cost per user.
-
Surgeon-Directed Cost Variation in Isolated Rotator Cuff Repair.
Terhune, E Bailey; Cannamela, Peter C; Johnson, Jared S; Saad, Charles D; Barnes, John; Silbernagel, Janette; Faciszewski, Thomas; Shea, Kevin G
2016-12-01
As value becomes a larger component of heath care decision making, cost data can be evaluated for regional and physician variation. Value is determined by outcome divided by cost, and reducing cost increases value for patients. "Third-party spend" items are individual selections by surgeons used to perform procedures. Cost data for third-party spend items provide surgeons and hospitals with important information regarding care value, potential cost-saving opportunities, and the total cost of ownership of specific clinical decisions. To perform a cost review of isolated rotator cuff repair within a regional 7-hospital system and to document procedure cost variation among operating surgeons. Economic and decision analysis; Level of evidence, 4. Current Procedural Terminology (CPT) codes were used to retrospectively identify subjects who received an isolated rotator cuff repair within a 7-hospital system. Cost data were collected for clinically sensitive third-party spend items and divided into 4 cost groups: (1) suture anchors, (2) suture-passing devices and needles, (3) sutures used for cuff repair, and (4) disposable tools or instruments. A total of 62 isolated rotator cuff repairs were performed by 17 surgeons over a 13-month period. The total cost per case for clinically sensitive third-party spend items (in 2015 US dollars) ranged from $293 to $3752 (mean, $1826). Four surgeons had a mean procedure cost that was higher than the data set mean procedure cost. The cost of an individual suture anchor ranged from $75 to $1775 (mean, $403). One disposable suture passer was used, which cost $140. The cost of passing needles ranged from $140 to $995 (mean, $468). The cost per repair suture (used to repair cuff tears) varied from $18 to $298 (mean, $61). The mean suture (used to close wounds) cost per case was $81 (range, $0-$454). A total of 316 tools or disposable instruments were used, costing $1 to $1573 per case (mean, $624). This study demonstrates significant cost variation with respect to cost per case and cost of individual items used during isolated rotator cuff repair. Suture anchors represent the most expensive and variable surgeon-directed cost. The wide cost variation seen in all cost categories illustrates both the effect of surgeon choice in procedure cost and the opportunity for significant cost savings in cases of isolated rotator cuff repair. Engaging surgeons in discussion on cost can positively influence the value of care provided to patients if costs can be reduced without affecting the quality of patient outcomes.
-
Financial impact of hand surgery programs on academic medical centers.
Hasan, Jafar S; Chung, Kevin C; Storey, Amy F; Bolg, Mary L; Taheri, Paul A
2007-02-01
This study analyzes the financial performance of hand surgery in the Department of Surgery at the University of Michigan. This analysis can serve as a reference for other medical centers in the financial evaluation of a hand surgery program. Fiscal year 2004 billing records for all patients (n = 671) who underwent hand surgery procedures were examined. The financial data were separated into professional revenues and costs (relating to the hand surgery program in the Section of Plastic Surgery) and into facility revenues and costs (relating to the overall University of Michigan Health System). Professional net revenue was calculated by applying historical collection rates to procedural and clinic charges. Facility revenue was calculated by applying historical collection rates to the following charge categories: inpatient/operating room, clinic facility, neurology/electromyography, radiology facilities, and occupational therapy. Total professional costs were calculated by adding direct costs and allocated overhead costs. Facility costs were obtained from the hospital's cost accounting system. Professional and facility incomes were calculated by subtracting costs from revenues. The net professional revenue and total costs were 1,069,836 and 1,027,421 dollars, respectively. Professional operating income was 42,415 dollars, or 3.96 percent of net professional revenue. Net facility revenue and total costs were 5,500,606 and 4,592,534 dollars, respectively. Facility operating income was 908,071 dollars, or 16.51 percent of net facility revenues. While contributing to the academic mission of the institution, hand surgery is financially rewarding for the Department of Surgery. In addition, hand surgery activity contributes substantially to the financial well-being of the academic medical center.
-
Hou, Lingling; Hoag, Dana L K; Keske, Catherine M H
2015-02-01
This study proposes the use of marginal abatement cost curves to calculate environmental damages of agricultural systems in China's Loess Plateau. Total system costs and revenues, management characteristics and pollution attributes are imputed into a directional output distance function, which is then used to determine shadow prices and abatement cost curves for soil and nitrogen loss. Marginal abatement costs curves are an effective way to compare economic and conservation tradeoffs when field-specific data are scarce. The results show that sustainable agricultural practices can balance soil conservation and agricultural production; land need not be retired, as is current policy. Published by Elsevier Ltd.
-
Lee, Youngin; Lee, Seung Hun; Kim, Yun Jin; Lee, Sang Yeoup; Lee, Jeong Gyu; Jeong, Dong Wook; Yi, Yu Hyeon; Tak, Young Jin; Hwang, Hye Rim; Gwon, Mieun
2018-03-07
This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, "old" and "new," by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p < 0.001); however, the new system registers lower patient out-of-pocket expenses (p < 0.001). The novelty of this study is proving that the new medical insurance payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.
-
[Classification of severely injured patients in the G-DRG System 2008].
Juhra, C; Franz, D; Roeder, N; Vordemvenne, T; Raschke, M J
2009-05-01
Since the introduction of a per-case reimbursement system in Germany (German Diagnosis-Related Groups, G-DRG), the correct reimbursement for the treatment of severely injured patients has been much debated. While the classification of a patient in a polytrauma DRG follows different rules than the usual clinical definition, leading to a high number of patients not grouped as severely injured by the system, the system was also criticized in 2005 for its shortcomings in financing the treatment of severely injured patients. The development of financial reimbursement will be discussed in this paper. 167 patients treated in 2006 and 2007 due to a severe injury at the University-Hospital Münster and grouped into a polytrauma-DRG were included in this study. For each patient, cost-equivalents were estimated. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK cost-calculation method. The reimbursement was calculated using the G-DRG-Systems of 2007, 2008 and 2009. Cost-equivalents/costs and clinical parameters were correlated. A total of 167 patients treated in 2006 and 2007 for a severe injury at the Münster University Hospital and grouped into a polytrauma DRG were included in this study. Cost equivalents were estimated for each patient. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK (Institute for the Hospital Remuneration System) cost calculation method. Reimbursement was calculated using the G-DRG systems of 2007, 2008 and 2009. Cost equivalents/costs and clinical parameters were correlated. With the ongoing development of the G-DRG system, reimbursement for the treatment of severely injured patient has improved, but the amount of underfinancing remains substantial. As treatment of severely injured patients must be reimbursed using the G-DRG system, this system must be further adapted to better meet the needs of severely injured patients. Parameters such as total surgery time, injury severity score (ISS) and LOS in ICU could be used for this purpose. In future, data obtained in trauma networks can help optimize reimbursement for the treatment of these patients.
-
76 FR 16816 - Agency Information Collection Activities: Proposed Collection, Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2011-03-25
... comment and provide your total capital and startup cost components or annual operation, maintenance, and..., including system and technology acquisition, expected useful life of capital equipment, discount rate(s), and the period over which you incur costs. Capital and startup costs include, among other items...
-
Federal Register 2010, 2011, 2012, 2013, 2014
2011-01-28
... disclose this information, you should comment and provide your total capital and startup cost components or... use to estimate major cost factors, including system and technology acquisition, expected useful life... startup costs include, among other items, computers and software you purchase to prepare for collecting...
-
Final Report. Solar Assist for Administration Building and Community Gym/Pool
DOE Office of Scientific and Technical Information (OSTI.GOV)
Synder, Randy; Bresette, Joseph
2015-06-23
Tonto Apache Tribe applied to the Department of Energy’s “Tribal Energy Program” for the “Community Scale Clean Energy Projects” in Indian Country in 2013 to implement a solar project to reduce energy use in two tribal buildings. Total estimated project cost was $804,140, with the Department and Tribe each providing 50% of the project costs. Photovoltaic systems totaling 75 kW on the Administration Building and 192 kW on the Gymnasium were installed. We used roof tops and installed canopies in adjacent parking areas for mounting the systems. The installed systems were designed to offset 65% of the facilities electric load.
-
Code of Federal Regulations, 2011 CFR
2011-04-01
... system, what are the total estimated costs of the system, including but not limited to, the costs of... productive well cannot be installed, include a statement to the effect that there is no assurance a productive well can be installed and, if it cannot, no refund of the purchase price of the lot will be made...
-
Code of Federal Regulations, 2012 CFR
2012-04-01
... system, what are the total estimated costs of the system, including but not limited to, the costs of... productive well cannot be installed, include a statement to the effect that there is no assurance a productive well can be installed and, if it cannot, no refund of the purchase price of the lot will be made...
-
Code of Federal Regulations, 2013 CFR
2013-04-01
... system, what are the total estimated costs of the system, including but not limited to, the costs of... productive well cannot be installed, include a statement to the effect that there is no assurance a productive well can be installed and, if it cannot, no refund of the purchase price of the lot will be made...
-
Code of Federal Regulations, 2014 CFR
2014-04-01
... system, what are the total estimated costs of the system, including but not limited to, the costs of... productive well cannot be installed, include a statement to the effect that there is no assurance a productive well can be installed and, if it cannot, no refund of the purchase price of the lot will be made...
-
NASA Astrophysics Data System (ADS)
Abeygunawardane, Saranga Kumudu
2018-02-01
Any electrical utility prefers to implement demand side management and change the shape of the demand curve in a beneficial manner. This paper aims to assess the financial gains (or losses) to the generating sector through the implementation of demand side management programs. An optimization algorithm is developed to find the optimal generation mix that minimizes the daily total generating cost. This daily total generating cost includes the daily generating cost as well as the environmental damage cost. The proposed optimization algorithm is used to find the daily total generating cost for the base case and for several demand side management programs using the data obtained from the Sri Lankan power system. Results obtained for DSM programs are compared with the results obtained for the base case to assess the financial benefits of demand side management to the generating sector.
-
Steam bottoming cycle for an adiabatic diesel engine
NASA Technical Reports Server (NTRS)
Poulin, E.; Demier, R.; Krepchin, I.; Walker, D.
1984-01-01
Steam bottoming cycles using adiabatic diesel engine exhaust heat which projected substantial performance and economic benefits for long haul trucks were studied. Steam cycle and system component variables, system cost, size and performance were analyzed. An 811 K/6.90 MPa state of the art reciprocating expander steam system with a monotube boiler and radiator core condenser was selected for preliminary design. The costs of the diesel with bottoming system (TC/B) and a NASA specified turbocompound adiabatic diesel with aftercooling with the same total output were compared, the annual fuel savings less the added maintenance cost was determined to cover the increase initial cost of the TC/B system in a payback period of 2.3 years. Steam bottoming system freeze protection strategies were developed, technological advances required for improved system reliability are considered and the cost and performance of advanced systes are evaluated.
-
Vogl, Matthias; Schildmann, Eva; Leidl, Reiner; Hodiamont, Farina; Kalies, Helen; Maier, Bernd Oliver; Schlemmer, Marcus; Roller, Susanne; Bausewein, Claudia
2018-04-05
Hospital costs and cost drivers in palliative care are poorly analysed. It remains unknown whether current German Diagnosis-Related Groups, mainly relying on main diagnosis or procedure, reproduce costs adequately. The aim of this study was therefore to analyse costs and reimbursement for inpatient palliative care and to identify relevant cost drivers. Two-center, standardised micro-costing approach with patient-level cost calculations and analysis of the reimbursement situation for patients receiving palliative care at two German hospitals (7/2012-12/2013). Data were analysed for the total group receiving hospital care covering, but not exclusively, palliative care (group A) and the subgroup receiving palliative care only (group B). Patient and care characteristics predictive of inpatient costs of palliative care were derived by generalised linear models and investigated by classification and regression tree analysis. Between 7/2012 and 12/2013, 2151 patients received care in the two hospitals including, but not exclusively, on the PCUs (group A). In 2013, 784 patients received care on the two PCUs only (group B). Mean total costs per case were € 7392 (SD 7897) (group A) and € 5763 (SD 3664) (group B), mean total reimbursement per case € 5155 (SD 6347) (group A) and € 4278 (SD 2194) (group B). For group A/B on the ward, 58%/67% of the overall costs and 48%/53%, 65%/82% and 64%/72% of costs for nursing, physicians and infrastructure were reimbursed, respectively. Main diagnosis did not significantly influence costs. However, duration of palliative care and total length of stay were (related to the cost calculation method) identified as significant cost drivers. Related to the cost calculation method, total length of stay and duration of palliative care were identified as significant cost drivers. In contrast, main diagnosis did not reflect costs. In addition, results show that reimbursement within the German Diagnosis-Related Groups system does not reproduce the costs adequately, but causes a financing gap for inpatient palliative care.
-
NASA Astrophysics Data System (ADS)
Vijayashree, M.; Uthayakumar, R.
2017-09-01
Lead time is one of the major limits that affect planning at every stage of the supply chain system. In this paper, we study a continuous review inventory model. This paper investigates the ordering cost reductions are dependent on lead time. This study addressed two-echelon supply chain problem consisting of a single vendor and a single buyer. The main contribution of this study is that the integrated total cost of the single vendor and the single buyer integrated system is analyzed by adopting two different (linear and logarithmic) types ordering cost reductions act dependent on lead time. In both cases, we develop effective solution procedures for finding the optimal solution and then illustrative numerical examples are given to illustrate the results. The solution procedure is to determine the optimal solutions of order quantity, ordering cost, lead time and the number of deliveries from the single vendor and the single buyer in one production run, so that the integrated total cost incurred has the minimum value. Ordering cost reduction is the main aspect of the proposed model. A numerical example is given to validate the model. Numerical example solved by using Matlab software. The mathematical model is solved analytically by minimizing the integrated total cost. Furthermore, the sensitivity analysis is included and the numerical examples are given to illustrate the results. The results obtained in this paper are illustrated with the help of numerical examples. The sensitivity of the proposed model has been checked with respect to the various major parameters of the system. Results reveal that the proposed integrated inventory model is more applicable for the supply chain manufacturing system. For each case, an algorithm procedure of finding the optimal solution is developed. Finally, the graphical representation is presented to illustrate the proposed model and also include the computer flowchart in each model.
-
Hysteroscopic Endometrial Polypectomy: Clinical and Economic Data in Decision Making.
Franchini, Mario; Lippi, Giuseppe; Calzolari, Stefano; Giarrè, Giovanna; Gubbini, Giampietro; Catena, Ursula; Di Spiezio Sardo, Attilio; Florio, Pasquale
To compare the costs of hysteroscopic polypectomy using mechanical and electrosurgical systems in the hospital operating room and an office-based setting. Retrospective cohort study (Canadian Task Force classification II-2). Tertiary referral hospital and center for gynecologic care. Seven hundred and fifty-four women who underwent endometrial polypectomy between January 20, 2015, and April 27, 2016. Hysteroscopic endometrial polypectomy performed in the same-day hospital setting or office setting using one of the following: bipolar electrode, loop electrode, mechanical device, or hysteroscopic tissue removal system. The various costs associated with the 2 clinical settings at Palagi Hospital, Florence, Italy were compiled, and a direct cost comparison was made using an activity-based cost-management system. The costs for using reusable loop electrode resection-16 or loop electrode resection-26 were significantly less expensive than using disposable loop electrode resection-27, the tissue removal system, or bipolar electrode resection (p = .0002). Total hospital costs for polypectomy with all systems were significantly less expensive in an office setting compared with same-day surgery in the hospital setting (p = .0001). Office-based hysteroscopic tissue removal was associated with shorter operative time compared with the other procedures (p = .0002) CONCLUSION: The total cost of hysteroscopic polypectomy is markedly higher when using disposable equipment compared with reusable equipment, both in the hospital operating room and the office setting. Same-day hospital or office-based surgery with reusable loop electrode resection is the most cost-effective approach in each settings, but requires experienced surgeons. Finally, the shorter surgical time should be taken into consideration for patients undergoing vaginal polypectomy in the office setting, owing more to patient comfort than to cost savings. Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.
-
Damage Control Technology - A Literature Review
2006-03-01
The Canadian Navy has identified the reduction of the total operating cost ( TOC ) of new ships as a priority. The major contributors to the TOC of a...Corporation, California, USA AC-CAS Group Co. Ltd., Bangkok, Thailand Apollo Fire Detectors, Hempshire, England, UK Compania Panamena de Sistemas ...National Defence DRDC Defence Research and Development Canada TOC Total Operating Cost BDCS Battle Damage Control System DC-ARM Damage Control
-
Turró-Garriga, O; Calvó-Perxas, L; Albaladejo, R; Alsina, E; Cuy, J M; Llinàs-Reglà, J; Roig, A M; Serena, J; Vallmajó, N; Viñas, M; López-Pousa, S; Vilalta-Franch, J; Garre-Olmo, J
2015-01-01
Drug spending increases exponentially from the age of 65-70 years, and dementia is one of the diseases significantly contributing to this increase. Our aim was to describe pharmaceutical consumption and cost in patients with dementia, using the Anatomical Therapeutic Chemical (ATC) classification system. We also assessed the evolution of costs and consumption, and the variables associated to this evolution during three years. Three years prospective cohort study using data from the ReDeGi and the Health Region of Girona (HRG) Pharmacy Unit database from the Public Catalan Healthcare Service (PCHS). Frequency of consumption and costs of ATC categories of drugs were calculated. Sample of 869 patients with dementia, most of them with a diagnosis of degenerative dementia (72.6%), and in a mild stage of the disease (68.2%). Central nervous system (CNS) drugs had the highest consumption rate (97.2%), followed by metabolic system drugs (80.1%), and cardiovascular system drugs (75.4%). Total pharmaceutical cost was of 2124.8 € per patient/year (standard deviation (SD)=1018.5 €), and spending on CNS drugs was 55.5% of the total cost. After 36 months, pharmaceutical cost increased in 694.9 € (SD=1741.9), which was associated with dementia severity and institutionalization at baseline. Pharmaceutical consumption and costs are high in patients with dementia, and they increase with time, showing an association with baseline dementia severity and institutionalization. CNS drugs are the pharmaceuticals with highest prescription rates and associated costs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
-
NASA Technical Reports Server (NTRS)
Jones, Harry
2003-01-01
The ALS project plan goals are reducing cost, improving performance, and achieving flight readiness. ALS selects projects to advance the mission readiness of low cost, high performance technologies. The role of metrics is to help select good projects and report progress. The Equivalent Mass (EM) of a system is the sum of the estimated mass of the hardware, of its required materials and spares, and of the pressurized volume, power supply, and cooling system needed to support the hardware in space. EM is the total payload launch mass needed to provide and support a system. EM is directly proportional to the launch cost.
-
NASA Astrophysics Data System (ADS)
Orans, Ren
1990-10-01
Existing procedures used to develop marginal costs for electric utilities were not designed for applications in an increasingly competitive market for electric power. The utility's value of receiving power, or the costs of selling power, however, depend on the exact location of the buyer or seller, the magnitude of the power and the period of time over which the power is used. Yet no electric utility in the United States has disaggregate marginal costs that reflect differences in costs due to the time, size or location of the load associated with their power or energy transactions. The existing marginal costing methods used by electric utilities were developed in response to the Public Utilities Regulatory Policy Act (PURPA) in 1978. The "ratemaking standards" (Title 1) established by PURPA were primarily concerned with the appropriate segmentation of total revenues to various classes-of-service, designing time-of-use rating periods, and the promotion of efficient long-term resource planning. By design, the methods were very simple and inexpensive to implement. Now, more than a decade later, the costing issues facing electric utilities are becoming increasingly complex, and the benefits of developing more specific marginal costs will outweigh the costs of developing this information in many cases. This research develops a framework for estimating total marginal costs that vary by the size, timing, and the location of changes in loads within an electric distribution system. To complement the existing work at the Electric Power Research Institute (EPRI) and Pacific Gas and Electric Company (PGandE) on estimating disaggregate generation and transmission capacity costs, this dissertation focuses on the estimation of distribution capacity costs. While the costing procedure is suitable for the estimation of total (generation, transmission and distribution) marginal costs, the empirical work focuses on the geographic disaggregation of marginal costs related to electric utility distribution investment. The study makes use of data from an actual distribution planning area, located within PGandE's service territory, to demonstrate the important characteristics of this new costing approach. The most significant result of this empirical work is that geographic differences in the cost of capacity in distribution systems can be as much as four times larger than the current system average utility estimates. Furthermore, lumpy capital investment patterns can lead to significant cost differences over time.
-
Exploration of the horizontally staggered light guides for high concentration CPV applications.
Selimoglu, Ozgur; Turan, Rasit
2012-08-13
The material and processing costs are still the major drawbacks of the c-Si based photovoltaic (PV) technology. The wafer cost comprises up to 35-40% of the total module cost. New approaches and system designs are needed in order to reduce the share of the wafer cost in photovoltaic energy systems. Here we explore the horizontally staggered light guide solar optics for use in Concentrated Photovoltaic (CPV) applications. This optical system comprises a lens array system coupled to a horizontal light guide which directs the incoming light beam to its edge. We have designed and simulated this system using a commercial ray tracing software (Zemax). The system is more compact, thinner and more robust compared to the conventional CPV systems. Concentration levels as high as 1000x can easily be reached when the system is properly designed. With such a high concentration level, a good acceptance angle of + -1 degree is still be conserved. The analysis of the system reveals that the total optical efficiency of the system could be as high as %94.4 without any anti-reflection (AR) coating. Optical losses can be reduced by just accommodating a single layer AR coating on the initial lens array leading to a %96.5 optical efficiency. Thermal behavior of high concentration linear concentrator is also discussed and compared with a conventional point focus CPV system.
-
Academic Health Systems Management: The Rationale Behind Capitated Contracts
Taheri, Paul A.; Butz, David A.; Greenfield, Lazar J.
2000-01-01
Objective To determine why hospitals enter into “capitated” contracts, which often generate accounting losses. The authors’ hypothesis is that hospitals coordinate contracts to keep beds full and that in principal, capitated contracts reflect sound capacity management. Summary Background Data In high-overhead industries, different consumers pay different prices for similar services (e.g., full-fare vs. advanced-purchase plane tickets, full tuition vs. financial aid). Some consumers gain access by paying less than total cost. Hospitals, like other high-overhead business enterprises, must optimize the use of their capacity, amortizing overhead over as many patients as possible. This necessity for enhanced throughput forces hospitals and health systems to discount empty beds, sometimes to the point where they incur accounting losses serving some payors. Methods The authors analyzed the cost accounting system at their university teaching hospital to compare hospital and intensive care unit (ICU) lengths of stay (LOS), variable direct costs (VDC), overhead of capitated patients, and reimbursement versus other payors for all hospital discharges (n = 29,036) in fiscal year 1998. The data were analyzed by diagnosis-related groups (DRGs), length of stay (LOS), insurance carrier, proximity to hospital, and discharge disposition. Patients were then distinguished across payor categories based on their resource utilization, proximity to the hospital, DRG, LOS, and discharge status. Results The mean cost for capitated patients was $4,887, less than half of the mean cost of $10,394 for the entire hospitalized population. The mean capitated reimbursement was $928/day, exceeding the mean daily VDC of $616 but not the total cost of $1,445/day. Moreover, the mean total cost per patient day of treating a capitated patient was $400 less than the mean total cost per day for noncapitated patients. The hospital’s capitated health maintenance organization (HMO) patients made up 16.0% of the total admissions but only 9.4% of the total patient days. Both the mean LOS of 3.4 days and the mean ICU LOS of 0.3 days were significantly different from the overall values of 5.8 days and 1 day, respectively, for the noncapitated population. For patients classified with a DRG with complication who traveled from more than 60 miles away, the mean LOS was 10.7 days and the mean total cost was $21,658. This is in contrast to all patients who traveled greater than 60 miles, who had an LOS of 7.2 days and a mean total cost of $12,569. Conclusion The capitated payor directed the bulk of its subscribers to one hospital (other payors transferred their sicker patients). This was reflected in the capitated group’s lower costs and LOS. This stable stream of relatively low-acuity patients enhanced capacity utilization. For capitated patients, the hospital still benefits by recovering the incremental cost (VDC) of treating these patients, and only a portion of the assigned overhead. Thus, in the short run, capitated patients provide a positive economic benefit. Other payors’ higher-acuity patients arrive more randomly, place greater strains on capacity, and generate higher overhead costs. This results in differential reimbursement to cover this incremental overhead. Having a portfolio of contracts allows the hospital to optimize capacity both in terms of patient flows and acuity. One risk of operating near capacity is that capitated patients could displace other higher-paying patients. PMID:10816628
-
Academic health systems management: the rationale behind capitated contracts.
Taheri, P A; Butz, D A; Greenfield, L J
2000-06-01
To determine why hospitals enter into "capitated" contracts, which often generate accounting losses. The authors' hypothesis is that hospitals coordinate contracts to keep beds full and that in principal, capitated contracts reflect sound capacity management. In high-overhead industries, different consumers pay different prices for similar services (e.g., full-fare vs. advanced-purchase plane tickets, full tuition vs. financial aid). Some consumers gain access by paying less than total cost. Hospitals, like other high-overhead business enterprises, must optimize the use of their capacity, amortizing overhead over as many patients as possible. This necessity for enhanced throughput forces hospitals and health systems to discount empty beds, sometimes to the point where they incur accounting losses serving some payors. The authors analyzed the cost accounting system at their university teaching hospital to compare hospital and intensive care unit (ICU) lengths of stay (LOS), variable direct costs (VDC), overhead of capitated patients, and reimbursement versus other payors for all hospital discharges (n = 29,036) in fiscal year 1998. The data were analyzed by diagnosis-related groups (DRGs), length of stay (LOS), insurance carrier, proximity to hospital, and discharge disposition. Patients were then distinguished across payor categories based on their resource utilization, proximity to the hospital, DRG, LOS, and discharge status. The mean cost for capitated patients was $4,887, less than half of the mean cost of $10,394 for the entire hospitalized population. The mean capitated reimbursement was $928/day, exceeding the mean daily VDC of $616 but not the total cost of $1,445/day. Moreover, the mean total cost per patient day of treating a capitated patient was $400 less than the mean total cost per day for noncapitated patients. The hospital's capitated health maintenance organization (HMO) patients made up 16. 0% of the total admissions but only 9.4% of the total patient days. Both the mean LOS of 3.4 days and the mean ICU LOS of 0.3 days were significantly different from the overall values of 5.8 days and 1 day, respectively, for the noncapitated population. For patients classified with a DRG with complication who traveled from more than 60 miles away, the mean LOS was 10.7 days and the mean total cost was $21,658. This is in contrast to all patients who traveled greater than 60 miles, who had an LOS of 7.2 days and a mean total cost of $12,569. The capitated payor directed the bulk of its subscribers to one hospital (other payors transferred their sicker patients). This was reflected in the capitated group's lower costs and LOS. This stable stream of relatively low-acuity patients enhanced capacity utilization. For capitated patients, the hospital still benefits by recovering the incremental cost (VDC) of treating these patients, and only a portion of the assigned overhead. Thus, in the short run, capitated patients provide a positive economic benefit. Other payors' higher-acuity patients arrive more randomly, place greater strains on capacity, and generate higher overhead costs. This results in differential reimbursement to cover this incremental overhead. Having a portfolio of contracts allows the hospital to optimize capacity both in terms of patient flows and acuity. One risk of operating near capacity is that capitated patients could displace other higher-paying patients.
-
Cost implications of PSA screening differ by age.
Rao, Karthik; Liang, Stella; Cardamone, Michael; Joshu, Corinne E; Marmen, Kyle; Bhavsar, Nrupen; Nelson, William G; Ballentine Carter, H; Albert, Michael C; Platz, Elizabeth A; Pollack, Craig E
2018-05-09
Multiple guidelines seek to alter rates of prostate-specific antigen (PSA)-based prostate cancer screening. The costs borne by payers associated with PSA-based screening for men of different age groups-including the costs of screening and subsequent diagnosis, treatment, and adverse events-remain uncertain. We sought to develop a model of PSA costs that could be used by payers and health care systems to inform cost considerations under a range of different scenarios. We determined the prevalence of PSA screening among men aged 50 and higher using 2013-2014 data from a large, multispecialty group, obtained reimbursed costs associated with screening, diagnosis, and treatment from a commercial health plan, and identified transition probabilities for biopsy, diagnosis, treatment, and complications from the literature to generate a cost model. We estimated annual total costs for groups of men ages 50-54, 55-69, and 70+ years, and varied annual prostate cancer screening prevalence in each group from 5 to 50% and tested hypothetical examples of different test characteristics (e.g., true/false positive rate). Under the baseline screening patterns, costs of the PSA screening represented 10.1% of the total costs; costs of biopsies and associated complications were 23.3% of total costs; and, although only 0.3% of all screen eligible patients were treated, they accounted for 66.7% of total costs. For each 5-percentage point decrease in PSA screening among men aged 70 and older for a single calendar year, total costs associated with prostate cancer screening decreased by 13.8%. For each 5-percentage point decrease in PSA screening among men 50-54 and 55-69 years old, costs were 2.3% and 7.3% lower respectively. With constrained financial resources and with national pressure to decrease use of clinically unnecessary PSA-based prostate cancer screening, there is an opportunity for cost savings, especially by focusing on the downstream costs disproportionately associated with screening men 70 and older.
-
Wouters, Hanne; Thijs, Vincent; Annemans, Lieven
2013-01-01
To assess the cost-effectiveness of dabigatran etexilate ('dabigatran') vs vitamin K antagonists (VKAs) in the Belgian healthcare setting for the prevention of stroke and systemic embolism (SE) in patients with non-valvular atrial fibrillation (AF). A Markov model was used to calculate the cost-effectiveness of dabigatran vs VKAs in Belgium, whereby warfarin was considered representative for the VKA class. Efficacy and safety data were taken from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial and a network meta-analysis. Local resource use and unit costs were included in the model. Effectiveness was expressed in Quality Adjusted Life-Years (QALYs). The model outcomes were total costs, total QALYs, incremental costs, incremental QALYs and the incremental cost-effectiveness ratio (ICER). The level of International Normalized Ratio (INR) control and the use of other antithrombotic therapies observed in Belgian clinical practice were reflected in two scenario analyses. In the base case analysis, total costs per patient were €13,333 for dabigatran and €12,454 for warfarin. Total QALYs per patient were 9.51 for dabigatran and 9.19 for warfarin. The corresponding ICER was €2807/QALY. The ICER of dabigatran was €970/QALY vs warfarin with real-world INR control and €5296/QALY vs a mix of warfarin, aspirin, and no treatment. Results were shown to be robust in one-way and probabilistic sensitivity analyses. The analysis does not include long-term costs for clinical events, as these data were not available for Belgium. As in any economic model based on data from a randomized clinical trial, several assumptions had to be made when extrapolating results to routine clinical practice in Belgium. This analysis suggests that dabigatran, a novel oral anticoagulant, is a cost-effective treatment for the prevention of stroke and SE in patients with non-valvular AF in the Belgian healthcare setting.
-
Atluri, Pavan; Stetson, Robert L; Hung, George; Gaffey, Ann C; Szeto, Wilson Y; Acker, Michael A; Hargrove, W Clark
2016-02-01
Mitral valve surgery is increasingly performed through minimally invasive approaches. There are limited data regarding the cost of minimally invasive mitral valve surgery. Moreover, there are no data on the specific costs associated with mitral valve surgery. We undertook this study to compare the costs (total and subcomponent) of minimally invasive mitral valve surgery relative to traditional sternotomy. All isolated mitral valve repairs performed in our health system from March 2012 through September 2013 were analyzed. To ensure like sets of patients, only those patients who underwent isolated mitral valve repairs with preoperative Society of Thoracic Surgeons scores of less than 4 were included in this study. A total of 159 patients were identified (sternotomy, 68; mini, 91). Total incurred direct cost was obtained from hospital financial records. Analysis demonstrated no difference in total cost (operative and postoperative) of mitral valve repair between mini and sternotomy ($25,515 ± $7598 vs $26,049 ± $11,737; P = .74). Operative costs were higher for the mini cohort, whereas postoperative costs were significantly lower. Postoperative intensive care unit and total hospital stays were both significantly shorter for the mini cohort. There were no differences in postoperative complications or survival between groups. Minimally invasive mitral valve surgery can be performed with overall equivalent cost and shorter hospital stay relative to traditional sternotomy. There is greater operative cost associated with minimally invasive mitral valve surgery that is offset by shorter intensive care unit and hospital stays. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
-
ROMI 3.1 Least-cost lumber grade mix solver using open source statistical software
Rebecca A. Buck; Urs Buehlmann; R. Edward Thomas
2010-01-01
The least-cost lumber grade mix solution has been a topic of interest to both industry and academia for many years due to its potential to help wood processing operations reduce costs. A least-cost lumber grade mix solver is a rough mill decision support system that describes the lumber grade or grade mix needed to minimize raw material or total production cost (raw...
-
Electric Propulsion System Selection Process for Interplanetary Missions
NASA Technical Reports Server (NTRS)
Landau, Damon; Chase, James; Kowalkowski, Theresa; Oh, David; Randolph, Thomas; Sims, Jon; Timmerman, Paul
2008-01-01
The disparate design problems of selecting an electric propulsion system, launch vehicle, and flight time all have a significant impact on the cost and robustness of a mission. The effects of these system choices combine into a single optimization of the total mission cost, where the design constraint is a required spacecraft neutral (non-electric propulsion) mass. Cost-optimal systems are designed for a range of mass margins to examine how the optimal design varies with mass growth. The resulting cost-optimal designs are compared with results generated via mass optimization methods. Additional optimizations with continuous system parameters address the impact on mission cost due to discrete sets of launch vehicle, power, and specific impulse. The examined mission set comprises a near-Earth asteroid sample return, multiple main belt asteroid rendezvous, comet rendezvous, comet sample return, and a mission to Saturn.
-
Bardají, Azucena; Sanz, Sergi; Alonso, Sergi; Hanson, Kara; Arevalo-Herrera, Myriam; Menéndez, Clara
2018-01-01
Malaria in pregnancy threatens birth outcomes and the health of women and their newborns. This is also the case in low transmission areas, such as Colombia, where Plasmodium vivax is the dominant parasite species. Within the Colombian health system, which underwent major reforms in the 90s, malaria treatment is provided free of charge to patients. However, patients still incur costs, such as transportation and value of time lost due to the disease. We estimated such costs among 40 pregnant women with clinical malaria (30% Plasmodium falciparum, 70% Plasmodium vivax) in the municipality of Tierralta, Northern Colombia. In a cross-sectional study, women were interviewed after an outpatient or inpatient laboratory confirmed malaria episode. Women were asked to report all types of cost incurred before (including prevention), during and immediately after the contact with the health facility. Median total cost was over 16US$ for an outpatient visit, rising to nearly 30US$ if other treatments were sought before reaching the health facility. Median total inpatient cost was 26US$ or 54US$ depending on whether costs incurred prior to admission were excluded or included. For both outpatients and inpatients, direct costs were largely due to transportation and indirect costs constituted the largest share of total costs. Estimated costs are likely to represent only one of the constraints that women face when seeking treatment in an area characterized, at the time of the study, by armed conflict, displacement, and high vulnerability of indigenous women, the group at highest risk of malaria. Importantly, the Colombian peace process, which culminated with the cease-fire in August 2016, may have a positive impact on achieving universal access to healthcare in conflict areas. The current study can inform malaria elimination initiatives in Colombia. PMID:29718903
-
Sicuri, Elisa; Bardají, Azucena; Sanz, Sergi; Alonso, Sergi; Fernandes, Silke; Hanson, Kara; Arevalo-Herrera, Myriam; Menéndez, Clara
2018-05-01
Malaria in pregnancy threatens birth outcomes and the health of women and their newborns. This is also the case in low transmission areas, such as Colombia, where Plasmodium vivax is the dominant parasite species. Within the Colombian health system, which underwent major reforms in the 90s, malaria treatment is provided free of charge to patients. However, patients still incur costs, such as transportation and value of time lost due to the disease. We estimated such costs among 40 pregnant women with clinical malaria (30% Plasmodium falciparum, 70% Plasmodium vivax) in the municipality of Tierralta, Northern Colombia. In a cross-sectional study, women were interviewed after an outpatient or inpatient laboratory confirmed malaria episode. Women were asked to report all types of cost incurred before (including prevention), during and immediately after the contact with the health facility. Median total cost was over 16US$ for an outpatient visit, rising to nearly 30US$ if other treatments were sought before reaching the health facility. Median total inpatient cost was 26US$ or 54US$ depending on whether costs incurred prior to admission were excluded or included. For both outpatients and inpatients, direct costs were largely due to transportation and indirect costs constituted the largest share of total costs. Estimated costs are likely to represent only one of the constraints that women face when seeking treatment in an area characterized, at the time of the study, by armed conflict, displacement, and high vulnerability of indigenous women, the group at highest risk of malaria. Importantly, the Colombian peace process, which culminated with the cease-fire in August 2016, may have a positive impact on achieving universal access to healthcare in conflict areas. The current study can inform malaria elimination initiatives in Colombia.
-
Analysis and optimization of hybrid electric vehicle thermal management systems
NASA Astrophysics Data System (ADS)
Hamut, H. S.; Dincer, I.; Naterer, G. F.
2014-02-01
In this study, the thermal management system of a hybrid electric vehicle is optimized using single and multi-objective evolutionary algorithms in order to maximize the exergy efficiency and minimize the cost and environmental impact of the system. The objective functions are defined and decision variables, along with their respective system constraints, are selected for the analysis. In the multi-objective optimization, a Pareto frontier is obtained and a single desirable optimal solution is selected based on LINMAP decision-making process. The corresponding solutions are compared against the exergetic, exergoeconomic and exergoenvironmental single objective optimization results. The results show that the exergy efficiency, total cost rate and environmental impact rate for the baseline system are determined to be 0.29, ¢28 h-1 and 77.3 mPts h-1 respectively. Moreover, based on the exergoeconomic optimization, 14% higher exergy efficiency and 5% lower cost can be achieved, compared to baseline parameters at an expense of a 14% increase in the environmental impact. Based on the exergoenvironmental optimization, a 13% higher exergy efficiency and 5% lower environmental impact can be achieved at the expense of a 27% increase in the total cost.
-
Cellular Manufacturing System with Dynamic Lot Size Material Handling
NASA Astrophysics Data System (ADS)
Khannan, M. S. A.; Maruf, A.; Wangsaputra, R.; Sutrisno, S.; Wibawa, T.
2016-02-01
Material Handling take as important role in Cellular Manufacturing System (CMS) design. In several study at CMS design material handling was assumed per pieces or with constant lot size. In real industrial practice, lot size may change during rolling period to cope with demand changes. This study develops CMS Model with Dynamic Lot Size Material Handling. Integer Linear Programming is used to solve the problem. Objective function of this model is minimizing total expected cost consisting machinery depreciation cost, operating costs, inter-cell material handling cost, intra-cell material handling cost, machine relocation costs, setup costs, and production planning cost. This model determines optimum cell formation and optimum lot size. Numerical examples are elaborated in the paper to ilustrate the characterictic of the model.
-
NASA Astrophysics Data System (ADS)
Reger, Darren; Madanat, Samer; Horvath, Arpad
2014-10-01
As road conditions worsen, users experience an increase in fuel consumption and vehicle wear and tear. This increases the costs incurred by the drivers, and also increases the amount of greenhouse gases (GHGs) that vehicles emit. Pavement condition can be improved through rehabilitation activities (resurfacing) to reduce the effects on users, but these activities also have significant cost and GHG emission impacts. The objective of pavement management is to minimize total societal (user and agency) costs. However, the environmental impacts associated with the cost-minimizing policy are not currently accounted for. We show that there exists a range of potentially optimal decisions, known as the Pareto frontier, in which it is not possible to decrease total emissions without increasing total costs and vice versa. This research explores these tradeoffs for a system of pavement segments. For a case study, a network was created from a subset of California’s highways using available traffic data. It was shown that the current resurfacing strategy used by the state’s transportation agency, Caltrans, does not fall on the Pareto frontier, meaning that significant savings in both total costs and total emissions can be achieved by switching to one of the optimal policies. The methods presented in this paper also allow the decision maker to evaluate the impact of other policies, such as reduced vehicle kilometers traveled or better construction standards.
-
Reconciling quality and cost: A case study in interventional radiology.
Zhang, Li; Domröse, Sascha; Mahnken, Andreas
2015-10-01
To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Qi, Junjian; Pfenninger, Stefan
In this paper, we propose a strategy to control the self-organizing dynamics of the Bak-Tang-Wiesenfeld (BTW) sandpile model on complex networks by allowing some degree of failure tolerance for the nodes and introducing additional active dissipation while taking the risk of possible node damage. We show that the probability for large cascades significantly increases or decreases respectively when the risk for node damage outweighs the active dissipation and when the active dissipation outweighs the risk for node damage. By considering the potential additional risk from node damage, a non-trivial optimal active dissipation control strategy which minimizes the total cost inmore » the system can be obtained. Under some conditions the introduced control strategy can decrease the total cost in the system compared to the uncontrolled model. Moreover, when the probability of damaging a node experiencing failure tolerance is greater than the critical value, then no matter how successful the active dissipation control is, the total cost of the system will have to increase. This critical damage probability can be used as an indicator of the robustness of a network or system. Copyright (C) EPLA, 2015« less
-
Modelling and genetic algorithm based optimisation of inverse supply chain
NASA Astrophysics Data System (ADS)
Bányai, T.
2009-04-01
The design and control of recycling systems of products with environmental risk have been discussed in the world already for a long time. The main reasons to address this subject are the followings: reduction of waste volume, intensification of recycling of materials, closing the loop, use of less resource, reducing environmental risk [1, 2]. The development of recycling systems is based on the integrated solution of technological and logistic resources and know-how [3]. However the financial conditions of recycling systems is partly based on the recovery, disassembly and remanufacturing options of the used products [4, 5, 6], but the investment and operation costs of recycling systems can be characterised with high logistic costs caused by the geographically wide collection system with more collection level and a high number of operation points of the inverse supply chain. The reduction of these costs is a popular area of the logistics researches. These researches include the design and implementation of comprehensive environmental waste and recycling program to suit business strategies (global system), design and supply all equipment for production line collection (external system), design logistics process to suit the economical and ecological requirements (external system) [7]. To the knowledge of the author, there has been no research work on supply chain design problems that purpose is the logistics oriented optimisation of inverse supply chain in the case of non-linear total cost function consisting not only operation costs but also environmental risk cost. The antecedent of this research is, that the author has taken part in some research projects in the field of closed loop economy ("Closing the loop of electr(on)ic products and domestic appliances from product planning to end-of-life technologies), environmental friendly disassembly (Concept for logistical and environmental disassembly technologies) and design of recycling systems of household appliances (Recycling of household appliances with emphasis on reuse options). The purpose of this paper is the presentation of a possible method for avoiding the unnecessary environmental risk and landscape use through unprovoked large supply chain of collection systems of recycling processes. In the first part of the paper the author presents the mathematical model of recycling related collection systems (applied especially for wastes of electric and electronic products) and in the second part of the work a genetic algorithm based optimisation method will be demonstrated, by the aid of which it is possible to determine the optimal structure of the inverse supply chain from the point of view economical, ecological and logistic objective functions. The model of the inverse supply chain is based on a multi-level, hierarchical collection system. In case of this static model it is assumed that technical conditions are permanent. The total costs consist of three parts: total infrastructure costs, total material handling costs and environmental risk costs. The infrastructure-related costs are dependent only on the specific fixed costs and the specific unit costs of the operation points (collection, pre-treatment, treatment, recycling and reuse plants). The costs of warehousing and transportation are represented by the material handling related costs. The most important factors determining the level of environmental risk cost are the number of out of time recycled (treated or reused) products, the number of supply chain objects and the length of transportation routes. The objective function is the minimization of the total cost taking into consideration the constraints. However a lot of research work discussed the design of supply chain [8], but most of them concentrate on linear cost functions. In the case of this model non-linear cost functions were used. The non-linear cost functions and the possible high number of objects of the inverse supply chain leaded to the problem of choosing a possible solution method. By the aid of analytical methods, the problem can not be solved, so a genetic algorithm based heuristic optimisation method was chosen to find the optimal solution. The input parameters of the optimisation are the followings: specific fixed, unit and environmental risk costs of the collection points of the inverse supply chain, specific warehousing and transportation costs and environmental risk costs of transportation. The output parameters are the followings: the number of objects in the different hierarchical levels of the collection system, infrastructure costs, logistics costs and environmental risk costs from used infrastructures, transportation and number of products recycled out of time. The next step of the research work was the application of the above mentioned method. The developed application makes it possible to define the input parameters of the real system, the graphical view of the chosen optimal solution in the case of the given input parameters, graphical view of the cost structure of the optimal solution, determination of the parameters of the algorithm (e.g. number of individuals, operators and termination conditions). The sensibility analysis of the objective function and the test results showed that the structure of the inverse supply chain depends on the proportion of the specific costs. Especially the proportion of the specific environmental risk costs influences the structure of the system and the number of objects at each hierarchical level of the collection system. The sensitivity analysis of the total cost function was performed in three cases. In the first case the effect of the proportion of specific infrastructure and logistics costs were analysed. If the infrastructure costs are significantly lower than the total costs of warehousing and transportation, then almost all objects of the first hierarchical level of the collection (collection directly from the users) were set up. In the other case of the proportion of costs the first level of the collection is not necessary, because it is replaceable by the more expensive transportation directly to the objects of the second or lower hierarchical level. In the second case the effect of the proportion of the logistics and environmental risk costs were analysed. In this case the analysis resulted to the followings: if the logistics costs are significantly higher than the total environmental risk costs, then because of the constant infrastructure costs the preference of logistics operations depends on the proportion of the environmental risk costs caused by of out of time recycled products and transportation. In the third case of the analysis the effect of the proportion of infrastructure and environmental risk costs were examined. If the infrastructure costs are significantly lower than the environmental risk costs, then almost all objects of the first hierarchical level of the collection (collection directly from the users) were set up. In the other case of the proportion of costs the first collection phase will be shifted near to the last hierarchical level of the supply chain to avoid a very high infrastructure set up and operation cost. The advantages of the presented model and solution method can be summarised in the followings: the model makes it possible to decide the structure of the inverse supply chain (which object to open or close); reduces infrastructure cost, especially for supply chain with high specific fixed costs; reduces the environmental risk cost through finding an optimal balance between number of objects of the system and out of time recycled products, reduces the logistics costs through determining the optimal quantitative parameters of material flow operations. The future of this research work is the use of differentiated lead-time, which makes it possible to take into consideration the above mentioned non-linear infrastructure, transportation, warehousing and environmental risk costs in the case of a given product portfolio segmented by lead-time. This publication was supported by the National Office for Research and Technology within the frame of Pázmány Péter programme. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Office for Research and Technology. Literature: [1] H. F. Lund: McGraw-Hill Recycling Handbook. McGraw-Hill. 2000. [2] P. T. Williams: Waste Treatment and Disposal. John Wiley and Sons Ltd. 2005. [3] M. Christopher: Logistics & Supply Chain Management: creating value-adding networks. Pearson Education [4] A. Gungor, S. M. Gupta: Issues in environmentally conscious manufacturing and product recovery: a survey. Computers & Industrial Engineering. Volume 36. Issue 4. 1999. pp. 811-853. [5] H. C. Zhang, T. C. Kuo, H. Lu, S. H. Huang: Environmentally conscious design and manufacturing: A state-of-the-art survey. Journal of Manufacturing Systems. Volume 16. Issue 5. 1997. pp. 352-371. [6] P. Veerakamolmal, S. Gupta: Design for Disassembly, Reuse, and Recycling. Green Electronics/Green Bottom Line. 2000. pp. 69-82. [7] A. Rushton, P. Croucher, P. Baker: The Handbook of Logistics and Distribution Management. Kogan P.page Limited. 2006. [8] H. Stadtler, C. Kilger: Supply Chain Management and Advanced Planning: Concepts, Models, Software, and Case Studies. Springer. 2005.
-
A scientific operations plan for the large space telescope. [ground support system design
NASA Technical Reports Server (NTRS)
West, D. K.
1977-01-01
The paper describes an LST ground system which is compatible with the operational requirements of the LST. The goal of the approach is to minimize the cost of post launch operations without seriously compromising the quality and total throughput of LST science. Attention is given to cost constraints and guidelines, the telemetry operations processing systems (TELOPS), the image processing facility, ground system planning and data flow, and scientific interfaces.
-
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.
-
Relative costs of specialist services in a family practice population
Norton, Peter G.; Nelson, Wendy; Rudner, Howard L.; Dunn, Earl V.
1985-01-01
The frequency and cost of referrals to specialists in March 1984 for 8980 rostered patients attending a family practice clinic located in a teaching hospital were analysed. The patients made 1891 visits to specialists. In all age groups and for all specialties female patients were more likely to be seen. The total direct provider costs were higher for female patients than for male patients. However, costs per patient seen were higher for male patients, except for psychiatry and medicine. Visits to surgeons had the highest total cost, while visits to psychiatrists had the highest cost per patient seen. Of the direct provider costs 61% was for specialist services. The family physician, in the “gatekeeper” role, has an opportunity to control some of the costs of the health care system by ensuring that the best and most efficient use is made of the referral network. PMID:4042059
-
1984-10-01
are shared with the production facility. I Capital Costs: $260,000 (1976) plus $45,000 for the building. Operating and Maintenance Costs: O&M costs are...agricultural product processing plant. Operation: Three shifts, 5.5 days/week, 52 weeks/year. Capital Costs: Total capital cost S1,400,000 (1981...which makes their operating and maintenance costs, waste tonnages, ; and steam production readily available. Sample Data (All Numbers Rounded) 1st
-
Cromwell, I; Ferreira, Z; Smith, L; van der Hoek, K; Ogilvie, G; Coldman, A; Peacock, S J
2016-02-01
We set out to assess the health care resource utilization and cost of cervical cancer from the perspective of a single-payer health care system. Retrospective observational data for women diagnosed with cervical cancer in British Columbia between 2004 and 2009 were analyzed to calculate patient-level resource utilization patterns from diagnosis to death or 5-year discharge. Domains of resource use within the scope of this cost analysis were chemotherapy, radiotherapy, and brachytherapy administered by the BC Cancer Agency; resource utilization related to hospitalization and outpatient visits as recorded by the B.C. Ministry of Health; medically required services billed under the B.C. Medical Services Plan; and prescriptions dispensed under British Columbia's health insurance programs. Unit costs were applied to radiotherapy and brachytherapy, producing per-patient costs. The mean cost per case of treating cervical cancer in British Columbia was $19,153 (standard error: $3,484). Inpatient hospitalizations, at 35%, represented the largest proportion of the total cost (95% confidence interval: 32.9% to 36.9%). Costs were compared for subgroups of the total cohort. As health care systems change the way they manage, screen for, and prevent cervical cancer, cost-effectiveness evaluations of the overall approach will require up-to-date data for resource utilization and costs. We provide information suitable for such a purpose and also identify factors that influence costs.
-
Bretland, P M
1988-01-01
The existing National Health Service financial system makes comprehensive costing of any service very difficult. A method of costing using modern commercial methods has been devised, classifying costs into variable, semi-variable and fixed and using the principle of overhead absorption for expenditure not readily allocated to individual procedures. It proved possible to establish a cost spectrum over the financial year 1984-85. The cheapest examinations were plain radiographs outside normal working hours, followed by plain radiographs, ultrasound, special procedures, fluoroscopy, nuclear medicine, angiography and angiographic interventional procedures in normal working hours. This differs from some published figures, particularly those in the Körner report. There was some overlap between fluoroscopic interventional and the cheaper nuclear medicine procedures, and between some of the more expensive nuclear medicine procedures and the cheaper angiographic ones. Only angiographic and the few more expensive nuclear medicine procedures exceed the cost of the inpatient day. The total cost of the imaging service to the district was about 4% of total hospital expenditure. It is shown that where more procedures are undertaken, the semi-variable and fixed (including capital) elements of the cost decrease (and vice versa) so that careful study is required to assess the value of proposed economies. The method is initially time-consuming and requires a computer system with 512 Kb of memory, but once the basic costing system is established in a department, detailed financial monitoring should become practicable. The necessity for a standard comprehensive costing procedure of this nature, based on sound cost accounting principles, appears inescapable, particularly in view of its potential application to management budgeting.
-
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.
-
Proceedings of the Second IDA-CIISS Workshop: Common Security Challenges and Defense Personnel Costs
2008-01-01
exchanges with about 100 relevant research institutions in more than 50 countries . CIISS believes the academic exchanges in the forms of exchanging...personnel costs. Session 4 focused on the personnel portion of total defense costs in both countries , with Stanley Horowitz discussing DoD personnel...was the system was intended to deal with rogue countries and the system was not capable of dealing with China. Secretary Gates called for more
-
Economic optimization of the energy transport component of a large distributed solar power plant
NASA Technical Reports Server (NTRS)
Turner, R. H.
1976-01-01
A solar thermal power plant with a field of collectors, each locally heating some transport fluid, requires a pipe network system for eventual delivery of energy power generation equipment. For a given collector distribution and pipe network geometry, a technique is herein developed which manipulates basic cost information and physical data in order to design an energy transport system consistent with minimized cost constrained by a calculated technical performance. For a given transport fluid and collector conditions, the method determines the network pipe diameter and pipe thickness distribution and also insulation thickness distribution associated with minimum system cost; these relative distributions are unique. Transport losses, including pump work and heat leak, are calculated operating expenses and impact the total system cost. The minimum cost system is readily selected. The technique is demonstrated on six candidate transport fluids to emphasize which parameters dominate the system cost and to provide basic decision data. Three different power plant output sizes are evaluated in each case to determine severity of diseconomy of scale.
-
Economic Analysis of 4221 Revisions Due to Periprosthetic Joint Infection in Poland.
Babiak, Ireneusz; Pędzisz, Piotr; Janowicz, Jakub; Kulig, Mateusz; Małdyk, Paweł
2017-01-26
Periprosthetic joint infection (PJI) is one of the most severe complications of total hip (THA) and total knee (TKA) arthroplasty. The aim of the study is to determine the number and type of hip and knee prosthesis revisions in Poland performed due to infection and reimbursement of the cost of septic revisions and to compare the costs of septic and aseptic revisions in Poland and other countries. The data published for the period 2009-2013 by the National Health Fund (NHF) were analysed and the average cost of septic and aseptic revisions was calculated. In the years 2009-2013, a total of 260,030 hip and knee arthroplasties including 23,027 revisions (incl. 4,221 septic) were performed in Poland. In 2013, septic revisions accounted for 1.38% of all hip replacement procedures, 2.56% of all knee replacement procedures and 14.67% of all hip revisions and 30.23% of all knee revisions. In 2013, the difference between the average cost incurred by the hospital and the NHF refund for septic revision due to PJI was at least €238 and the cost-refund gap for the entire year was €219198. 1. The system of reporting periprostheticjoint infections currently in use in Poland does not adequately reflect the current classification of PJI and reimbursement for septic revision of joint prosthesis does not match the actual costs. 2. The Polish DRG system does not distinguish between early and late PJI and fails to acknowledge basic guidelines for infection treatment currently followed in Poland and worldwide. 3. According to the DRG system, patients requiring different treatment are placed in one category. 4. Until the year 2013, the less expensive treatment of early infections had been reimbursed on the same basis as the more costly two-stage revision procedures.
-
Estimating the cost of skin cancer detection by dermatology providers in a large health care system.
Matsumoto, Martha; Secrest, Aaron; Anderson, Alyce; Saul, Melissa I; Ho, Jonhan; Kirkwood, John M; Ferris, Laura K
2018-04-01
Data on the cost and efficiency of skin cancer detection through total body skin examination are scarce. To determine the number needed to screen (NNS) and biopsy (NNB) and cost per skin cancer diagnosed in a large dermatology practice in patients undergoing total body skin examination. This is a retrospective observational study. During 2011-2015, a total of 20,270 patients underwent 33,647 visits for total body skin examination; 9956 lesion biopsies were performed yielding 2763 skin cancers, including 155 melanomas. The NNS to detect 1 skin cancer was 12.2 (95% confidence interval [CI] 11.7-12.6) and 1 melanoma was 215 (95% CI 185-252). The NNB to detect 1 skin cancer was 3.0 (95% CI 2.9-3.1) and 1 melanoma was 27.8 (95% CI 23.3-33.3). In a multivariable model for NNS, age and personal history of melanoma were significant factors. Age switched from a protective factor to a risk factor at 51 years of age. The estimated cost per melanoma detected was $32,594 (95% CI $27,326-$37,475). Data are from a single health care system and based on physician coding. Melanoma detection through total body skin examination is most efficient in patients ≥50 years of age and those with a personal history of melanoma. Our findings will be helpful in modeling the cost effectiveness of melanoma screening by dermatologists. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
-
Permanent magnet design for magnetic heat pumps using total cost minimization
NASA Astrophysics Data System (ADS)
Teyber, R.; Trevizoli, P. V.; Christiaanse, T. V.; Govindappa, P.; Niknia, I.; Rowe, A.
2017-11-01
The active magnetic regenerator (AMR) is an attractive technology for efficient heat pumps and cooling systems. The costs associated with a permanent magnet for near room temperature applications are a central issue which must be solved for broad market implementation. To address this problem, we present a permanent magnet topology optimization to minimize the total cost of cooling using a thermoeconomic cost-rate balance coupled with an AMR model. A genetic algorithm identifies cost-minimizing magnet topologies. For a fixed temperature span of 15 K and 4.2 kg of gadolinium, the optimal magnet configuration provides 3.3 kW of cooling power with a second law efficiency (ηII) of 0.33 using 16.3 kg of permanent magnet material.
-
Ruger, Jennifer Prah; Emmons, Karen M; Kearney, Margaret H; Weinstein, Milton C
2009-01-01
Background Economic theory provides the philosophical foundation for valuing costs in judging medical and public health interventions. When evaluating smoking cessation interventions, accurate data on costs are essential for understanding resource consumption. Smoking cessation interventions, for which prior data on resource costs are typically not available, present special challenges. We develop a micro-costing methodology for estimating the real resource costs of outreach motivational interviewing (MI) for smoking cessation and relapse prevention among low-income pregnant women and report results from a randomized controlled trial (RCT) employing the methodology. Methodological standards in cost analysis are necessary for comparison and uniformity in analysis across interventions. Estimating the costs of outreach programs is critical for understanding the economics of reaching underserved and hard-to-reach populations. Methods Randomized controlled trial (1997-2000) collecting primary cost data for intervention. A sample of 302 low-income pregnant women was recruited from multiple obstetrical sites in the Boston metropolitan area. MI delivered by outreach health nurses vs. usual care (UC), with economic costs as the main outcome measures. Results The total cost of the MI intervention for 156 participants was $48,672 or $312 per participant. The total cost of $311.8 per participant for the MI intervention compared with a cost of $4.82 per participant for usual care, a difference of $307 ([CI], $289.2 to $322.8). The total fixed costs of the MI were $3,930 and the total variable costs of the MI were $44,710. The total expected program costs for delivering MI to 500 participants would be 147,430, assuming no economies of scale in program delivery. The main cost components of outreach MI were intervention delivery, travel time, scheduling, and training. Conclusion Grounded in economic theory, this methodology systematically identifies and measures resource utilization, using a process tracking system and calculates both component-specific and total costs of outreach MI. The methodology could help improve collection of accurate data on costs and estimates of the real resource costs of interventions alongside clinical trials and improve the validity and reliability of estimates of resource costs for interventions targeted at underserved and hard-to-reach populations. PMID:19775455
-
Comparative analysis for various redox flow batteries chemistries using a cost performance model
NASA Astrophysics Data System (ADS)
Crawford, Alasdair; Viswanathan, Vilayanur; Stephenson, David; Wang, Wei; Thomsen, Edwin; Reed, David; Li, Bin; Balducci, Patrick; Kintner-Meyer, Michael; Sprenkle, Vincent
2015-10-01
The total energy storage system cost is determined by means of a robust performance-based cost model for multiple flow battery chemistries. Systems aspects such as shunt current losses, pumping losses and various flow patterns through electrodes are accounted for. The system cost minimizing objective function determines stack design by optimizing the state of charge operating range, along with current density and current-normalized flow. The model cost estimates are validated using 2-kW stack performance data for the same size electrodes and operating conditions. Using our validated tool, it has been demonstrated that an optimized all-vanadium system has an estimated system cost of < 350 kWh-1 for 4-h application. With an anticipated decrease in component costs facilitated by economies of scale from larger production volumes, coupled with performance improvements enabled by technology development, the system cost is expected to decrease to 160 kWh-1 for a 4-h application, and to 100 kWh-1 for a 10-h application. This tool has been shared with the redox flow battery community to enable cost estimation using their stack data and guide future direction.
-
Zimlichman, Eyal; Keohane, Carol; Franz, Calvin; Everett, Wendy L; Seger, Diane L; Yoon, Catherine; Leung, Alexander A; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan E; Bates, David W
2013-07-01
In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts. Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE. Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%. Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.
-
Cost Estimation of Naval Ship Acquisition.
1983-12-01
one a 9-sub- system model , the other a single total cost model . The models were developed using the linear least squares regression tech- nique with...to Linear Statistical Models , McGraw-Hill, 1961. 11. Helmer, F. T., Bibliography on Pricing Methodology and Cost Estimating, Dept. of Economics and...SUPPI.EMSaTARY NOTES IS. KWRo" (Cowaft. en tever aide of ..aesep M’ Idab~t 6 Week ONNa.) Cost estimation; Acquisition; Parametric cost estimate; linear
-
Teixeira de Siqueira-Filha, Noemia; Militao de Albuquerque, Maria de Fatima; Cunha Rodrigues, Laura; Legood, Rosa; Costa Santos, Andreia
2018-03-15
The objective of this study was to measure the costs of people living with HIV (PLHIV) as well as active tuberculosis (TB/HIV), latent tuberculosis infection (LTBI/HIV) or without TB (HIV/AIDS). We analysed the costs through the entire pathway of care during the prediagnosis and treatment periods from the Brazilian public health system perspective. We applied a combination of bottom-up and top-down approaches to capture and estimate direct medical and non-medical costs. We measured the mean cost per patient per type of care (inpatient, outpatient and emergency care) and disease category (HIV/AIDS, HIV/AIDS death, TB/HIV, TB/HIV death and LTBI/HIV). Between March 2014 and March 2016 we recruited 239 PLHIV. During the follow-up 26 patients were diagnosed and treated for TB and 5 received chemoprophylaxis for LTBI. During the prediagnosis and treatment period, the mean total costs for HIV or AIDS and AIDS death categories were US$1558 and US$2828, respectively. The mean total costs for TB/HIV and TB/HIV death categories were US$5289.0 and US$8281, respectively. The mean total cost for the LTBI/HIV category was US$882. Patients with TB/HIV impose a higher economic burden on the health system than HIV/AIDS and LTBI/HIV. Patients with LTBI/HIV were the lowest cost group among all disease categories, indicating that preventive TB treatment can avoid the further costs treating active TB. RBR-22t943, Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
-
2014-01-01
Background To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population. Methods Using a cross-sectional design, cost data of 3,124 participants aged 57–84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents’ homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Results Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Conclusions Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs. PMID:24524754
-
Heider, Dirk; Matschinger, Herbert; Müller, Heiko; Saum, Kai-Uwe; Quinzler, Renate; Haefeli, Walter Emil; Wild, Beate; Lehnert, Thomas; Brenner, Hermann; König, Hans-Helmut
2014-02-14
To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen's behavioral model of health care utilization, in the German elderly population. Using a cross-sectional design, cost data of 3,124 participants aged 57-84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents' homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
-
Comparison of Actual Costs to Integrate Commercial Buildings with the Grid
DOE Office of Scientific and Technical Information (OSTI.GOV)
Piette, Mary Ann; Black, Doug; Yin, Rongxin
During the past decade, the technology to automate demand response (DR) in buildings and industrial facilities has advanced significantly. Automation allows rapid, repeatable, reliable operation. This study focuses on costs for DR automation in commercial buildings with some discussion on residential buildings and industrial facilities. DR automation technology relies on numerous components, including communication systems, hardware and software gateways, standards-based messaging protocols, controls and integration platforms, and measurement and telemetry systems. This paper discusses the impact factors that contribute to the costs of automated DR systems, with a focus on OpenADR 1.0 and 2.0 systems. In addition, this report comparesmore » cost data from several DR automation programs and pilot projects, evaluates trends in the cost per unit of DR and kilowatts (kW) available from automated systems, and applies a standard naming convention and classification or taxonomy for system elements. In summary, median costs for the 56 installed automated DR systems studied here are about $200/kW. The deviation around this median is large with costs in some cases being an order of magnitude greater or less than median. Costs to automate fast DR systems for ancillary services are not fully analyzed in this report because additional research is needed to determine the total such costs.« less
-
The role of total laboratory automation in a consolidated laboratory network.
Seaberg, R S; Stallone, R O; Statland, B E
2000-05-01
In an effort to reduce overall laboratory costs and improve overall laboratory efficiencies at all of its network hospitals, the North Shore-Long Island Health System recently established a Consolidated Laboratory Network with a Core Laboratory at its center. We established and implemented a centralized Core Laboratory designed around the Roche/Hitachi CLAS Total Laboratory Automation system to perform the general and esoteric laboratory testing throughout the system in a timely and cost-effective fashion. All remaining STAT testing will be performed within the Rapid Response Laboratories (RRLs) at each of the system's hospitals. Results for this laboratory consolidation and implementation effort demonstrated a decrease in labor costs and improved turnaround time (TAT) at the core laboratory. Anticipated system savings are approximately $2.7 million. TATs averaged 1.3 h within the Core Laboratory and less than 30 min in the RRLs. When properly implemented, automation systems can reduce overall laboratory expenses, enhance patient services, and address the overall concerns facing the laboratory today: job satisfaction, decreased length of stay, and safety. The financial savings realized are primarily a result of labor reductions.
-
Cost analysis of an integrated vaccine-preventable disease surveillance system in Costa Rica.
Toscano, C M; Vijayaraghavan, M; Salazar-Bolaños, H M; Bolaños-Acuña, H M; Ruiz-González, A I; Barrantes-Solis, T; Fernández-Vargas, I; Panero, M S; de Oliveira, L H; Hyde, T B
2013-07-02
Following World Health Organization recommendations set forth in the Global Framework for Immunization Monitoring and Surveillance, Costa Rica in 2009 became the first country to implement integrated vaccine-preventable disease (iVPD) surveillance, with support from the U.S. Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO). As surveillance for diseases prevented by new vaccines is integrated into existing surveillance systems, these systems could cost more than routine surveillance for VPDs targeted by the Expanded Program on Immunization. We estimate the costs associated with establishing and subsequently operating the iVPD surveillance system at a pilot site in Costa Rica. We retrospectively collected data on costs incurred by the institutions supporting iVPD surveillance during the preparatory (January 2007 through August 2009) and implementation (September 2009 through August 2010) phases of the iVPD surveillance project in Costa Rica. These data were used to estimate costs for personnel, meetings, infrastructure, office equipment and supplies, transportation, and laboratory facilities. Costs incurred by each of the collaborating institutions were also estimated. During the preparatory phase, the estimated total cost was 128,000 U.S. dollars (US$), including 64% for personnel costs. The preparatory phase was supported by CDC and PAHO. The estimated cost for 1 year of implementation was US$ 420,000, including 58% for personnel costs, 28% for laboratory costs, and 14% for meeting, infrastructure, office, and transportation costs combined. The national reference laboratory and the PAHO Costa Rica office incurred 64% of total costs, and other local institutions supporting iVPD surveillance incurred the remaining 36%. Countries planning to implement iVPD surveillance will require adequate investments in human resources, laboratories, data management, reporting, and investigation. Our findings will be valuable for decision makers and donors planning and implementing similar strategies in other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.
-
Cost analysis of an integrated vaccine-preventable disease surveillance system in Costa Rica✩
Toscano, C.M.; Vijayaraghavan, M.; Salazar-Bolaños, H.M.; Bolaños-Acuña, H.M.; Ruiz-González, A.I.; Barrantes-Solis, T.; Fernández-Vargas, I.; Panero, M.S.; de Oliveira, L.H.; Hyde, T.B.
2015-01-01
Introduction Following World Health Organization recommendations set forth in the Global Framework for Immunization Monitoring and Surveillance, Costa Rica in 2009 became the first country to implement integrated vaccine-preventable disease (iVPD) surveillance, with support from the U.S. Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO). As surveillance for diseases prevented by new vaccines is integrated into existing surveillance systems, these systems could cost more than routine surveillance for VPDs targeted by the Expanded Program on Immunization. Objectives We estimate the costs associated with establishing and subsequently operating the iVPD surveillance system at a pilot site in Costa Rica. Methods We retrospectively collected data on costs incurred by the institutions supporting iVPD surveillance during the preparatory (January 2007 through August 2009) and implementation (September 2009 through August 2010) phases of the iVPD surveillance project in Costa Rica. These data were used to estimate costs for personnel, meetings, infrastructure, office equipment and supplies, transportation, and laboratory facilities. Costs incurred by each of the collaborating institutions were also estimated. Results During the preparatory phase, the estimated total cost was 128,000 U.S. dollars (US$), including 64% for personnel costs. The preparatory phase was supported by CDC and PAHO. The estimated cost for 1 year of implementation was US$ 420,000, including 58% for personnel costs, 28% for laboratory costs, and 14% for meeting, infrastructure, office, and transportation costs combined. The national reference laboratory and the PAHO Costa Rica office incurred 64% of total costs, and other local institutions supporting iVPD surveillance incurred the remaining 36%. Conclusions Countries planning to implement iVPD surveillance will require adequate investments in human resources, laboratories, data management, reporting, and investigation. Our findings will be valuable for decision makers and donors planning and implementing similar strategies in other countries. PMID:23777698
-
Space Tug Docking Study. Volume 5: Cost Analysis
NASA Technical Reports Server (NTRS)
1976-01-01
The cost methodology, summary cost data, resulting cost estimates by Work Breakdown Structure (WBS), technical characteristics data, program funding schedules and the WBS for the costing are discussed. Cost estimates for two tasks of the study are reported. The first, developed cost estimates for design, development, test and evaluation (DDT&E) and theoretical first unit (TFU) at the component level (Level 7) for all items reported in the data base. Task B developed total subsystem DDT&E costs and funding schedules for the three candidate Rendezvous and Docking Systems: manual, autonomous, and hybrid.
-
NASA Astrophysics Data System (ADS)
Krugon, Seelam; Nagaraju, Dega
2017-05-01
This work describes and proposes an two echelon inventory system under supply chain, where the manufacturer offers credit period to the retailer with exponential price dependent demand. The model is framed as demand is expressed as exponential function of retailer’s unit selling price. Mathematical model is framed to demonstrate the optimality of cycle time, retailer replenishment quantity, number of shipments, and total relevant cost of the supply chain. The major objective of the paper is to provide trade credit concept from the manufacturer to the retailer with exponential price dependent demand. The retailer would like to delay the payments of the manufacturer. At the first stage retailer and manufacturer expressions are expressed with the functions of ordering cost, carrying cost, transportation cost. In second stage combining of the manufacturer and retailer expressions are expressed. A MATLAB program is written to derive the optimality of cycle time, retailer replenishment quantity, number of shipments, and total relevant cost of the supply chain. From the optimality criteria derived managerial insights can be made. From the research findings, it is evident that the total cost of the supply chain is decreased with the increase in credit period under exponential price dependent demand. To analyse the influence of the model parameters, parametric analysis is also done by taking with help of numerical example.
-
Cost of illness associated with Niemann-Pick disease type C in the UK.
Imrie, Jackie; Galani, Carmen; Gairy, Kerry; Lock, Kevin; Hunsche, Elke
2009-09-01
Niemann-Pick disease type C (NP-C) is a rare and devastating genetic disorder characterised by a range of progressive neurological symptoms, which imposes a burden on patients, family members, the healthcare system and society overall. The objective of this study was to assess direct and indirect costs associated with NP-C in the UK. This was a non-interventional, retrospective, cross-sectional cohort study based on responses from patients and/or their carers/guardians recruited from a UK NP-C database. Resource use and direct medical, direct non-medical and indirect costs were evaluated using data collected via postal survey in October 2007, which included a Medical Resource Use questionnaire. Total annual costs per patient were estimated. In total, 18 Medical Resource Use questionnaires (29% response rate) were received and analysed. The mean total annual cost (SD) of NP-C per patient was 39,168 pounds (50,315 pounds); 46% were direct medical costs, to which home visits and residential care contributed 68% and 15%, respectively. Direct non-medical costs accounted for 24% of the average annual cost per patient, mainly due to specialist education, and indirect costs 30%. If only direct medical costs were considered, the mean annual cost (SD) per patient was reduced to 18,012 pounds (46,536 pounds). The direct annual per-patient cost of NP-C illness in 2007 appears moderate when compared with other rare and severely disabling diseases. However, cost estimates may be conservative, since findings are limited by a small sample size, low survey response rate and potential recall bias. As demonstrated by this study, a substantial proportion of the cost is shifted from the healthcare system to the patient, family and non-medical providers. These findings highlight the need for treatments that can slow or stop disease progression in NP-C.
-
The cost effectiveness of intracyctoplasmic sperm injection (ICSI).
Hollingsworth, Bruce; Harris, Anthony; Mortimer, Duncan
2007-12-01
To estimate the incremental cost effectiveness of ICSI, and total costs for the population of Australia. Treatment effects for three patient groups were drawn from a published systematic review and meta-analysis of trials comparing fertilisation outcomes for ICSI. Incremental costs derived from resource-based costing of ICSI and existing practice comparators for each patient group. Incremental cost per live birth for patients unsuited to IVF is estimated between A$8,500 and 13,400. For the subnormal semen indication, cost per live birth could be as low as A$3,600, but in the worst case scenario, there would just be additional incremental costs of A$600 per procedure. Multiplying out the additional costs of ICSI over the relevant target populations in Australia gives potential total financial implications of over A$31 million per annum. While there are additional benefits from ICSI procedure, particularly for those with subnormal sperm, the additional cost for the health care system is substantial.
-
European Union-28: An annualised cost-of-illness model for venous thromboembolism.
Barco, Stefano; Woersching, Alex L; Spyropoulos, Alex C; Piovella, Franco; Mahan, Charles E
2016-04-01
Annual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5-2.2 billion, €1.0-1.5 billion, €0.5-1.1 billion and €0.2-0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8-3.3 billion, €1.2-2.4 billion, €0.6-1.8 billion and €0.2-0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0-8.5 billion, €2.2-6.2 billion, €1.1-4.6 billion and €0.5-1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5-13.2 billion, €1.0-9.7 billion, €0.5-7.3 billion and €0.2-6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28's healthcare systems and that significant savings could be realised if better preventive measures are applied.
-
An Affordability Comparison Tool (ACT) for Space Transportation
NASA Technical Reports Server (NTRS)
McCleskey, C. M.; Bollo, T. R.; Garcia, J. L.
2012-01-01
NASA bas recently emphasized the importance of affordability for Commercial Crew Development Program (CCDP), Space Launch Systems (SLS) and Multi-Purpose Crew Vehicle (MPCV). System architects and designers are challenged to come up with architectures and designs that do not bust the budget. This paper describes the Affordability Comparison Tool (ACT) analyzes different systems or architecture configurations for affordability that allows for a comparison of: total life cycle cost; annual recurring costs, affordability figures-of-merit, such as cost per pound, cost per seat, and cost per flight, as well as productivity measures, such as payload throughput. Although ACT is not a deterministic model, the paper develops algorithms and parametric factors that use characteristics of the architectures or systems being compared to produce important system outcomes (figures-of-merit). Example applications of outcome figures-of-merit are also documented to provide the designer with information on the relative affordability and productivity of different space transportation applications.
-
Chassin, David P.; Behboodi, Sahand; Djilali, Ned
2018-01-28
This article proposes a system-wide optimal resource dispatch strategy that enables a shift from a primarily energy cost-based approach, to a strategy using simultaneous price signals for energy, power and ramping behavior. A formal method to compute the optimal sub-hourly power trajectory is derived for a system when the price of energy and ramping are both significant. Optimal control functions are obtained in both time and frequency domains, and a discrete-time solution suitable for periodic feedback control systems is presented. The method is applied to North America Western Interconnection for the planning year 2024, and it is shown that anmore » optimal dispatch strategy that simultaneously considers both the cost of energy and the cost of ramping leads to significant cost savings in systems with high levels of renewable generation: the savings exceed 25% of the total system operating cost for a 50% renewables scenario.« less
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Chassin, David P.; Behboodi, Sahand; Djilali, Ned
This article proposes a system-wide optimal resource dispatch strategy that enables a shift from a primarily energy cost-based approach, to a strategy using simultaneous price signals for energy, power and ramping behavior. A formal method to compute the optimal sub-hourly power trajectory is derived for a system when the price of energy and ramping are both significant. Optimal control functions are obtained in both time and frequency domains, and a discrete-time solution suitable for periodic feedback control systems is presented. The method is applied to North America Western Interconnection for the planning year 2024, and it is shown that anmore » optimal dispatch strategy that simultaneously considers both the cost of energy and the cost of ramping leads to significant cost savings in systems with high levels of renewable generation: the savings exceed 25% of the total system operating cost for a 50% renewables scenario.« less
-
Costs to Automate Demand Response - Taxonomy and Results from Field Studies and Programs
DOE Office of Scientific and Technical Information (OSTI.GOV)
Piette, Mary A.; Schetrit, Oren; Kiliccote, Sila
During the past decade, the technology to automate demand response (DR) in buildings and industrial facilities has advanced significantly. Automation allows rapid, repeatable, reliable operation. This study focuses on costs for DR automation in commercial buildings with some discussion on residential buildings and industrial facilities. DR automation technology relies on numerous components, including communication systems, hardware and software gateways, standards-based messaging protocols, controls and integration platforms, and measurement and telemetry systems. This report compares cost data from several DR automation programs and pilot projects, evaluates trends in the cost per unit of DR and kilowatts (kW) available from automated systems,more » and applies a standard naming convention and classification or taxonomy for system elements. Median costs for the 56 installed automated DR systems studied here are about $200/kW. The deviation around this median is large with costs in some cases being an order of magnitude great or less than the median. This wide range is a result of variations in system age, size of load reduction, sophistication, and type of equipment included in cost analysis. The costs to automate fast DR systems for ancillary services are not fully analyzed in this report because additional research is needed to determine the total cost to install, operate, and maintain these systems. However, recent research suggests that they could be developed at costs similar to those of existing hot-summer DR automation systems. This report considers installation and configuration costs and does include the costs of owning and operating DR automation systems. Future analysis of the latter costs should include the costs to the building or facility manager costs as well as utility or third party program manager cost.« less
-
Silicon solar photovoltaic power stations
NASA Technical Reports Server (NTRS)
Chowaniec, C. R.; Ferber, R. R.; Pittman, P. F.; Marshall, B. W.
1977-01-01
Modular design of components and arrays, cost estimates for modules and support structures, and cost/performance analysis of a central solar photovoltaic power plant are discussed. Costs of collector/reflector arrays are judged the dominant element in the total capital investment. High-concentration solar tracking arrays are recommended as the most economic means for producing solar photovoltaic energy when solar cells costs are high ($500 per kW generated). Capital costs for power conditioning subsystem components are itemized and system busbar energy costs are discussed at length.
-
Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation.
Elsamadicy, Aladine A; Yang, Siyun; Sergesketter, Amanda R; Ashraf, Bilal; Charalambous, Lefko; Kemeny, Hanna; Ejikeme, Tiffany; Ren, Xinru; Pagadala, Promila; Parente, Beth; Xie, Jichun; Lad, Shivanand P
2017-09-29
The diagnosis and treatment of complex regional pain syndrome (CRPS) is challenging and there is a paucity of data describing its overall cost burden and quantifying its impact on the US healthcare system. The aim of this study was to assess the prevalence and healthcare utilization costs associated with CRPS. A retrospective longitudinal study was performed using the Truven MarketScan® database to identify patients with a new indexed diagnosis of CRPS (Type I, II, or both) from 2001 to 2012. We collected total, outpatient, and pain prescription costs three years prior to CRPS diagnosis (baseline), at year of CRPS diagnosis, and eight-year post-CRPS diagnosis. A longitudinal multivariate analysis was used to model the estimated total and pain prescription cost ratios comparing patients diagnosed before and after CRPS. We included 35,316 patients with a newly indexed diagnosis of CRPS (Type I: n = 18,703, Type II: n = 14,599, Unspecified: n = 2014). Baseline characteristics were similar between the CRPS cohorts. Compared to two- and three-year baseline costs, one-year prior to diagnosis for all CRPS patients yielded the highest interquartile median [IQR] costs: total costs $7904[$3469, $16,084]; outpatient costs $6706[$3119, $12,715]; and pain prescription costs $1862[$147, $7649]. At the year of CRPS diagnosis, the median [IQR] costs were significantly higher than baseline costs: total costs $8508[$3943, $16,666]; outpatient costs $7251[$3527, $13,568]; and pain prescription costs $2077[$140, $8856]. Over the eight-year period after CRPS diagnosis, costs between all the years were similar, ranging from the highest (one-year) to lowest (seven-years), $4845 to $3888. The median total cumulative cost 8-years after CRPS diagnosis was $43,026 and $12,037 for pain prescription costs. [Correction added on 06 November 2017 after first online publication: the preceding sentence has been updated to demonstrate the median cumulative cost in replacement of the additive cumulative mean costs.]. During the CRPS diagnosis period, patients are expected to have a total cost 2.17-fold and prescription cost 2.56-fold of their baseline cost annually. Our study demonstrates that there is a significant increase in cost and healthcare resource utilization one-year prior to and around the time of CRPS diagnosis. Furthermore, there is an increased annual cost post-diagnosis compared to baseline costs prior to CRPS diagnosis. © 2017 International Neuromodulation Society.
-
Blake, Diane R; Spielberg, Freya; Levy, Vivian; Lensing, Shelly; Wolff, Peter A; Venkatasubramanian, Lalitha; Acevedo, Nincoshka; Padian, Nancy; Chattopadhyay, Ishita; Gaydos, Charlotte A
2015-01-01
Results of a recent demonstration project evaluating feasibility, acceptability, and cost of a Web-based sexually transmitted infection (STI) testing and e-prescription treatment program (eSTI) suggest that this approach could be a feasible alternative to clinic-based testing and treatment, but the results need to be confirmed by a randomized comparative effectiveness trial. We modeled a decision tree comparing (1) cost of eSTI screening using a home collection kit and an e-prescription for uncomplicated treatment versus (2) hypothetical costs derived from the literature for referral to standard clinic-based STI screening and treatment. Primary outcome was number of STIs detected. Analyses were conducted from the clinical trial perspective and the health care system perspective. The eSTI strategy detected 75 infections, and the clinic referral strategy detected 45 infections. Total cost of eSTI was $94,938 ($1266/STI detected) from the clinical trial perspective and $96,088 ($1281/STI detected) from the health care system perspective. Total cost of clinic referral was $87,367 ($1941/STI detected) from the clinical trial perspective and $71,668 ($1593/STI detected) from the health care system perspective. Results indicate that eSTI will likely be more cost-effective (lower cost/STI detected) than clinic-based STI screening, both in the context of clinical trials and in routine clinical care. Although our results are promising, they are based on a demonstration project and estimates from other small studies. A comparative effectiveness research trial is needed to determine actual cost and impact of the eSTI system on identification and treatment of new infections and prevention of their sequelae.
-
Cost minimization analysis of a store-and-forward teledermatology consult system.
Pak, Hon S; Datta, Santanu K; Triplett, Crystal A; Lindquist, Jennifer H; Grambow, Steven C; Whited, John D
2009-03-01
The aim of this study was to perform a cost minimization analysis of store-and-forward teledermatology compared to a conventional dermatology referral process (usual care). In a Department of Defense (DoD) setting, subjects were randomized to either a teledermatology consult or usual care. Accrued healthcare utilization recorded over a 4-month period included clinic visits, teledermatology visits, laboratories, preparations, procedures, radiological tests, and medications. Direct medical care costs were estimated by combining utilization data with Medicare reimbursement rates and wholesale drug prices. The indirect cost of productivity loss for seeking treatment was also included in the analysis using an average labor rate. Total and average costs were compared between groups. Teledermatology patients incurred $103,043 in total direct costs ($294 average), while usual-care patients incurred $98,365 ($283 average). However, teledermatology patients only incurred $16,359 ($47 average) in lost productivity cost while usual-care patients incurred $30,768 ($89 average). In total, teledermatology patients incurred $119,402 ($340 average) and usual-care patients incurred $129,133 ($372 average) in costs. From the economic perspective of the DoD, store-and-forward teledermatology was a cost-saving strategy for delivering dermatology care compared to conventional consultation methods when productivity loss cost is taken into consideration.
-
ERIC Educational Resources Information Center
Combs, Joseph, Jr.
1995-01-01
Reviews the Total Library Computerization program, which can be used to manage small to midsized libraries. Discusses costs; operating system requirements; security features; user-interface styles; and system modules including online cataloging, circulation, serials control, acquisitions, authorities control, and interlibrary loan. (Author/JMV)
-
Economic and workflow analysis of a blood bank automated system.
Shin, Kyung-Hwa; Kim, Hyung Hoi; Chang, Chulhun L; Lee, Eun Yup
2013-07-01
This study compared the estimated costs and times required for ABO/Rh(D) typing and unexpected antibody screening using an automated system and manual methods. The total cost included direct and labor costs. Labor costs were calculated on the basis of the average operator salaries and unit values (minutes), which was the hands-on time required to test one sample. To estimate unit values, workflows were recorded on video, and the time required for each process was analyzed separately. The unit values of ABO/Rh(D) typing using the manual method were 5.65 and 8.1 min during regular and unsocial working hours, respectively. The unit value was less than 3.5 min when several samples were tested simultaneously. The unit value for unexpected antibody screening was 2.6 min. The unit values using the automated method for ABO/Rh(D) typing, unexpected antibody screening, and both simultaneously were all 1.5 min. The total cost of ABO/Rh(D) typing of only one sample using the automated analyzer was lower than that of testing only one sample using the manual technique but higher than that of testing several samples simultaneously. The total cost of unexpected antibody screening using an automated analyzer was less than that using the manual method. ABO/Rh(D) typing using an automated analyzer incurs a lower unit value and cost than that using the manual technique when only one sample is tested at a time. Unexpected antibody screening using an automated analyzer always incurs a lower unit value and cost than that using the manual technique.
-
Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo
2018-02-23
To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.
-
Design-Tradeoff Model For Space Station
NASA Technical Reports Server (NTRS)
Chamberlain, Robert G.; Smith, Jeffrey L.; Borden, Chester S.; Deshpande, Govind K.; Fox, George; Duquette, William H.; Dilullo, Larry A.; Seeley, Larry; Shishko, Robert
1990-01-01
System Design Tradeoff Model (SDTM) computer program produces information which helps to enforce consistency of design objectives throughout system. Mathematical model of set of possible designs for Space Station Freedom. Program finds particular design enabling station to provide specified amounts of resources to users at lowest total (or life-cycle) cost. Compares alternative design concepts by changing set of possible designs, while holding specified services to users constant, and then comparing costs. Finally, both costs and services varied simultaneously when comparing different designs. Written in Turbo C 2.0.
-
Energy Systems Integration: Data Call -- Become a Data Partner
DOE Office of Scientific and Technical Information (OSTI.GOV)
2017-01-01
This project aims to advance the understanding of costs associated with integrating PV onto the electric power distribution system while maintaining reliable grid operations. We have developed a bottom-up framework for calculating these costs as a function of PV penetration levels on specific feeders. This framework will used to inform and improve utility planning decisions, increase the transparency and speed associated with the interconnection process, and provide policymakers with more information on the total cost of energy from PV.
-
Methanator Fueled Engines for Pollution Control
NASA Technical Reports Server (NTRS)
Cagliostro, D. E.; Winkler, E. L.
1973-01-01
A methanator fueled Otto-cycle engine is compared with other methods proposed to control pollution due to automobile exhaust emissions. The comparison is made with respect to state of development, emission factors, capital cost, operational and maintenance costs, performance, operational limitations, and impact on the automotive industries. The methanator fueled Otto-cycle engine is projected to meet 1975 emission standards and operate at a lower relative total cost compared to the catalytic muffler system and to have low impact. Additional study is required for system development.
-
2010-01-01
Background In Switzerland, General Practitioners (GPs) play an important role for out-of-hours emergency care as one service option beside freely accessible and costly emergency departments of hospitals. The aim of this study was to evaluate the services provided and the economic consequences of a Swiss GP out-of-hours service. Methods GPs participating in the out-of-hours service in the city of Zurich collected data on medical problems (ICPC coding), mode of contact, mode of resource use and services provided (time units; diagnostics; treatments). From a health care insurance perspective, we assessed the association between total costs and its two components (basic costs: charges for time units and emergency surcharge; individual costs: charges for clinical examination, diagnostics and treatment in the discretion of the GP). Results 125 GPs collected data on 685 patient contacts. The most prevalent health problems were of respiratory (24%), musculoskeletal (13%) and digestive origin (12%). Home visits (61%) were the most common contact mode, followed by practice (25%) and telephone contacts (14%). 82% of patients could be treated by ambulatory care. In 20% of patients additional technical diagnostics, most often laboratory tests, were used. The mean total costs for one emergency patient contact were €144 (95%-CI: 137-151). The mode of contact was an important determinant of total costs (mean total costs for home visits: €176 [95%-CI: 168-184]; practice contact: €90 [95%-CI: 84-98]; telephone contact: €48 [95%-CI: 40-55]). Basic costs contributed 83% of total costs for home visits and 70% of total costs for practice contacts. Individual mean costs were similarly low for home visits (€30) and practice contacts (€27). Medical problems had no relevant influence on this cost pattern. Conclusions GPs managed most emergency demand in their out-of-hours service by ambulatory care. They applied little diagnostic testing and basic care. Our findings are of relevance for policy makers even from other countries with different pricing policies. Policy makers should be interested in a reimbursement system promoting out-of-hours care run by GPs as one valuable service option. PMID:21171989
-
Economic impact of medication non-adherence by disease groups: a systematic review.
Cutler, Rachelle Louise; Fernandez-Llimos, Fernando; Frommer, Michael; Benrimoj, Charlie; Garcia-Cardenas, Victoria
2018-01-21
To determine the economic impact of medication non-adherence across multiple disease groups. Systematic review. A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist. Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to 'all causes' non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents. Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required. CRD42015027338. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
-
Govan, L; Wu, O; Briggs, A; Colhoun, H M; McKnight, J A; Morris, A D; Pearson, D W M; Petrie, J R; Sattar, N; Wild, S H; Lindsay, R S
2011-08-01
The rising prevalence of diabetes worldwide has increased interest in the cost of diabetes. Inpatient costs for all people with diabetes in Scotland were investigated. The Scottish Care Information-Diabetes Collaboration (SCI-DC), a real-time clinical information system of almost all diagnosed cases of diabetes in Scotland, UK, was linked to data on all hospital admissions for people with diabetes. Inpatient stay costs were estimated using the 2007-2008 Scottish National Tariff. The probability of hospital admission and total annual cost of admissions were estimated in relation to age, sex, type of diabetes, history of vascular admission, HbA(1c), creatinine, body mass index and diabetes duration. In Scotland during 2005-2007, 24,750 people with type 1 and 195,433 people with type 2 diabetes were identified, accounting for approximately 4.3% of the total Scottish population (5.1 million). The estimated total annual cost of admissions for all people diagnosed with type 1 and type 2 diabetes was £26 million and £275 million, respectively, approximately 12% of the total Scottish inpatient expenditure (£2.4 billion). Sex, increasing age, serum creatinine, previous vascular history and HbA(1c) (the latter differentially in type 1 and type 2) were all associated with likelihood and total annual cost of admission. Diabetes inpatient expenditure accounted for 12% of the total Scottish inpatient expenditure, whilst people with diabetes account for 4.3% of the population. Of the modifiable risk factors, HbA(1c) was the most important driver of cost in type 1 diabetes.
-
COMPARISON OF RECENTLY USED PHACOEMULSIFICATION SYSTEMS USING A HEALTH TECHNOLOGY ASSESSMENT METHOD.
Huang, Jiannan; Wang, Qi; Zhao, Caimin; Ying, Xiaohua; Zou, Haidong
2017-01-01
To compare the recently used phacoemulsification systems using a health technology assessment (HTA) model. A self-administered questionnaire, which included questions to gauge on the opinions of the recently used phacoemulsification systems, was distributed to the chief cataract surgeons in the departments of ophthalmology of eighteen tertiary hospitals in Shanghai, China. A series of senile cataract patients undergoing phacoemulsification surgery were enrolled in the study. The surgical results and the average costs related to their surgeries were all recorded and compared for the recently used phacoemulsification systems. The four phacoemulsification systems currently used in Shanghai are the Infiniti Vision, Centurion Vision, WhiteStar Signature, and Stellaris Vision Enhancement systems. All of the doctors confirmed that the systems they used would help cataract patients recover vision. A total of 150 cataract patients who underwent phacoemulsification surgery were enrolled in the present study. A significant difference was found among the four groups in cumulative dissipated energy, with the lowest value found in the Centurion group. No serious complications were observed and a positive trend in visual acuity was found in all four groups after cataract surgery. The highest total cost of surgery was associated with procedures conducted using the Centurion Vision system, and significant differences between systems were mainly because of the cost of the consumables used in the different surgeries. This HTA comparison of four recently used phacoemulsification systems found that each of system offers a satisfactory vision recovery outcome, but differs in surgical efficacy and costs.
-
Module Interconnection Frameworks for a Real-Time Spreadsheet
1993-10-19
Malaysian Navy by the Malaysian subsidiary of Encore, and that response has been favorable. Prototyping is another area where rapid. interactive...contract with Encore which provides software royalties for every Infinity system shipped. Royalties from the Encore product RTware, Inc. 714 9th St. Suite...Overhead: $153,035 Total Cost: $ 680,074 13.17. Royalties : N/A 13.18. Fee or Profit- $50,000 13.19. Total Estimated Cost: $ 730,743 13.20. Authorized
-
NASA Technical Reports Server (NTRS)
Garrocq, C. A.; Hurley, M. J.; Dublin, M.
1973-01-01
A baseline implementation plan, including alternative implementation approaches for critical software elements and variants to the plan, was developed. The basic philosophy was aimed at: (1) a progressive release of capability for three major computing systems, (2) an end product that was a working tool, (3) giving participation to industry, government agencies, and universities, and (4) emphasizing the development of critical elements of the IPAD framework software. The results of these tasks indicate an IPAD first release capability 45 months after go-ahead, a five year total implementation schedule, and a total developmental cost of 2027 man-months and 1074 computer hours. Several areas of operational cost increases were identified mainly due to the impact of additional equipment needed and additional computer overhead. The benefits of an IPAD system were related mainly to potential savings in engineering man-hours, reduction of design-cycle calendar time, and indirect upgrading of product quality and performance.
-
Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities.
Bratt, John H; Torpey, Kwasi; Kabaso, Mushota; Gondwe, Yebo
2011-01-01
To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT-supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in Zambia. Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV/AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7-$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0-114.2 million for ART and US$57.7 million for ANC including PMTCT. Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening. © 2010 Blackwell Publishing Ltd.
-
Analysis of the economics of photovoltaic-diesel-battery energy systems for remote applications
NASA Technical Reports Server (NTRS)
Brainard, W. A.
1983-01-01
Computer simulations were conducted to analyze the performance and operating cost of a photovoltaic energy source combined with a diesel generator system and battery storage. The simulations were based on the load demand profiles used for the design of an all photovoltaic energy system installed in the remote Papago Indian Village of Schuchuli, Arizona. Twenty year simulations were run using solar insolation data from Phoenix SOLMET tapes. Total energy produced, energy consumed, operation and maintenance costs were calculated. The life cycle and levelized energy costs were determined for a variety of system configurations (i.e., varying amounts of photovoltaic array and battery storage).
-
Development costs for a nuclear electric propulsion stage.
NASA Technical Reports Server (NTRS)
Mondt, J. F.; Prickett, W. Z.
1973-01-01
Development costs are presented for an unmanned nuclear electric propulsion (NEP) stage based upon a liquid metal cooled, in-core thermionic reactor. A total of 120 kWe are delivered to the thrust subsystem which employs mercury ion engines for electric propulsion. This study represents the most recent cost evaluation of the development of a reactor power system for a wide range of nuclear space power applications. These include geocentric, and outer planet and other deep space missions. The development program is described for the total NEP stage, based upon specific development programs for key NEP stage components and subsystems.
-
Patel, Twisha S.; Kaakeh, Rola; Nagel, Jerod L.; Newton, Duane W.
2016-01-01
ABSTRACT Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. PMID:27795335
-
Flat plate vs. concentrator solar photovoltaic cells - A manufacturing cost analysis
NASA Technical Reports Server (NTRS)
Granon, L. A.; Coleman, M. G.
1980-01-01
The choice of which photovoltaic system (flat plate or concentrator) to use for utilizing solar cells to generate electricity depends mainly on the cost. A detailed, comparative manufacturing cost analysis of the two types of systems is presented. Several common assumptions, i.e., cell thickness, interest rate, power rate, factory production life, polysilicon cost, and direct labor rate are utilized in this analysis. Process sequences, cost variables, and sensitivity analyses have been studied, and results of the latter show that the most important parameters which determine manufacturing costs are concentration ratio, manufacturing volume, and cell efficiency. The total cost per watt of the flat plate solar cell is $1.45, and that of the concentrator solar cell is $1.85, the higher cost being due to the increased process complexity and material costs.
-
Fuel-Burning Technology Alternatives for the Army.
1985-01-01
control 0.85 2,287,000 Flue gas desulfurization 0.68 3,410,000 Total 12,478,000 *Capital cost estimate...34......... . . Particulate and sulfur dioxide control are needed. A baghouse and flue gas desulfurization (FD) scrubber system must be installed. Each item’s cost in...direct cost) Contingency (20% of 1,253,000 direct and indirect costs) Subtotal 7,518,000 Particulate control 1,342,000 Flue gas desulfurization
-
Economic costs of recorded reasons for cow mortality and culling in a pasture-based dairy industry.
Kerslake, J I; Amer, P R; O'Neill, P L; Wong, S L; Roche, J R; Phyn, C V C
2018-02-01
The objective of this study was to determine the economic costs associated with different reasons for cow culling or on-farm mortality in a pasture-based seasonal system. A bioeconomic model was developed to quantify costs associated with the different farmer-recorded reasons and timing of cow wastage. The model accounted for the parity and stage of lactation at which the cows were removed as well as the consequent effect on the replacement rate and average age structure of the herd. The costs and benefits associated with the change were quantified, including animal replacement cost, cull salvage value, milk production loss, and the profitability of altered genetic merit based on industry genetic trends for each parity. The total cost of cow wastage was estimated to be NZ$23,628/100 cows per year (NZ$1 = US$0.69) in a pasture-based system. Of this total cost, NZ$14,300/100 cows worth of removals were for nonpregnancy and unknown reasons, and another NZ$3,631/100 cows was attributed to low milk production, mastitis, and udder problems. The total cost for cow removals due to farmer-recorded biological reasons (excluding unknown, production, and management-related causes) was estimated to be NZ$13,632/100 cows per year. Of this cost, an estimated NZ$10,286/100 cows was attributed to nonpregnancy, mastitis, udder problems, calving trouble, and injury or accident. There is a strong economic case for the pasture-based dairy industries to invest in genetic, herd health, and production management research focused on reducing animal wastage due to reproductive failure, mastitis, udder problems, injuries or accidents, and calving difficulties. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
-
Oda, Hitomi; Miyauchi, Akira; Ito, Yasuhiro; Sasai, Hisanori; Masuoka, Hiroo; Yabuta, Tomonori; Fukushima, Mitsuhiro; Higashiyama, Takuya; Kihara, Minoru; Kobayashi, Kaoru; Miya, Akihiro
2017-01-30
The incidence of thyroid cancer is increasing rapidly in many countries, resulting in rising societal costs of the care of thyroid cancer. We reported that the active surveillance of low-risk papillary microcarcinoma had less unfavorable events than immediate surgery, while the oncological outcomes of these managements were similarly excellent. Here we calculated the medical costs of these two managements. We created a model of the flow of these managements, based on our previous study. The flow and costs include the step of diagnosis, surgery, prescription of medicine, recurrence, salvage surgery for recurrence, and care for 10 years after the diagnosis. The costs were calculated according to the typical clinical practices at Kuma Hospital performed under the Japanese Health Care Insurance System. If conversion surgeries were not considered, the 'simple cost' of active surveillance for 10 years was 167,780 yen/patient. If there were no recurrences, the 'simple cost' of immediate surgery was calculated as 794,770 yen/patient to 1,086,070 yen/patient, depending on the type of surgery and postoperative medication. The 'simple cost' of surgery was 4.7 to 6.5 times the 'simple cost' of surveillance. When conversion surgeries and recurrence were considered, the 'total cost' of active surveillance for 10 years became 225,695 yen/patient. When recurrence were considered, the 'total cost' of immediate surgery was 928,094 yen/patient, which was 4.1 times the 'total cost' of the active surveillance. At Kuma Hospital in Japan, the 10-year total cost of immediate surgery was 4.1 times expensive than active surveillance.
-
NASA Astrophysics Data System (ADS)
Oda, Takuya; Akisawa, Atushi; Kashiwagi, Takao
If the economic activity in the commercial and residential sector continues to grow, improvement in energy conversion efficiencies of energy supply systems is necessary for CO2 mitigation. In recent years, the electricity driven hot water heat pump (EDHP) and the solar photo voltaic (PV) are commercialized. The fuel cell (FC) of co-generation system (CGS) for the commercial and residential sector will be commercialized in the future. The aim is to indicate the ideal energy supply system of the users sector, which both manages the economical cost and CO2 mitigation, considering the grid power system. In the paper, cooperative Japanese energy supply systems are modeled by linear-programming. It includes the grid power system and energy systems of five commercial sectors and a residential sector. The demands of sectors are given by the objective term for 2005 to 2025. 24 hours load for each 3 annual seasons are considered. The energy systems are simulated to be minimize the total cost of energy supply, and to be mitigate the CO2 discharge. As result, the ideal energy system at 2025 is shown. The CGS capacity grows to 30% (62GW) of total power system, and the EDHP capacity is 26GW, in commercial and residential sectors.
-
[Environmental cost of rice production in Dongting Lake area of Hunan Province].
Xiang, Ping'an; Huang, Huang; Yan, Huimin; Zhou, Yan; Zheng, Hua; Huang, Xingguo
2005-11-01
To evaluate the environmental cost of rice production is of significance for the sustainable development of agriculture and the set-up of green GDP accounting system. In this paper, the environmental cost of rice production in Dongting Lake area, one of the main bread baskets in China, was evaluated from the aspects of pesticide pollution, chemical fertilizer pollution, greenhouse gases emission, plastic film persistence, paddyfield gleyization, and polderization. The results showed that in 1999, the total environmental cost of rice production in this area was 41.91 billion yuan, equivalent to 26.8% of its total agricultural production value, or 28.5% of the gross output of its planting industry. For the sustainable production of rice, the strategies for decrease environmental cost intrinsically were put forward.
-
NASA Astrophysics Data System (ADS)
Brandt, J.; Silver, J. D.; Christensen, J. H.; Andersen, M. S.; Bønløkke, J. H.; Sigsgaard, T.; Geels, C.; Gross, A.; Hansen, A. B.; Hansen, K. M.; Hedegaard, G. B.; Kaas, E.; Frohn, L. M.
2013-03-01
An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed, to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North Seas, since special regulatory actions on sulphur emissions, called SECA (sulphur emission control area), have been introduced in these areas,. We conclude that despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem to human health, hence the related external costs are considerable. The total health-related external costs for the whole of Europe is estimated at 803 bn Euro yr-1 for the year 2000, decreasing to 537 bn Euro yr-1 in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680 000 yr-1, decreasing to approximately 450 000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulphur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern Hemisphere, or at least in areas close to Europe, would have a significant positive impact on human health in Europe.
-
NASA Astrophysics Data System (ADS)
Brandt, J.; Silver, J. D.; Christensen, J. H.; Andersen, M. S.; Bønløkke, J. H.; Sigsgaard, T.; Geels, C.; Gross, A.; Hansen, A. B.; Hansen, K. M.; Hedegaard, G. B.; Kaas, E.; Frohn, L. M.
2013-08-01
An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North seas, since special regulatory actions on sulfur emissions, called SECA (sulfur emission control area), have been introduced in these areas. We conclude that, despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem for human health. Hence the related external costs are considerable. The total health-related external costs for the whole of Europe are estimated at 803 bn euros yr-1 for the year 2000, decreasing to 537 bn euros yr-1 in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680 000 yr-1, decreasing to approximately 450 000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulfur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern Hemisphere, or at least in areas close to Europe, would have a significant positive impact on human health in Europe.
-
NASA Astrophysics Data System (ADS)
Brandt, Jørgen; Silver, Jeremy D.; Christensen, Jesper H.; Andersen, Mikael S.; Bønløkke, Jakob H.; Sigsgaard, Torben; Geels, Camilla; Gross, Allan; Hansen, Ayoe B.; Hansen, Kaj M.; Hedegaard, Gitte B.; Kaas, Eigil; Frohn, Lise M.
2013-04-01
An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed, to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North Seas, since special regulatory actions on sulphur emissions, called SECA (sulphur emission control area), have been intro-duced in these areas,. We conclude that despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem to human health, hence the related external costs are considerable. The total health-related external costs for the whole of Europe is estimated at 803 bn Euro/year for the year 2000, decreasing to 537 bn Euro/year in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680,000/year, decreasing to approximately 450,000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulphur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern Hemisphere, or at least in areas close to Europe, would have a significant posi-tive impact on human health in Europe.
-
Optimal deployment of thermal energy storage under diverse economic and climate conditions
DOE Office of Scientific and Technical Information (OSTI.GOV)
DeForest, Nicholas; Mendes, Gonçalo; Stadler, Michael
2014-04-01
This paper presents an investigation of the economic benefit of thermal energy storage (TES) for cooling, across a range of economic and climate conditions. Chilled water TES systems are simulated for a large office building in four distinct locations, Miami in the U.S.; Lisbon, Portugal; Shanghai, China; and Mumbai, India. Optimal system size and operating schedules are determined using the optimization model DER-CAM, such that total cost, including electricity and amortized capital costs are minimized. The economic impacts of each optimized TES system is then compared to systems sized using a simple heuristic method, which bases system size as fractionmore » (50percent and 100percent) of total on-peak summer cooling loads. Results indicate that TES systems of all sizes can be effective in reducing annual electricity costs (5percent-15percent) and peak electricity consumption (13percent-33percent). The investigation also indentifies a number of criteria which drive TES investment, including low capital costs, electricity tariffs with high power demand charges and prolonged cooling seasons. In locations where these drivers clearly exist, the heuristically sized systems capture much of the value of optimally sized systems; between 60percent and 100percent in terms of net present value. However, in instances where these drivers are less pronounced, the heuristic tends to oversize systems, and optimization becomes crucial to ensure economically beneficial deployment of TES, increasing the net present value of heuristically sized systems by as much as 10 times in some instances.« less
-
Tseng, Chih-Chieh; Lai, Ming-Tang; Wu, Chia-Che; Yuan, Sheng-Po; Ding, Yi-Fang
2018-03-01
Health care systems and physicians need to conform to budgets and streamline resources to provide cost-effective quality care. Although endoscopic tympanoplasty (ET) has been performed for decades, no studies on the cost-effectiveness of ET and microscopic tympanoplasty (MT) for treating chronic otitis media have been published. The present study aimed to compare the cost-effectiveness of ET and MT for treating chronic otitis media. This study was performed using a Cohort-style Markov decision-tree economic model with a 30-year time horizon. The economic perspective was that of a third-party payer (Taiwan National Health Insurance System). Two treatment strategies were compared, namely ET and MT. The primary outcome was the incremental cost per quality-adjusted life year (QALY). Probabilities were obtained from meta-analyses. Costs were obtained from the published literature and Taiwan National Health Insurance System database. Multiple sensitivity analyses were performed to account for data uncertainty. The reference case revealed that the total cost of ET was $NT 20,901 for 17.08 QALY per patient. By contrast, the total cost of MT was $NT 21,171 for 17.15 QALY per patient. The incremental cost effectiveness ratio for ET versus that of MT was $NT 3703 per QALY. The cost-effectiveness acceptability curve indicated that ET was comparable to MT at a willingness-to-pay threshold of larger than $NT 35,000 per QALY. This cost-effectiveness analysis indicates that ET is comparable to MT for treating chronic otitis media in Taiwan. This result provides the latest information for physicians, the government, and third-party payers to select proper clinical practice. Copyright © 2017. Published by Elsevier Taiwan LLC.
-
Bohl, Alex A; Phelan, Elizabeth A; Fishman, Paul A; Harris, Jeffrey R
2012-10-01
To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity. We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual provides 2-3 years of administrative data grouped into 3-month intervals relative to an index date. We identified 8,969 medical fallers through International Classification of Diseases, 9th Revision, codes and E-Codes and used 8,956 nonfaller controls, identified through age and gender frequency matching. Total costs were partitioned into 7 components: inpatient, outpatient, emergency, radiology, pharmacy, postacute care, and "other." The large increase in costs after a hospitalized fall is mainly associated with inpatient and postacute care components. The spike in costs after a nonhospitalized fall is attributable to outpatient and "other" (e.g., ambulatory surgery or community health services) components. Hospitalized fallers' inpatient, emergency, postacute care, outpatient, and radiology costs are not always greater than those for nonhospitalized fallers. Components associated with increased costs after a medical fall vary over time and by injury severity. Future studies should compare if delivering certain acute and postacute health services improve health and reduce cost trajectories after a medical fall more than others. Additionally, since the older adult population and the problem of falls are growing, health care delivery systems should develop standardized methodology to monitor medical fall rates.
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Ardani, Kristen; O'Shaughnessy, Eric; Fu, Ran
2016-12-01
In this report, we fill a gap in the existing knowledge about PV-plus-storage system costs and value by providing detailed component- and system-level installed cost benchmarks for residential systems. We also examine other barriers to increased deployment of PV-plus-storage systems in the residential sector. The results are meant to help technology manufacturers, installers, and other stakeholders identify cost-reduction opportunities and inform decision makers about regulatory, policy, and market characteristics that impede solar plus storage deployment. In addition, our periodic cost benchmarks will document progress in cost reductions over time. To analyze costs for PV-plus-storage systems deployed in the first quartermore » of 2016, we adapt the National Renewable Energy Laboratory's component- and system-level cost-modeling methods for standalone PV. In general, we attempt to model best-in-class installation techniques and business operations from an installed-cost perspective. In addition to our original analysis, model development, and review of published literature, we derive inputs for our model and validate our draft results via interviews with industry and subject-matter experts. One challenge to analyzing the costs of PV-plus-storage systems is choosing an appropriate cost metric. Unlike standalone PV, energy storage lacks universally accepted cost metrics, such as dollars per watt of installed capacity and lifetime levelized cost of energy. We explain the difficulty of arriving at a standard approach for reporting storage costs and then provide the rationale for using the total installed costs of a standard PV-plus-storage system as our primary metric, rather than using a system-size-normalized metric.« less
-
Wells, Philip S; Lensing, Anthonie W A; Haskell, Lloyd; Levitan, Bennett; Laliberté, François; Durkin, Michael; Ashton, Veronica; Xiao, Yongling; Crivera, Concetta; Lejeune, Dominique; Schein, Jeff; Lefebvre, Patrick
2018-06-01
The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (vs placebo) after 6-12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo, based on the EINSTEIN-EXT event rates. Total healthcare cost was calculated as the sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e. recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA). Total healthcare cost was $1,454 lower for rivaroxaban-treated (vs placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (-$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI] = -$1,454 [-$2,396, $1,231]). This study was conducted over the 1-year observation period of the EINSTEIN-EXT trial, which limited "real-world" applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and, thus, not applicable to other healthcare systems. Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6-12 months of VTE treatment.
-
New workers' compensation legislation: expected pharmaceutical cost savings.
Wilson, Leslie; Gitlin, Matthew
2005-10-01
California Workers' Compensation (WC) system costs are under review. With recently approved California State Assembly Bill (AB) 749 and Senate Bill (SB) 228, an assessment of proposed pharmaceutical cost savings is needed. A large workers' compensation database provided by the California Workers' Compensation Institute (CWCI) and Medi-Cal pharmacy costs obtained from the State Drug Utilization Project are utilized to compare frequency, costs and savings to Workers' Compensation in 2002 with the new pharmacy legislation. Compared to the former California Workers' Compensation fee schedule, the newly implemented 100% Medi-Cal fee schedule will result in savings of 29.5% with a potential total pharmacy cost savings of $125 million. Further statistical analysis demonstrated that a large variability in savings across drugs could not be controlled with this drug pricing system. Despite the large savings in pharmaceuticals, inconsistencies between the two pharmaceutical payment systems could lead to negative incentives and uncertainty for long-term savings. Proposed alternative pricing systems could be considered. However, pain management implemented along with other cost containment strategies could more effectively reduce overall drug spending in the workers' compensation system.
-
Ahmed, Osman; Patel, Mikin; Ward, Thomas; Sze, Daniel Y; Telischak, Kristen; Kothary, Nishita; Hofmann, Lawrence V
2015-12-01
To increase cost transparency and uncover potential areas for savings in patients receiving selective transarterial chemoembolization at a tertiary care academic center. The hospital cost accounting system charge master sheet for direct and total costs associated with selective transarterial chemoembolization in fiscal years 2013 and 2014 was queried for each of the four highest volume interventional radiologists at a single institution. There were 517 cases (range, 83-150 per physician) performed; direct costs incurred relating to care before, during, and after the procedure with respect to labor, supply, and equipment fees were calculated. A median of 48 activity codes were charged per selective transarterial chemoembolization from five cost centers, represented by the angiography suite, units for care before and after the procedure, pharmacy, and observation floors. The average direct cost of selective transarterial chemoembolization did not significantly differ among operators at $9,126.94, $8,768.77, $9,027.33, and $8,909.75 (P = .31). Intraprocedural costs accounted for 82.8% of total direct costs and provided the greatest degree in cost variability ($7,268.47-$7,691.27). The differences in intraprocedural expense among providers were not statistically significant (P = .09), even when separated into more specific procedure-related labor and supply costs. Cost accounting systems could effectively be interrogated as a method for calculating direct costs associated with selective transarterial chemoembolization. The greatest source of expenditure and variability in cost among providers was shown to be intraprocedural labor and supplies, although the effect did not appear to be operator dependent. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.
-
Cost effectiveness evaluation of a rotavirus vaccination program in Argentina.
Martí, Sebastián García; Alcaraz, Andrea; Valanzasca, Pilar; McMullen, Mercedes; Standaert, Baudouin; Garay, Ulises; Lepetic, Alejandro; Gomez, Jorge
2015-10-13
Rotavirus diarrhea is one of the most important vaccine-preventable causes of severe diarrhea in children worldwide. There are two live-attenuated virus vaccines licensed, Rotarix (RV1) a monovalent vaccine by GlaxoSmithKline and a pentavalent vaccine, RotaTeq(RV5), by Merck & Co., with similar results. This study aim was to evaluate the cost-effectiveness of the utilization of RV1 compared with RV5 in Argentina. A deterministic Markov model based on the lifetime follow up of a static cohort was used. Quality Adjusted Life Years (QALYs) as a measure of results, the perspective of the health care system and a 5% discount rate for health benefits and costs has been used. A review of the literature to obtain epidemiologic and resources utilization of rotavirus diarrhea was performed. The sources used to estimate epidemiologic parameters were the National Health Surveillance System, the national mortality statistics and national database of hospital discharges records. Costs were obtained from different health subsectors and are expressed in local currency. Both vaccination alternatives were less costly and more effective than the strategy without vaccination (total costs $ 69,700,645 and 2575 total QALYs lost). When comparing RV1 vs. RV5, RV1 was less expensive ($ 60,174,508 vs. $ 67,545,991 total costs) and more effective (1105 vs. 1213 total QALYs lost) than RV5, RV1 being therefore a dominating strategy. Probabilistic sensitivity analysis showed results to be robust with a 100% probability of being cost-effective at a WTP threshold of 1 GDP per capita when comparing the RV1 vs. no vaccination. Both RV1 and RV5 schedules dominate the no vaccination strategy and RV5 was dominated by RV1. This information is a valuable input regarding the incorporation of this kind of vaccines into the national vaccination programs. Copyright © 2015 Elsevier Ltd. All rights reserved.
-
The Development of Patient Scheduling Groups for an Effective Appointment System
2016-01-01
Summary Background Patient access to care and long wait times has been identified as major problems in outpatient delivery systems. These aspects impact medical staff productivity, service quality, clinic efficiency, and health-care cost. Objectives This study proposed to redesign existing patient types into scheduling groups so that the total cost of clinic flow and scheduling flexibility was minimized. The optimal scheduling group aimed to improve clinic efficiency and accessibility. Methods The proposed approach used the simulation optimization technique and was demonstrated in a Primary Care physician clinic. Patient type included, emergency/urgent care (ER/UC), follow-up (FU), new patient (NP), office visit (OV), physical exam (PE), and well child care (WCC). One scheduling group was designed for this physician. The approach steps were to collect physician treatment time data for each patient type, form the possible scheduling groups, simulate daily clinic flow and patient appointment requests, calculate costs of clinic flow as well as appointment flexibility, and find the scheduling group that minimized the total cost. Results The cost of clinic flow was minimized at the scheduling group of four, an 8.3% reduction from the group of one. The four groups were: 1. WCC, 2. OV, 3. FU and ER/UC, and 4. PE and NP. The cost of flexibility was always minimized at the group of one. The total cost was minimized at the group of two. WCC was considered separate and the others were grouped together. The total cost reduction was 1.3% from the group of one. Conclusions This study provided an alternative method of redesigning patient scheduling groups to address the impact on both clinic flow and appointment accessibility. Balance between them ensured the feasibility to the recognized issues of patient service and access to care. The robustness of the proposed method on the changes of clinic conditions was also discussed. PMID:27081406
-
Chun, K R Julian; Brugada, Josep; Elvan, Arif; Gellér, Laszlo; Busch, Matthias; Barrera, Alberto; Schilling, Richard J; Reynolds, Matthew R; Hokanson, Robert B; Holbrook, Reece; Brown, Benedict; Schlüter, Michael; Kuck, Karl-Heinz
2017-07-27
This study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial. A trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [€], the United Kingdom [£], and the United States [$]). Total payer costs were calculated by applying standard unit costs to hospital stays, using International Classification of Diseases, 10th Revision diagnoses and procedure codes that were mapped to country-specific diagnosis-related groups. Patients (N=750) randomized 1:1 to cryoballoon (n=374) or RFC (n=376) ablation were followed for a mean of 1.5 years. Resource use was lower in the cryoballoon than the RFC group (205 hospitalizations and/or interventions in 122 patients versus 268 events in 154 patients). The cost differences per patient in mean total payer costs during follow-up were €640, £364, and $925 in favor of cryoballoon ablation ( P =0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of €245 000, £140 000, and $355 000. When compared with RFC ablation, cryoballoon ablation was associated with a reduction in resource use and payer costs. In all 3 national healthcare systems analyzed, this reduction resulted in substantial trial period cost savings, primarily attributable to fewer repeat ablations and a reduction in cardiovascular rehospitalizations with cryoballoon ablation. URL: http://www.clinicaltrials.gov. Identifier: NCT01490814. © 2017 The Authors and Medtronic. Published on behalf of the American Heart Association, Inc., by Wiley.
-
Abe, Katsumi; Kosuda, Shigeru; Kusano, Shoichi; Nagata, Masayoshi
2003-11-01
It is crucial to evaluate an annual balance before-hand when an institution installs a PET system because the revised Japanese national insurance reimbursement system set the cost of a FDG PET study as 75,000 yen. A break-even point was calculated in an 8-hour or a 24-hour operation of a PET system, based on the total costs reported. The break-even points were as follows: 13.4, 17.7, 22.1 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in an ordinary PET system operation of 8 hours. The break-even points were 19.9, 25.5, 31.2 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in a full PET system operation of 24 hours. The results indicate no profit would accrue in an ordinary PET system operation of 8 hours. The annual profit and break-even point for the total cost including the initial investment would be respectively 530 million yen and 2.8 years in a 24-hour operation with 1 cyclotron-3 PET cameras system.
-
The role of ERTS in the establishment and of a nationwide land cover information system
NASA Technical Reports Server (NTRS)
Abram, P.; Tullos, J.
1974-01-01
The economic potential of utilizing an ERTS type satellite in the development, updating, and maintenance of a nation-wide land cover information system in the post-1977 time frame was examined. Several alternative acquisition systems were evaluated for land cover data acquisition, processing, and interpretation costs in order to determine, on a total life cycle cost basis, under which conditions of user demand (i.e., area of coverage, frequency of coverage, timeliness of information, and level of information detail) an ERTS type satellite would be cost effective, and what the annual cost savings benefits would be. It was concluded that a three satellite system with high and low altitude aircraft and ground survey team utilizing automatic interpretation and classification techniques is an economically sound proposal.
-
Study of Lyndon B. Johnson Space Center utility systems
NASA Technical Reports Server (NTRS)
Redding, T. E.; Huber, W. C.
1977-01-01
The results of an engineering study of potential energy saving utility system modifications for the NASA Lyndon B. Johnson Space Center are presented. The objective of the study was to define and analyze utility options that would provide facility energy savings in addition to the approximately 25 percent already achieved through an energy loads reduction program. A systems engineering approach was used to determine total system energy and cost savings resulting from each of the ten major options investigated. The results reported include detailed cost analyses and cost comparisons of various options. Cost are projected to the year 2000. Also included are a brief description of a mathematical model used for the analysis and the rationale used for a site survey to select buildings suitable for analysis.
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Weng, Yu-Chi, E-mail: clyde.weng@gmail.com; Fujiwara, Takeshi
2011-06-15
In order to develop a sound material-cycle society, cost-effective municipal solid waste (MSW) management systems are required for the municipalities in the context of the integrated accounting system for MSW management. Firstly, this paper attempts to establish an integrated cost-benefit analysis (CBA) framework for evaluating the effectiveness of MSW management systems. In this paper, detailed cost/benefit items due to waste problems are particularly clarified. The stakeholders of MSW management systems, including the decision-makers of the municipalities and the citizens, are expected to reconsider the waste problems in depth and thus take wise actions with the aid of the proposed CBAmore » framework. Secondly, focusing on the financial cost, this study develops a generalized methodology to evaluate the financial cost-effectiveness of MSW management systems, simultaneously considering the treatment technological levels and policy effects. The impacts of the influencing factors on the annual total and average financial MSW operation and maintenance (O and M) costs are analyzed in the Taiwanese case study with a demonstrative short-term future projection of the financial costs under scenario analysis. The established methodology would contribute to the evaluation of the current policy measures and to the modification of the policy design for the municipalities.« less
-
Information transfer satellite concept study. Volume 4: computer manual
NASA Technical Reports Server (NTRS)
Bergin, P.; Kincade, C.; Kurpiewski, D.; Leinhaupel, F.; Millican, F.; Onstad, R.
1971-01-01
The Satellite Telecommunications Analysis and Modeling Program (STAMP) provides the user with a flexible and comprehensive tool for the analysis of ITS system requirements. While obtaining minimum cost design points, the program enables the user to perform studies over a wide range of user requirements and parametric demands. The program utilizes a total system approach wherein the ground uplink and downlink, the spacecraft, and the launch vehicle are simultaneously synthesized. A steepest descent algorithm is employed to determine the minimum total system cost design subject to the fixed user requirements and imposed constraints. In the process of converging to the solution, the pertinent subsystem tradeoffs are resolved. This report documents STAMP through a technical analysis and a description of the principal techniques employed in the program.
-
Resource costs for asthma-related care among pediatric patients in managed care.
Gendo, Karna; Sullivan, Sean D; Lozano, Paula; Finkelstein, Jonathan A; Fuhlbrigge, Anne; Weiss, Kevin B
2003-09-01
In 1998, the economic burden of asthma in the United States was estimated to be 12.7 billion dollars. Yet few studies have examined the relationship between the total costs of asthma-related care and measures of asthma morbidity. Understanding the relationship between total costs of asthma-related care and morbidity can assist in designing the most cost-effective asthma care strategies to improve patient outcomes and minimize total costs. To investigate correlates of asthma costs for children with mild-to-moderate persistent asthma and, specifically, to characterize how closely the percentage of predicted forced expiratory volume in 1 second (FEV1) and symptom days were correlated with costs of illness. A total of 638 parents and children with mild-to-moderate persistent asthma in 4 managed care delivery systems in 3 different US geographic regions were enrolled. Symptom burden and annual resource utilization were determined from reports of physician visits, hospitalizations, emergency department visits, medication use, and parental missed workdays. Spirometry was conducted on children who were 5 years and older. To characterize the relationship between symptom days and the percentage of predicted FEV1 with costs, we specified a multivariate regression model. The median total annual asthma-related cost for the group was 564 dollars (interquartile range [IQR], 131 dollars-1602 dollars). Indirect costs represented 54.6% of total costs. Medicines accounted for 52.6% of direct costs. The mean percentage of predicted FEV1 was 101.6% (range, 39.3%-183.5%; IQR, 91.6%-111.3%), with 91.4% of patients with a percentage of predicted FEV1 of more than 80%. Based on multivariate modeling, increasing asthma severity, use of peak expiratory flow rate meters, younger age, low-income status and nonwhite race, and longer duration of asthma were significantly associated with increasing cost. Symptom days (P < 0.001) predicted annual costs better than percentage of predicted FEV1 (P < 0.16) in this group of children. For the large number of children with mild-to-moderate persistent asthma and normal or near-normal lung function, symptom days are predictive of health care costs. For these insured children receiving care from 3 large managed care providers, low-income status and nonwhite race were the strongest correlates for increased asthma-related costs.
-
Low-Cost, Light Weight, Thin Film Solar Concentrator
NASA Technical Reports Server (NTRS)
Ganapathi, G.; Palisoc, A.; Nesmith, B.; Greschik, G.; Gidanian, K.; Kindler, A.
2013-01-01
This research addresses a cost barrier towards achieving a solar thermal collector system with an installed cost of $75/sq m and meet the Department of Energy's (DOE's) performance targets for optical errors, operations during windy conditions and lifetime. Current concentrators can cost as much as 40-50% of the total installed costs for a CSP plant. In order to reduce the costs from current $200-$250/sq m, it is important to focus on the overall system. The reflector surface is a key cost driver, and our film-based polymer reflector will help significantly in achieving DOE's cost target of $75/sq m. The ease of manufacturability, installation and replacement make this technology a compelling one to develop. This technology can be easily modified for a variety of CSP options including heliostats, parabolic dishes and parabolic troughs.
-
Distribution and sharing of palliative care costs in rural areas of Canada.
Dumont, Serge; Jacobs, Philip; Turcotte, Véronique; Turcotte, Stéphane; Johnston, Grace
2014-01-01
Few data are available on the costs occurring during the palliative phase of care and on the sharing of these costs in rural areas. This study aimed to evaluate the costs related to all resources used by rural palliative care patients and to examine how these costs were shared between the public healthcare system (PHCS), patients' families, and not-for-profit organizations (NFPOs). A prospective longitudinal study was undertaken of 82 palliative care patients and their main informal caregivers in rural areas of four Canadian provinces. Telephone interviews were completed at two-week intervals. The mean total cost per patient for a six-month participation in a palliative care program was CA$31,678 +/- 1,160. A large part of this cost was attributable to inpatient hospital stays and was assumed by the PHCS. The patient's family contributed less than a quarter of the mean total cost per patient, and this was mainly attributable to caregiving time.
-
Provincial Reconstruction Teams: Developing a Cost-Tracking Process will Enhance Decision-Making
2009-04-28
calculated on a per person basis these contractors account for approximately $9 million of the $30 7 While DoD captures costs in other areas, it...DoS Can Track PRT Costs Although U.S. government accounting standards require agencies to track program costs , according to officials, DoS and DoD...DoS’ global accounting and payroll systems have the capability to track total or individual PRT costs , according to DoS officials. In April 2008
-
First Destination Transportation Study
1978-03-03
avoidance potentials on a daily procurement basis. A "total" sys- tematic cost evaluation program, including specific de - cision rules needed on an...implementation priority :x needed. The rec- ommended priority is as follows: [ (1) Develop improved system management concepts that will "form the framework ...priority as it provides the overall framework for better system management. Cost evaluation and CCSS Enhancement Programs deserve next consideration, as
-
Kuklińska-Janiak, Dorota
2013-12-01
Lung cancer and pneumoconioses constitute two serious problems of contemporary medicine and a public health system. To analyze the costs associated with social security benefits provided to the insured presenting with lung cancer and pulmonary diseases (including pneumoconioses) caused by external factors. The analysis was based on the data obtained from the Department of Statistics and Actuarial Forecasts of the Social Insurance Institution (SlI) in Warsaw. Structural diversity of the costs of the separate benefits available within the national health insurance system has been considered. Based on the data available in Poland costs associated with the incidence of lung cancer and pneumoconiosis were assessed taking into account sex and age of the insured as well as the administrative division of Poland. Additionally, mortality rates from the selected pulmonary diseases were analyzed. Costs of the pensions paid to the insured presenting with lung cancer amount to 81.11% of the total social security costs associated with these diseases, while the sick leave money paid to the insured lung cancer patients equal to 15.5% of the total costs. In the insured women, costs of the pensions paid due to occupational pulmonary diseases (predominantly pneumoconioses) constitute 41.1% and in the insured men--11.5% of the total 'occupational' pensions. Although the maximal incidence of lung cancer occurs in both men and women above their retirement ages the costs of the work incapacity pensions paid to lung cancer patients still exceed 81% of the total social security costs associated with these diseases. In the insured women, the cost of pensions paid due to occupational pulmonary diseases, most of which are pneumoconioses, ranks first among the costs of 'occupational' pensions received by these subjects, while in the insured men the respective cost ranks third (after injuries plus intoxications and cardiovascular diseases) among their 'occupational' pensions. Moreover, the results of the performed analyses indicate that data on the social insurance money allow to comprehensively evaluate the health status of the insured men and women as well as their quality of life and therapeutical, rehabilitational and prophylactic needs. These data can and should, therefore, be utilized in both clinical practice and for accomplishment of the public health tasks.
-
Garving, C; Weber, C D; Poßelt, S; Pishnamaz, M; Pape, H C; Dienstknecht, T
2014-06-01
The treatment of patients with mild head injury is related to a continuous lack of finances. The current investigation summarises radiological costs of patients from a level I trauma centre and discusses the indication for CT scanning within the G-DRG system. The study includes all patients who underwent a CCT scan in 2011. Diagnosis, length of stay and cost data were recorded for every patient. Finally, frequent diagnosis groups were summarised to clusters (Basis-DRG/MDC 21A). A total of 380 patients was treated. Within the largest group (G-DRG B80Z) the costs for a CCT already took up one quarter of the total proceedings. In combination with the high cost for monitoring patients with mild head injuries this causes an ongoing lack of finances. In spite of the often necessary CCT investigation in mild head injuries, the earnings do not cover the costs of the patients. To improve the situation clear guidelines for CCT scanning should be provided and the reimbursement in particular in the diagnosis group of the G-DRG B80Z has to be improved. Georg Thieme Verlag KG Stuttgart · New York.
-
Twomey, Conal; Prina, A Matthew; Baldwin, David S; Das-Munshi, Jayati; Kingdon, David; Koeser, Leonardo; Prince, Martin J; Stewart, Robert; Tulloch, Alex D; Cieza, Alarcos
2016-01-01
Few countries have made much progress in implementing transparent and efficient systems for the allocation of mental health care resources. In England there are ongoing efforts by the National Health Service (NHS) to develop mental health 'payment by results' (PbR). The system depends on the ability of patient 'clusters' derived from the Health of the Nation Outcome Scales (HoNOS) to predict costs. We therefore investigated the associations of individual HoNOS items and the Total HoNOS score at baseline with mental health service costs at one year follow-up. An historical cohort study using secondary care patient records from the UK financial year 2012-2013. Included were 1,343 patients with 'common mental health problems', represented by ICD-10 disorders between F32-48. Costs were based on patient contacts with community-based and hospital-based mental health services. The costs outcome was transformed into 'high costs' vs 'regular costs' in main analyses. After adjustment for covariates, 11 HoNOS items were not associated with costs. The exception was 'self-injury' with an odds ratio of 1.41 (95% CI 1.10-2.99). Population attributable fractions (PAFs) for the contribution of HoNOS items to high costs ranged from 0.6% (physical illness) to 22.4% (self-injury). After adjustment, the Total HoNOS score was not associated with costs (OR 1.03, 95% CI 0.99-1.07). However, the PAF (33.3%) demonstrated that it might account for a modest proportion of the incidence of high costs. Our findings provide limited support for the utility of the self-injury item and Total HoNOS score in predicting costs. However, the absence of associations for the remaining HoNOS items indicates that current PbR clusters have minimal ability to predict costs, so potentially contributing to a misallocation of NHS resources across England. The findings may inform the development of mental health payment systems internationally, especially since the vast majority of countries have not progressed past the early stages of this development. Discrepancies between our findings with those from Australia and New Zealand point to the need for further international investigations.
-
A comparison of the UHF Follow-On and MILSTAR satellite communication systems
NASA Astrophysics Data System (ADS)
Perkins, Clifton E., Jr.
1991-09-01
The author compares the UHF Follow-On and MILSTAR satellite communication systems. The comparison uses an analytical hierarchy process. Although the two systems have been tasked with different missions, a comparison of cost, capability, and orbit is conducted. UFO provides many of the same capabilities as MILSTAR, but on a smaller scale. Since UFO is also a new space system acquisition, it is used to compare dollars spent to field a viable communication system. A review of frequency bands, losses, and problems is conducted to establish the relationship. Cost data is provided to establish the major difference in the systems. While MILSTAR does possess more total capability than UFO, it is 10 times more costly. Additionally, UFO is a satellite that will evolve with new technology while MILSTAR is built to full capability immediately. In the author's opinion, the incremental performance of MILSTAR does not justify its incremental cost.
-
Chwała, Wiesław; Klimek, Andrzej; Mirek, Wacław
2014-01-01
The aim of the study was to assess energy cost and total external work (total energy) depending on the speed of race walking. Another objective was to determine the contribution of external work to total energy cost of walking at technical, threshold and racing speed in elite competitive race walkers. The study involved 12 competitive race walkers aged 24.9 4.10 years with 6 to 20 years of experience, who achieved a national or international sports level. Their aerobic endurance was determined by means of a direct method involving an incremental exercise test on the treadmill. The participants performed three tests walking each time with one of the three speeds according to the same protocol: an 8-minute walk with at steady speed was followed by a recovery phase until the oxygen debt was repaid. To measure exercise energy cost, an indirect method based on the volume of oxygen uptake was employed. The gait of the participants was recorded using the 3D Vicon opto-electronic motion capture system. Values of changes in potential energy and total kinetic energy in a gate cycle were determined based on vertical displacements of the centre of mass. Changes in mechanical energy amounted to the value of total external work of muscles needed to accelerate and lift the centre of mass during a normalised gait cycle. The values of average energy cost and of total external work standardised to body mass and distance covered calculated for technical speed, threshold and racing speeds turned out to be statistically significant (p 0.001). The total energy cost ranged from 51.2 kJ.m-1 during walking at technical speed to 78.3 kJ.m-1 during walking at a racing speed. Regardless of the type of speed, the total external work of muscles accounted for around 25% of total energy cost in race walking. Total external work mainly increased because of changes in the resultant kinetic energy of the centre of mass movement. PMID:25713673
-
Remediation System Design Optimization: Field Demonstration at the Umatilla Army Deport
NASA Astrophysics Data System (ADS)
Zheng, C.; Wang, P. P.
2002-05-01
Since the early 1980s, many researchers have shown that the simulation-optimization (S/O) approach is superior to the traditional trial-and-error method for designing cost-effective groundwater pump-and-treat systems. However, the application of the S/O approach to real field problems has remained limited. This paper describes the application of a new general simulation-optimization code to optimize an existing pump-and-treat system at the Umatilla Army Depot in Oregon, as part of a field demonstration project supported by the Environmental Security Technology Certification Program (ESTCP). Two optimization formulations were developed to minimize the total capital and operational costs under the current and possibly expanded treatment plant capacities. A third formulation was developed to minimize the total contaminant mass of RDX and TNT remaining in the shallow aquifer by the end of the project duration. For the first two formulations, this study produced an optimal pumping strategy that would achieve the cleanup goal in 4 years with a total cost of 1.66 million US dollars in net present value. For comparison, the existing design in operation was calculated to require 17 years for cleanup with a total cost of 3.83 million US dollars in net present value. Thus, the optimal pumping strategy represents a reduction of 13 years in cleanup time and a reduction of 56.6 percent in the expected total expenditure. For the third formulation, this study identified an optimal dynamic pumping strategy that would reduce the total mass remaining in the shallow aquifer by 89.5 percent compared with that calculated for the existing design. In spite of their intensive computational requirements, this study shows that the global optimization techniques including tabu search and genetic algorithms can be applied successfully to large-scale field problems involving multiple contaminants and complex hydrogeological conditions.
-
77 FR 27802 - Proposed Collection; Comments Request
Federal Register 2010, 2011, 2012, 2013, 2014
2012-05-11
... Costs: 0. Total Annual Costs (Operating/Maintaining systems or Purchasing Services): 0. The National... following public information collection request (ICR) to the Office of Management and Budget (OMB) for... Endowment for the Arts, Office of Management and Budget, Room 10235, Washington, DC 20503 202/395-7316...
-
2002-07-29
suggestions, and guidance concerning the technology assessment process. References 1. Using ACEIT for Total Ownership Cost Modeling and Analysis...2001 World Population Data Sheet, Population Reference Bureau, Washington, DC List of Acronyms ACEIT – Automated Cost Estimating Integrated
-
Total staff costs to implement a decision support system in nursing.
Castilho, Valéria; Lima, Antônio Fernandes Costa; Fugulin, Fernanda Maria Togeiro; Peres, Heloisa Helena Ciqueto; Gaidzinski, Raquel Rapone
2014-01-01
to identify the direct labor (DL) costs to put in practice a decision support system (DSS) in nursing at the University Hospital of the University of São Paulo (HU-USP). the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. the DL cost corresponded to R$ 752,618.56 (100%), R$ 26,000.00 (3.45%) of which were funded by a funding agency, while R$ 726,618.56 (96,55%) came from Hospital and University resources. considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing.
-
Spacecraft expected cost analysis with k-out-of-n:G subsystems
NASA Technical Reports Server (NTRS)
Patterson, Richard; Suich, Ron
1991-01-01
In designing a subsystem for a spacecraft, the design engineer is often faced with a number of options ranging from planning an inexpensive subsystem with low reliability to selecting a highly reliable system that would cost much more. We minimize the total of the cost of the subsytem and the costs that would occur if the subsystem fails. We choose the subsystem with the lowest total. A k-out-of-n:G subsystem has n modules, of which k are required to be good for the subsystem to be good. We examine two models to illustrate the principles of the k-out-of-n:G subsystem designs. For the first model, the following assumptions are necessary: the probability of failure of any module in the system is not affected by the failure of any other module; and each of the modules has the same probabillity of success. For the second model we are also free to choose k in our subsystem.
-
Performance and cost evaluation of constructed wetland for domestic waste water treatment.
Deeptha, V T; Sudarsan, J S; Baskar, G
2015-09-01
Root zone treatment through constructed wetlands is an engineered method of purifying wastewater. The aim of the present research was to study the potential of wetland plants Phragmites and Typha in treatment of wastewater and to compare the cost of constructed wetlands with that of conventional treatment systems. A pilot wetland unit of size 2x1x0.9 m was constructed in the campus. 3x3 rows of plants were transplanted into the pilot unit and subjected to wastewater from the hostels and other campus buildings. The raw wastewater and treated wastewater were collected periodically and tested for Total nitrogen (TN),Total Phosphorous (TP), Biological Oxygen Demand (BOD), Chemical Oxygen Demand (COD). It was observed that this pilot unit reduced the concentrations of TN, TP, BOD and COD by 76, 73, 83 and 86%, respectively, on an average. Root zone system achieved standards for tertiary treatment with low operating costs, low maintenance costs, enhance the landscape, provide a natural habitat for birds, and did not emit any odour.
-
Pressure injury in Australian public hospitals: a cost-of-illness study.
Nguyen, Kim-Huong; Chaboyer, Wendy; Whitty, Jennifer A
2015-06-01
Pressure injuries (PI) are largely preventable and can be viewed as an adverse outcome of a healthcare admission, yet they affect millions of people and consume billions of dollars in healthcare spending. The existing literature in Australia presents a patchy picture of the economic burden of PI on society and the health system. The aim of the present study was to provide a more comprehensive and updated picture of PI by state and severity using publicly available data. A cost-of-illness analysis was conducted using a prevalence approach and a 1-year time horizon based on data from the existing literature extrapolated using simulation methods to estimate the costs by PI severity and state subgroups. The treatment cost across all states and severity in 2012-13 was estimated to be A$983 million per annum, representing approximately 1.9% of all public hospital expenditure or 0.6% of the public recurrent health expenditure. The opportunity cost was valued at an additional A$820 million per annum. These estimates were associated with a total number of 121 645 PI cases in 2012-13 and a total number of 524 661 bed days lost. The costs estimated in the present study highlight the economic waste for the Australian health system associated with a largely avoidable injury. Wastage can also be reduced by preventing moderate injuries (Stage I and II) from developing into severe cases (Stage III and IV), because the severe cases, accounting for 12% of cases, mounted to 30% of the total cost.
-
Cost-Effectiveness of Nitrogen Mitigation by Alternative ...
Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. We seek to address two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes, and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets and neighborhood-scale blackwater digesters are also attractive options in some cases, particularly best-case nitrogen mitigation; innovative/advanced septic system
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Ardani, K.; Seif, D.; Margolis, R.
2013-08-01
The objective of this analysis is to roadmap the cost reductions and innovations necessary to achieve the U.S. Department of Energy (DOE) SunShot Initiative's total soft-cost targets by 2020. The roadmap focuses on advances in four soft-cost areas: (1) customer acquisition; (2) permitting, inspection, and interconnection (PII); (3) installation labor; and (4) financing. Financing cost reductions are in terms of the weighted average cost of capital (WACC) for financing PV system installations, with real-percent targets of 3.0% (residential) and 3.4% (commercial).
-
Modelling the resource implications and budget impact of managing cow milk allergy in Australia.
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.
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Martin, M.A.; Durfee, D.J.; Hughes, P.J.
1999-06-19
The Lincoln Public School District, in Lincoln, Nebraska, recently installed vertical-bore geothermal heat pump systems in four, new, elementary schools. Because the district has consistent maintenance records and procedures, it was possible to study repair, service and corrective maintenance requests for 20 schools in the district. Each school studied provides cooling to over 70% of its total floor area and uses one of the following heating and cooling systems: vertical-bore geothermal heat pumps (GHPs), air-cooled chiller with gas-fired hot water boiler (ACUGHWB), water-cooled chiller with gas-fired hot water boiler (WCCYGHWB), or water-cooled chiller with gas-fired steam boiler (WCUGSB). Preventative maintenancemore » and capital renewal activities were not included in the available database. GHP schools reported average total costs at 2.13 cents/ft{sup 2}-yr, followed by ACC/GHWB schools at 2.88 cents/ft{sup 2}-yr, WCC/GSB schools at 3.73 cents/ft{sup 2}-yr, and WCC/GHWB schools at 6.07 cents/ft{sup 2}-yr. Because of tax-exemptions on material purchases, a reliance on in-house labor, and the absence of preventative maintenance records in the database, these costs are lower than those reported in previous studies. A strong relationship (R{sup 2}=O.52) was found between costs examined and cooling system age: the newer the cooling equipment, the less it costs to maintain.« less
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Martin, M.A.; Durfee, D.J.; Hughes, P.J.
1999-07-01
The Lincoln Public School District, in Lincoln, Nebraska, recently installed vertical-bore geothermal heat pump systems in four new elementary schools. Because the district has consistent maintenance records and procedures, it was possible to study repair, service, and corrective maintenance requests for 20 schools in the district. Each school studied provides cooling to over 70% of its total floor area and uses one of the following heating and cooling systems: vertical-bore geothermal heat pumps (GHPs), air-cooled chiller with gas-fired hot water boiler (ACC/GHWB), water-cooled chiller with gas-fired hot water boiler (WCC/GHWB), or water-cooled chiller with gas-fired steam boiler (WCC/GSB). Preventative maintenancemore » and capital renewal activities were not included in the available database. GHP schools reported average total costs at 2.13{cents}/ft{sup 2}-yr, followed by ACC/GHWB schools at 2.884{cents}/ft{sup 2}-yr, WCC/GSB schools at 3.73{cents}/ft{sup 2}-yr, and WCC/GHWB schools at 6.07{cents}/ft{sup 2}-yr. Because of tax exemptions on material purchases, a reliance on in-house labor, and the absence of preventative maintenance records in the database, these costs are lower than those reported in previous studies. A strong relationship (R{sup 2} = 0.52) was found between costs examined and cooling system age: the newer the cooling equipment, the less it costs to maintain.« less
-
Makhni, Eric C; Swart, Eric; Steinhaus, Michael E; Mather, Richard C; Levine, William N; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N
2016-09-01
To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these patients. LEVEL OF EVIDENCE: Level II, economic decision analysis. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
-
Cost Analysis of Ceramic Heads in Primary Total Hip Arthroplasty.
Carnes, Keith J; Odum, Susan M; Troyer, Jennifer L; Fehring, Thomas K
2016-11-02
The advent of adverse local tissue reactions seen in metal-on-metal bearings, and the recent recognition of trunnionosis, have led many surgeons to recommend ceramic-on-polyethylene articulations for primary total hip arthroplasty. However, to our knowledge, there has been little research that has considered whether the increased cost of ceramic provides enough benefit over cobalt-chromium to justify its use. The primary purpose of this study was to compare the cost-effectiveness of ceramic-on-polyethylene implants and metal-on-polyethylene implants in patients undergoing total hip arthroplasty. Markov decision modeling was used to determine the ceramic-on-polyethylene implant revision rate necessary to be cost-effective compared with the revision rate of metal-on-polyethylene implants across a range of patient ages and implant costs. A different set of Markov models was used to estimate the national cost burden of choosing ceramic-on-polyethylene implants over metal-on-polyethylene implants for primary total hip arthroplasties. The Premier Research Database was used to identify 20,398 patients who in 2012 were ≥45 years of age and underwent a total hip arthroplasty with either a ceramic-on-polyethylene implant or a metal-on-polyethylene implant. The cost-effectiveness of ceramic heads is highly dependent on the cost differential between ceramic and metal femoral heads and the age of the patient. At a cost differential of $325, ceramic-on-polyethylene bearings are cost-effective for patients <85 years of age. At a cost differential of $600, it is cost-effective to utilize ceramic-on-polyethylene bearings in patients <65 years of age, and, at a differential of $1,003, ceramic-on-polyethylene bearings are not cost-effective at any age. The ability to recoup the initial increased expenditure of ceramic heads through a diminished lifetime revision cost is dependent on the price premium for ceramic and the age of the patient. A wholesale switch to ceramic bearings regardless of age or cost differential may result in an economic burden to the health system. Economic and decision analysis, Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.
-
Duncan, Stephen T; Jacobs, Cale A; Christensen, Christian P; Nunley, Ryan M; Macaulay, William B
2017-04-01
The Center for Medicare and Medicaid Services (CMS) has proposed a move to payment based on patient-reported outcomes (PROs), and failure to report on PROs will result in a penalty of 2% in 2016. However, the cost to the physician to collect PROs is not known. Using data from the 2013 Medical Group Management Association Compensation and Financial survey and Center for Medicare and Medicaid Services reimbursement, a calculation was performed to determine the cost to the physician to report on PROs for patients undergoing total knee arthroplasty and total hip arthroplasty. Using Medical Group Management Association and Medicare fee for service rates, calculations were performed based on an annual volume of 200 Medicare operative cases (125 total knee arthroplasties, 75 total hip arthroplasties) with 1000 new patients (level 4) and 2000 established patients (level 3) visits. A range of start-up and annual costs necessary to collect PROs including hardware, software, and personnel costs was calculated and then compared with the calculated 2% Medicare penalty for failing to report PROs in 2016. The cost to collect PROs ranged from $47,973 to $56,288 which far outweighed the penalty of $2954 in 2016 for failing to report these measures. With the move toward requiring surgeons to report PROs for reimbursement, the current financial model would prove to be cost prohibitive and the incentive to report PROs might be too costly to gain wide acceptance. Copyright © 2016 Elsevier Inc. All rights reserved.
-
CO2 Reduction Effect of the Utilization of Waste Heat and Solar Heat in City Gas System
NASA Astrophysics Data System (ADS)
Okamura, Tomohito; Matsuhashi, Ryuji; Yoshida, Yoshikuni; Hasegawa, Hideo; Ishitani, Hisashi
We evaluate total energy consumption and CO2 emissions in the phase of the city gas utilization system from obtaining raw materials to consuming the product. First, we develop a simulation model which calculates CO2 emissions for monthly and hourly demands of electricity, heats for air conditioning and hot-water in a typical hospital. Under the given standard capacity and operating time of CGS, energy consumption in the equipments is calculated in detail considering the partial load efficiency and the control by the temperature of exhaust heat. Then, we explored the optimal size and operation of city gas system that minimizes the life cycle CO2 emissions or total cost. The cost-effectiveness is compared between conventional co-generation, solar heat system, and hybrid co-generation utilizing solar heat. We formulate a problem of mixed integer programming that includes integral parameters that express the state of system devices such as on/off of switches. As a result of optimization, the hybrid co-generation can reduce annual CO2 emissions by forty-three percent compared with the system without co-generation. Sensitivity for the scale of CGS on CO2 reduction and cost is also analyzed.
-
NASA Technical Reports Server (NTRS)
Rabadi, Ghaith
2005-01-01
A significant portion of lifecycle costs for launch vehicles are generated during the operations phase. Research indicates that operations costs can account for a large percentage of the total life-cycle costs of reusable space transportation systems. These costs are largely determined by decisions made early during conceptual design. Therefore, operational considerations are an important part of vehicle design and concept analysis process that needs to be modeled and studied early in the design phase. However, this is a difficult and challenging task due to uncertainties of operations definitions, the dynamic and combinatorial nature of the processes, and lack of analytical models and the scarcity of historical data during the conceptual design phase. Ultimately, NASA would like to know the best mix of launch vehicle concepts that would meet the missions launch dates at the minimum cost. To answer this question, we first need to develop a model to estimate the total cost, including the operational cost, to accomplish this set of missions. In this project, we have developed and implemented a discrete-event simulation model using ARENA (a simulation modeling environment) to determine this cost assessment. Discrete-event simulation is widely used in modeling complex systems, including transportation systems, due to its flexibility, and ability to capture the dynamics of the system. The simulation model accepts manifest inputs including the set of missions that need to be accomplished over a period of time, the clients (e.g., NASA or DoD) who wish to transport the payload to space, the payload weights, and their destinations (e.g., International Space Station, LEO, or GEO). A user of the simulation model can define an architecture of reusable or expendable launch vehicles to achieve these missions. Launch vehicles may belong to different families where each family may have it own set of resources, processing times, and cost factors. The goal is to capture the required resource levels of the major launch elements and their required facilities. The model s output can show whether or not a certain architecture of vehicles can meet the launch dates, and if not, how much the delay cost would be. It will also produce aggregate figures of missions cost based on element procurement cost, processing cost, cargo integration cost, delay cost, and mission support cost. One of the most useful features of this model is that it is stochastic where it accepts statistical distributions to represent the processing times mimicking the stochastic nature of real systems.
-
Valladares Linares, R; Li, Z; Yangali-Quintanilla, V; Ghaffour, N; Amy, G; Leiknes, T; Vrouwenvelder, J S
2016-01-01
In recent years, forward osmosis (FO) hybrid membrane systems have been investigated as an alternative to conventional high-pressure membrane processes (i.e. reverse osmosis (RO)) for seawater desalination and wastewater treatment and recovery. Nevertheless, their economic advantage in comparison to conventional processes for seawater desalination and municipal wastewater treatment has not been clearly addressed. This work presents a detailed economic analysis on capital and operational expenses (CAPEX and OPEX) for: i) a hybrid forward osmosis - low-pressure reverse osmosis (FO-LPRO) process, ii) a conventional seawater reverse osmosis (SWRO) desalination process, and iii) a membrane bioreactor - reverse osmosis - advanced oxidation process (MBR-RO-AOP) for wastewater treatment and reuse. The most important variables affecting economic feasibility are obtained through a sensitivity analysis of a hybrid FO-LPRO system. The main parameters taken into account for the life cycle costs are the water quality characteristics (similar feed water and similar water produced), production capacity of 100,000 m(3) d(-1) of potable water, energy consumption, materials, maintenance, operation, RO and FO module costs, and chemicals. Compared to SWRO, the FO-LPRO systems have a 21% higher CAPEX and a 56% lower OPEX due to savings in energy consumption and fouling control. In terms of the total water cost per cubic meter of water produced, the hybrid FO-LPRO desalination system has a 16% cost reduction compared to the benchmark for desalination, mainly SWRO. Compared to the MBR-RO-AOP, the FO-LPRO systems have a 7% lower CAPEX and 9% higher OPEX, resulting in no significant cost reduction per m(3) produced by FO-LPRO. Hybrid FO-LPRO membrane systems are shown to have an economic advantage compared to current available technology for desalination, and comparable costs with a wastewater treatment and recovery system. Based on development on FO membrane modules, packing density, and water permeability, the total water cost could be further reduced. Copyright © 2015 Elsevier Ltd. All rights reserved.
-
Using patient classification systems to identify ambulatory care costs.
Karpiel, M S
1994-11-01
Ambulatory care continues to increase as a percentage of total hospital revenue. Until recently, reimbursement for ambulatory care was provided on a cost basis. However, payers are attempting to exert more control over reimbursement for ambulatory care. The Health Care Financing Administration, for example, is expanding the use of prospective payment to cover more forms of outpatient care. Thus, in order to ensure the financial viability of their organizations, healthcare financial managers will need cost-accounting tools, such as patient classification systems, to ascertain the direct and indirect costs of emergency or outpatient visits and thereby to refine pricing, contracting, staffing, productivity, and profitability analyses for ambulatory care.
-
Cost and utilization outcomes of patients receiving hospital-based palliative care consultation.
Penrod, Joan D; Deb, Partha; Luhrs, Carol; Dellenbaugh, Cornelia; Zhu, Carolyn W; Hochman, Tsivia; Maciejewski, Matthew L; Granieri, Evelyn; Morrison, R Sean
2006-08-01
To compare per diem total direct, ancillary (laboratory and radiology) and pharmacy costs of palliative care (PC) compared to usual care (UC) patients during a terminal hospitalization; to examine the association between PC and ICU admission. Retrospective, observational cost analysis using a VA (payer) perspective. Two urban VA medical centers. Demographic and health characteristics of 314 veterans admitted during two years were obtained from VA administrative data. Hospital costs came from the VA cost accounting system. Generalized linear models (GLM) were estimated for total direct, ancillary and pharmacy costs. Predictors included patient age, principal diagnosis, comorbidity, whether patient stay was medical or surgical, site and whether the patient was seen by the palliative care consultation team. A probit regression was used to analyze probability of ICU admission. Propensity score matching was used to improve balance in observed covariates. PC patients were 42 percentage points (95% CI, -56% [corrected] to -31%) less likely to be admitted to ICU. Total direct costs per day were $239 (95% CI, -387 to -122) lower and ancillary costs were $98 (95% CI, -133 to -57) lower than costs for UC patients. There was no difference in pharmacy costs. The results were similar using propensity score matching. PC was associated with significantly lower likelihood of ICU use and lower inpatient costs compared to UC. Our findings coupled with those indicating better patient and family outcomes with PC suggest both a cost and quality incentive for hospitals to develop PC programs.
-
Perineal tap water burns in the elderly: at what cost?
Potter, Michael D E; Maitz, Peter K M; Kennedy, Peter J; Goltsman, David
2017-11-01
Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population-specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns. Six elderly patients (75-92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into 'direct' and 'indirect' costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs. Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9-21% (mean 12.8%). Length of stay ranged from 26-98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01). Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort. © 2016 Royal Australasian College of Surgeons.
-
RAPID REMOVAL OF A GROUNDWATER CONTAMINANT PLUME.
Lefkoff, L. Jeff; Gorelick, Steven M.; ,
1985-01-01
A groundwater management model is used to design an aquifer restoration system that removes a contaminant plume from a hypothetical aquifer in four years. The design model utilizes groundwater flow simulation and mathematical optimization. Optimal pumping and injection strategies achieve rapid restoration for a minimum total pumping cost. Rapid restoration is accomplished by maintaining specified groundwater velocities around the plume perimeter towards a group of pumping wells located near the plume center. The model does not account for hydrodynamic dispersion. Results show that pumping costs are particularly sensitive to injection capacity. An 8 percent decrease in the maximum allowable injection rate may lead to a 29 percent increase in total pumping costs.
-
Reliability and cost analysis methods
NASA Technical Reports Server (NTRS)
Suich, Ronald C.
1991-01-01
In the design phase of a system, how does a design engineer or manager choose between a subsystem with .990 reliability and a more costly subsystem with .995 reliability? When is the increased cost justified? High reliability is not necessarily an end in itself but may be desirable in order to reduce the expected cost due to subsystem failure. However, this may not be the wisest use of funds since the expected cost due to subsystem failure is not the only cost involved. The subsystem itself may be very costly. We should not consider either the cost of the subsystem or the expected cost due to subsystem failure separately but should minimize the total of the two costs, i.e., the total of the cost of the subsystem plus the expected cost due to subsystem failure. This final report discusses the Combined Analysis of Reliability, Redundancy, and Cost (CARRAC) methods which were developed under Grant Number NAG 3-1100 from the NASA Lewis Research Center. CARRAC methods and a CARRAC computer program employ five models which can be used to cover a wide range of problems. The models contain an option which can include repair of failed modules.
-
48 CFR 49.206-2 - Bases for settlement proposals.
Code of Federal Regulations, 2013 CFR
2013-10-01
... construction or related professional services contract. (ii) The partial or complete termination of supply... distinguished from a lump-sum) professional services contract. (b) Total cost basis. (1) When use of the..., under the contractor's accounting system, unit costs for work in process and finished products cannot...
-
48 CFR 49.206-2 - Bases for settlement proposals.
Code of Federal Regulations, 2014 CFR
2014-10-01
... construction or related professional services contract. (ii) The partial or complete termination of supply... distinguished from a lump-sum) professional services contract. (b) Total cost basis. (1) When use of the..., under the contractor's accounting system, unit costs for work in process and finished products cannot...
-
48 CFR 49.206-2 - Bases for settlement proposals.
Code of Federal Regulations, 2012 CFR
2012-10-01
... construction or related professional services contract. (ii) The partial or complete termination of supply... distinguished from a lump-sum) professional services contract. (b) Total cost basis. (1) When use of the..., under the contractor's accounting system, unit costs for work in process and finished products cannot...
-
48 CFR 49.206-2 - Bases for settlement proposals.
Code of Federal Regulations, 2011 CFR
2011-10-01
... construction or related professional services contract. (ii) The partial or complete termination of supply... distinguished from a lump-sum) professional services contract. (b) Total cost basis. (1) When use of the..., under the contractor's accounting system, unit costs for work in process and finished products cannot...
-
41 CFR 101-39.406 - Responsibility for damages.
Code of Federal Regulations, 2012 CFR
2012-07-01
... Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR... total cost of all damages resulting from neglect or abuse of assigned or issued GSA IFMS vehicles. (c... charge all costs to that agency, including fair market value of the vehicle less any salvage value. Upon...
-
41 CFR 101-39.406 - Responsibility for damages.
Code of Federal Regulations, 2014 CFR
2014-07-01
... Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR... total cost of all damages resulting from neglect or abuse of assigned or issued GSA IFMS vehicles. (c... charge all costs to that agency, including fair market value of the vehicle less any salvage value. Upon...
-
41 CFR 101-39.406 - Responsibility for damages.
Code of Federal Regulations, 2013 CFR
2013-07-01
... Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR... total cost of all damages resulting from neglect or abuse of assigned or issued GSA IFMS vehicles. (c... charge all costs to that agency, including fair market value of the vehicle less any salvage value. Upon...
-
A Comparison of Three Commercial Online Vendors.
ERIC Educational Resources Information Center
Hoover, Ryan E.
1979-01-01
Compares database update currency, number of hits, elapsed time, number of offline prints or online types, offline print turnaround time, vendor rates, total search cost, and discounted search cost based on vendor discount rates for five simple searches run on three major commercial vendors' online systems. (CWM)
-
The impact of using an intravenous workflow management system (IVWMS) on cost and patient safety.
Lin, Alex C; Deng, Yihong; Thaibah, Hilal; Hingl, John; Penm, Jonathan; Ivey, Marianne F; Thomas, Mark
2018-07-01
The aim of this study was to determine the financial costs associated with wasted and missing doses before and after the implementation of an intravenous workflow management system (IVWMS) and to quantify the number and the rate of detected intravenous (IV) preparation errors. A retrospective analysis of the sample hospital information system database was conducted using three months of data before and after the implementation of an IVWMS System (DoseEdge ® ) which uses barcode scanning and photographic technologies to track and verify each step of the preparation process. The financial impact associated with wasted and missing >IV doses was determined by combining drug acquisition, labor, accessory, and disposal costs. The intercepted error reports and pharmacist detected error reports were drawn from the IVWMS to quantify the number of errors by defined error categories. The total number of IV doses prepared before and after the implementation of the IVWMS system were 110,963 and 101,765 doses, respectively. The adoption of the IVWMS significantly reduced the amount of wasted and missing IV doses by 14,176 and 2268 doses, respectively (p < 0.001). The overall cost savings of using the system was $144,019 over 3 months. The total number of errors detected was 1160 (1.14%) after using the IVWMS. The implementation of the IVWMS facilitated workflow changes that led to a positive impact on cost and patient safety. The implementation of the IVWMS increased patient safety by enforcing standard operating procedures and bar code verifications. Published by Elsevier B.V.
-
Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer.
Rocque, Gabrielle B; Pisu, Maria; Jackson, Bradford E; Kvale, Elizabeth A; Demark-Wahnefried, Wendy; Martin, Michelle Y; Meneses, Karen; Li, Yufeng; Taylor, Richard A; Acemgil, Aras; Williams, Courtney P; Lisovicz, Nedra; Fouad, Mona; Kenzik, Kelly M; Partridge, Edward E
2017-06-01
Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program. To examine the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network. This observational study from January 1, 2012, through December 31, 2015, used propensity score-matched regression analysis to compare quarterly changes in the mean total Medicare costs and resource use between navigated patients and nonnavigated, matched comparison patients. The setting was The University of Alabama at Birmingham Health System Cancer Community Network, which includes 2 academic and 10 community cancer centers across Alabama, Georgia, Florida, Mississippi, and Tennessee. Participants were Medicare beneficiaries with cancer who received care at participating institutions from 2012 through 2015. The primary exposure was contact with a patient navigator. Navigated patients were matched to nonnavigated patients on age, race, sex, cancer acuity (high vs low), comorbidity score, and preenrollment characteristics (costs, emergency department visits, hospitalizations, intensive care unit admissions, and chemotherapy in the preenrollment quarter). Total costs to Medicare, components of cost, and resource use (emergency department visits, hospitalizations, and intensive care unit admissions). In total, 12 428 patients (mean (SD) age at cancer diagnosis, 75 (7) years; 52.0% female) were propensity score matched, including 6214 patients in the navigated group and 6214 patients in the matched nonnavigated comparison group. Compared with the matched comparison group, the mean total costs declined by $781.29 more per quarter per navigated patient (β = -781.29, SE = 45.77, P < .001), for an estimated $19 million decline per year across the network. Inpatient and outpatient costs had the largest between-group quarterly declines, at $294 and $275, respectively, per patient. Emergency department visits, hospitalizations, and intensive care unit admissions decreased by 6.0%, 7.9%, and 10.6%, respectively, per quarter in navigated patients compared with matched comparison patients (P < .001). Costs to Medicare and health care use from 2012 through 2015 declined significantly for navigated patients compared with matched comparison patients. Lay navigation programs should be expanded as health systems transition to value-based health care.
-
Lince-Deroche, Naomi; Constant, Deborah; Harries, Jane; Blanchard, Kelly; Sinanovic, Edina; Grossman, Daniel
2015-10-01
To assess women's costs of accessing second-trimester labor induction and dilation and evacuation (D&E) services at four public hospitals in Western Cape Province, South Africa. From April to August 2010, in interviews immediately after completion of their abortion, we asked women about specific direct and indirect costs incurred. We collected information on recurring costs (i.e., per visit) and one-time expenditures and calculated total costs. In total, 194 patients participated (136 D&E; 58 induction). Their median age was 26; 37.6% reported being employed or doing paid work. Most (73.2%) women visited two different facilities, including the study facility, while seeking the procedure. Induction women reported a median of three required visits [interquartile range (IQR) 2.0-3.0] to the study facility, while D&E women reported two required visits [IQR 1.0-2.0]. Twenty-seven percent of women missed work due to the procedure, and few (4.6%) paid for childcare. At each visit, almost all women (180, 92.8%) paid for transportation costs and reported additional one-time costs (177, 91.2%) such as sanitary supplies or doctor's fees. The total median cost incurred per woman was $21.23 [IQR 11.94-44.68]. Roughly half (49.0%) received help with these costs. Although technically offered freely or low cost in the public sector, women accessing second-trimester abortion lost income and incurred costs for transport, fees, supplies and childcare. Their total costs could be reduced by minimizing the number of required visits to facilities and freely offering supplies such as sanitary pads and pregnancy tests. Limited access to second-trimester, safe abortion services in South Africa may result in some women incurring unnecessary costs. Women make multiple visits in attempting to obtain an abortion, often because of facility or health systems requirements, and incur costs for lost income, child care, transport, fees and supplies. Copyright © 2015 Elsevier Inc. All rights reserved.
-
Retinopathy of prematurity: the high cost of screening regional and remote infants.
Yu, Tzu-Ying; Donovan, Tim; Armfield, Nigel; Gole, Glen A
2018-01-25
Demand for retinopathy of prematurity (ROP) screening is increasing for infants born at rural and regional hospitals where the service is not generally available. The health system cost for screening regional/remote infants has not been reported. The objective of this study is to evaluate the cost of ROP screening at a large centralized tertiary neonatal service for infants from regional/rural hospitals. This is a retrospective study to establish the cost of transferring regional/rural infants to the Royal Brisbane and Women's Hospital for ROP screening over a 28-month period. A total of 131 infants were included in this study. Individual infant costs were calculated from analysis of clinical and administrative records. Economic cost of ROP screening for all transfers from regional/rural hospitals to Royal Brisbane and Women's Hospital. The average economic cost of ROP screening for this cohort was AUD$5110 per infant screened and the total cost was AUD$669 413. The average cost per infant screened was highest for infants from a regional centre with a population of 75 000 (AUD$14 856 per child), which was also geographically furthest from Brisbane. No infant in this cohort transferred from a regional nursery reached criteria for intervention for ROP by standard guidelines. Health system costs for ROP screening of remote infants at a centralized hospital are high. Alternative strategies using telemedicine can now be compared with centralized screening. © 2018 Royal Australian and New Zealand College of Ophthalmologists.
-
Economic burden of multimorbidity among older adults: impact on healthcare and societal costs.
Picco, Louisa; Achilla, Evanthia; Abdin, Edimansyah; Chong, Siow Ann; Vaingankar, Janhavi Ajit; McCrone, Paul; Chua, Hong Choon; Heng, Derrick; Magadi, Harish; Ng, Li Ling; Prince, Martin; Subramaniam, Mythily
2016-05-10
Multimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost. The Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors. The prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75-84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and 'Other' ethnicity were significantly associated with higher total healthcare costs. Multimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.
-
Cobos Muñoz, Daniel; Hansen, Kristian Schultz; Terris-Prestholt, Fern; Cianci, Fiona; Pérez-Lu, José Enrique; Lama, Aldo; García, Patricia J
2015-01-01
Prepaid contributory systems are increasingly being recognized as key mechanisms in achieving universal health coverage in low and middle-income countries. Peru created the Seguro Integral de Salud (SIS) to increase health service use amongst the poor by removing financial barriers. The SIS transfers funds on a fee-for-service basis to the regional health offices to cover recurrent cost (excluding salaries) of pre-specified packages of interventions. We aim to estimate the full cost of antenatal care (ANC) provision in the Ventanilla District (Callao-Peru) and to compare the actual cost to the reimbursement rates provided by SIS. The economic costs of ANC provision in 2011 in 8 of the 15 health centres in Ventanilla District were estimated from a provider perspective and the actual costs of those services covered by the SIS fee of $3.8 for each ANC visit were calculated. A combination of step-down and bottom-up costing methodologies was used. Sensitivity analysis was conducted to test the uncertainty around estimated parameters and model assumptions. Results are reported in 2011 US$. The total economic cost of ANC provision in all 8 health centres was $569,933 with an average cost per ANC visit of $31.3 (95 % CI $29.7-$33.5). Salaries comprised 74.4 % of the total cost. The average cost of the services covered by the SIS fee was $3.4 (95 % CI $3.0-$3.8) per ANC visit. Sensitivity analysis showed that the probability of the cost of an ANC visit being above the SIS reimbursed fee is 1.4 %. Our analysis suggests that the fee reimbursed by the SIS will cover the cost that it supposed to cover. However, there are significant threats to medium and longer term sustainability of this system as fee transfers represent a small fraction of the total cost of providing ANC. Increasing ANC coverage requires the other funding sources of the Regional Health Office (DIRESA) to adapt to increasing demand.
-
Space station ventilation study
NASA Technical Reports Server (NTRS)
Colombo, G. V.; Allen, G. E.
1972-01-01
A ventilation system design and selection method which is applicable to any manned vehicle were developed. The method was used to generate design options for the NASA 33-foot diameter space station, all of which meet the ventilation system design requirements. System characteristics such as weight, volume, and power were normalized to dollar costs for each option. Total system costs for the various options ranged from a worst case $8 million to a group of four which were all approximately $2 million. A system design was then chosen from the $2 million group and is presented in detail. A ventilation system layout was designed for the MSFC space station mockup which provided comfortable, efficient ventilation of the mockup. A conditioned air distribution system design for the 14-foot diameter modular space station, using the same techniques, is also presented. The tradeoff study resulted in the selection of a system which costs $1.9 million, as compared to the alternate configuration which would have cost $2.6 million.
-
Quantifying the direct public health care cost of systemic sclerosis
Morrisroe, Kathleen; Stevens, Wendy; Sahhar, Joanne; Ngian, Gene-Siew; Rabusa, Candice; Ferdowsi, Nava; Hill, Catherine; Proudman, Susanna; Nikpour, Mandana
2017-01-01
Abstract To quantify the direct healthcare cost of systemic sclerosis (SSc) and identify its determinants. Healthcare use was captured through data linkage, wherein clinical and medication data for SSc patients from the state of Victoria enrolled in the Australian Scleroderma Cohort Study were linked with the Victorian hospital admissions and emergency presentations data sets, and the Medicare Benefits Schedule which contains all government subsidized ambulatory care services, for the period 2011-2015. Medication cost was determined from the Pharmaceutical Benefits Scheme. Costs were extrapolated to all Australian SSc patients based on SSc prevalence of 21.1 per 100,000 and an Australian population of 24,304,682 in 2015. Determinants of healthcare cost were estimated using logistic regression. Total healthcare utilization cost to the Australian government extrapolated to all Australian SSc patients from 2011 to 2015 was Australian Dollar (AUD)$297,663,404.77, which is an average annual cost of AUD$59,532,680.95 (US Dollar [USD]$43,816,040.08) and annual cost per patient of AUD$11,607.07 (USD$8,542.80). Hospital costs, including inpatient hospitalization and emergency department presentations, accounted for the majority of these costs (44.4% of total), followed by medication cost (31.2%) and ambulatory care cost (24.4%). Pulmonary arterial hypertension (PAH) and gastrointestinal (GIT) involvement were the major determinants of healthcare cost (OR 2.3 and 1.8, P = .01 for hospitalizations; OR 2.8 and 2.0, P = .01 for ambulatory care; OR 7.8 and 1.6, P < .001 and P = .03 for medication cost, respectively). SSc is associated with substantial healthcare utilization and direct economic burden. The most costly aspects of SSc are PAH and GIT involvement. PMID:29310332
-
Morrisroe, Kathleen; Stevens, Wendy; Sahhar, Joanne; Ngian, Gene-Siew; Rabusa, Candice; Ferdowsi, Nava; Hill, Catherine; Proudman, Susanna; Nikpour, Mandana
2017-12-01
To quantify the direct healthcare cost of systemic sclerosis (SSc) and identify its determinants. Healthcare use was captured through data linkage, wherein clinical and medication data for SSc patients from the state of Victoria enrolled in the Australian Scleroderma Cohort Study were linked with the Victorian hospital admissions and emergency presentations data sets, and the Medicare Benefits Schedule which contains all government subsidized ambulatory care services, for the period 2011-2015. Medication cost was determined from the Pharmaceutical Benefits Scheme. Costs were extrapolated to all Australian SSc patients based on SSc prevalence of 21.1 per 100,000 and an Australian population of 24,304,682 in 2015. Determinants of healthcare cost were estimated using logistic regression. Total healthcare utilization cost to the Australian government extrapolated to all Australian SSc patients from 2011 to 2015 was Australian Dollar (AUD)$297,663,404.77, which is an average annual cost of AUD$59,532,680.95 (US Dollar [USD]$43,816,040.08) and annual cost per patient of AUD$11,607.07 (USD$8,542.80). Hospital costs, including inpatient hospitalization and emergency department presentations, accounted for the majority of these costs (44.4% of total), followed by medication cost (31.2%) and ambulatory care cost (24.4%). Pulmonary arterial hypertension (PAH) and gastrointestinal (GIT) involvement were the major determinants of healthcare cost (OR 2.3 and 1.8, P = .01 for hospitalizations; OR 2.8 and 2.0, P = .01 for ambulatory care; OR 7.8 and 1.6, P < .001 and P = .03 for medication cost, respectively). SSc is associated with substantial healthcare utilization and direct economic burden. The most costly aspects of SSc are PAH and GIT involvement.
-
NASA Astrophysics Data System (ADS)
1982-04-01
The feasibility of a geothermal heating system at the Ojo Caliente Mineral Springs Co. was investigated. The geothermal energy will be used to preheat hot water for the laundry facilities and to heat the water for a two pipe fan coil heating system in the hotel. Present annual heating fuel costs of $11,218 for propane will be replaced by electricity to operate fans and pump at an annual cost of $2547, resulting in a net savings of $8671. Installation costs include $10,100 for a well system, $1400 for a laundry system, and $41,100 for a heating system. With the addition of a 10% design fee the total installation cost is $57,860. Ignoring escalating propane fuel prices, tax credits for energy conservation equipment, and potential funding from the State of New Mexico for a geothermal demonstration project, the simple economic payback period for this project is 6.7 years.
-
Who Are the High-Cost Users? A Method for Person-Centred Attribution of Health Care Spending.
Guilcher, Sara J T; Bronskill, Susan E; Guan, Jun; Wodchis, Walter P
2016-01-01
To develop person-centered episodes of care (PCE) for community-dwelling individuals in the top fifth percentile of Ontario health care expenditures in order to: (1) describe the main clinical groupings for spending; and (2) identify patterns of spending by health sector (e.g. acute care, home care, physician billings) within and across PCE. Data were drawn from population-based administrative databases for all publicly funded health care in Ontario, Canada in 2010/11. This study is a retrospective cohort study. A total of 587,982 community-dwelling individuals were identified among those accounting for the top 5% of provincial health care expenditures between April 1, 2010 and March 31, 2011. PCE were defined as starting with an acute care admission and persisting through subsequent care settings and providers until individuals were without health system contact for 30 days. PCE were classified according to the clinical grouping for the initial admission. PCE and non-PCE costs were calculated and compared to provide a comprehensive measurement of total health system costs for the year. Among this community cohort, 697,059 PCE accounted for nearly 70% ($11,815.3 million (CAD)) of total annual publicly-funded expenditures on high-cost community-dwelling individuals. The most common clinical groupings to start a PCE were Acute Planned Surgical (35.2%), Acute Unplanned Medical (21.0%) and Post-Admission Events (10.8%). Median PCE costs ranged from $3,865 (IQR = $1,712-$10,919) for Acute Planned Surgical to $20,687 ($12,207-$39,579) for Post-Admission Events. Inpatient acute ($8,194.5 million) and inpatient rehabilitation ($434.6 million) health sectors accounted for the largest proportions of allocated PCE spending over the year. Our study provides a novel methodological approach to categorize high-cost health system users into meaningful person-centered episodes. This approach helps to explain how costs are attributable within individuals across sectors and has applications in episode-based payment formulas and quality monitoring.
-
ERIC Educational Resources Information Center
Putnam, Robert F.; Luiselli, James K.; Sennett, Kenneth; Malonson, Joanne
2002-01-01
Evaluation of out-of-district special education placement costs in the 15 largest Massachusetts public school districts found the criterion school district (which had developed a system-wide approach to behavioral intervention) had the lowest per capita cost, lowest percentage of total school budget consumed by out-of-district placements, and the…
-
Financial performance of the teaching pharmacies in Isfahan: an economic evaluation
Sabzghabaee, A.M.; Etebari, M.; Sajjadi, H.; Badri, Sh.; Hosseini-Biuki, S.M.; Sheikhaboumasoudi, R.
2009-01-01
Teaching pharmacies are amongst the important cornerstones of a healthcare system for drug supplying, pharmacy education and pharmacy practice research. Assessment of the Iranian healthcare system costs shows that after personnel charges, drug outlay is the second expensive factor. This great financial mass requires integral audit and management in order to provide costumers satisfaction in addition to financial viability. Teaching pharmacies are required to realize financial viability as well as providing several educational and drug servicing goals, which makes microeconomic analysis important. The aim of this study was to evaluate the financial performance of the teaching pharmacies affiliated with the Isfahan University of Medical Sciences (with the abrreviated names as: SHM, ISJ, AZH for the confidentialiy of the financial data). This is a descriptive and cross-sectional study done in 2008. The target pharmacies of this study were all the 3 teaching pharmacies affiliated with the Isfahan University of Medical Sciences. The data collecting template was prepared using the standard scientific methods according to the goals of this research The goals also nominated necessary items needed in economic profit evaluation. The data collection template was completed by reference to the teaching pharmacies financial documents and reports, used as a base for calculating the total income and the total costs in 2007-2008 financial year. The difference between these two balances showed the value of profits or loss. The profit/cost ratio was also calculated, using the proportion of the total income to the total costs. The collected data was statistically analyzed using the Excel software (Microsoft 2007). For the financial year 2007-2008, the difference between the total income and the total costs was -831.6 million Rials (excess costs to income) for the SHM pharmacy, + 25.4 billion Rials for the ISJ pharmacy and -429.5 million Rials for the AZH pharmacy. According to our findings there is a strong requirement to improve the financial performance of all the three teaching pharmacies while maintaining a high standardard of teaching and educational affairs. PMID:21589804
-
Liu, Shuang; Wang, Jing; Zhang, Liang; Zhang, Xiang
2018-03-09
In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County. Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables. The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples. The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers' motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals.
-
Financial performance of the teaching pharmacies in Isfahan: an economic evaluation.
Sabzghabaee, A M; Etebari, M; Sajjadi, H; Badri, Sh; Hosseini-Biuki, S M; Sheikhaboumasoudi, R
2009-07-01
Teaching pharmacies are amongst the important cornerstones of a healthcare system for drug supplying, pharmacy education and pharmacy practice research. Assessment of the Iranian healthcare system costs shows that after personnel charges, drug outlay is the second expensive factor. This great financial mass requires integral audit and management in order to provide costumers satisfaction in addition to financial viability. Teaching pharmacies are required to realize financial viability as well as providing several educational and drug servicing goals, which makes microeconomic analysis important. The aim of this study was to evaluate the financial performance of the teaching pharmacies affiliated with the Isfahan University of Medical Sciences (with the abrreviated names as: SHM, ISJ, AZH for the confidentialiy of the financial data). This is a descriptive and cross-sectional study done in 2008. The target pharmacies of this study were all the 3 teaching pharmacies affiliated with the Isfahan University of Medical Sciences. The data collecting template was prepared using the standard scientific methods according to the goals of this research The goals also nominated necessary items needed in economic profit evaluation. The data collection template was completed by reference to the teaching pharmacies financial documents and reports, used as a base for calculating the total income and the total costs in 2007-2008 financial year. The difference between these two balances showed the value of profits or loss. The profit/cost ratio was also calculated, using the proportion of the total income to the total costs. The collected data was statistically analyzed using the Excel software (Microsoft 2007). For the financial year 2007-2008, the difference between the total income and the total costs was -831.6 million Rials (excess costs to income) for the SHM pharmacy, + 25.4 billion Rials for the ISJ pharmacy and -429.5 million Rials for the AZH pharmacy. According to our findings there is a strong requirement to improve the financial performance of all the three teaching pharmacies while maintaining a high standardard of teaching and educational affairs.
-
Reduction of Total Ownership Cost
2003-09-30
preparation of the Technology Development Strategy, which addresses technology risk for a new weapon system. If there is a misstep...requirements for a new system may be transfixed by the technical performance and may not clearly establish requirements for ownership cost to achieve...important to the PM than TOC goals that will not be realized until long after the PM has departed for a new assignment or retired. If PMs and their
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Woodhouse, Michael; Jones-Albertus, Rebecca; Feldman, David
2016-05-01
This report examines the remaining challenges to achieving the competitive photovoltaic (PV) costs and large-scale deployment envisioned under the U.S. Department of Energy's SunShot Initiative. Solar-energy cost reductions can be realized through lower PV module and balance-of-system (BOS) costs as well as improved system efficiency and reliability. Numerous combinations of PV improvements could help achieve the levelized cost of electricity (LCOE) goals because of the tradeoffs among key metrics like module price, efficiency, and degradation rate as well as system price and lifetime. Using LCOE modeling based on bottom-up cost analysis, two specific pathways are mapped to exemplify the manymore » possible approaches to module cost reductions of 29%-38% between 2015 and 2020. BOS hardware and soft cost reductions, ranging from 54%-77% of total cost reductions, are also modeled. The residential sector's high supply-chain costs, labor requirements, and customer-acquisition costs give it the greatest BOS cost-reduction opportunities, followed by the commercial sector, although opportunities are available to the utility-scale sector as well. Finally, a future scenario is considered in which very high PV penetration requires additional costs to facilitate grid integration and increased power-system flexibility--which might necessitate even lower solar LCOEs. The analysis of a pathway to 3-5 cents/kWh PV systems underscores the importance of combining robust improvements in PV module and BOS costs as well as PV system efficiency and reliability if such aggressive long-term targets are to be achieved.« less
-
Cost-benefit analysis of electronic medical record system at a tertiary care hospital.
Choi, Jong Soo; Lee, Woo Baik; Rhee, Poong-Lyul
2013-09-01
Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric.
-
2012-01-01
Background Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS). Methods Population attributable risk (PAR) was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR) ≥ 1.20 or RR ≥1.10 and < 1.20, but important problem of public health due its high prevalence. After a broad search in the literature, two meta-analysis were selected to provide RR for PAR calculation. The prevalence rates of overweight and obesity in Brazilians with ≥18 years were obtained from large national survey. The national health database (DATASUS) was used to estimate the annual cost of the Brazilian Unified Health System (SUS) with the diseases included in the analysis. The extracted values were stratified by sex, type of service (inpatient or outpatient care) and year. Data were collected from 2008 to 2010 and the results reflect the average of 3 years. Brazilian costs were converted into US dollars during the analysis using a purchasing power parity basis (2010). Results The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs) due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. Conclusion The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions. PMID:22713624
-
Mathauer, Inke; Nicolle, Emmanuelle
2011-10-01
Administrative costs are an important spending category in total health insurance expenditure. Yet, they have rarely been a topic outside the US and there is no cross-country comparison available. This paper provides a global overview and analysis of administrative costs for social security schemes (SSS) and private health insurance schemes (PHI). The analysis is based on data of the World Health Organization (WHO) National Health Accounts (NHA) and the Organisation for Economic Cooperation and Development (OECD) System of Health Accounts (SHA). These are the only worldwide databases on health expenditure data. Further data was retrieved from a literature search. Administrative costs are presented as a share of total health insurance costs. Data is available for 58 countries. In high-income OECD countries, the average SSS administrative costs are 4.2%. Average PHI administrative costs are about three times higher. The shares are much higher for low- and middle-income countries. However, considerable variations across and within countries over time are revealed. Seven explanatory factors are explored to explain the variations: health financing system aspects, administrative activities undertaken, insurance design aspects, context factors, reporting format, accounting methods, and management and administrative efficiency measures. More detailed reporting of administrative costs would enhance comparability and provide benchmarks. Improved administrative efficiency could free resources to expand coverage. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
-
NASA Technical Reports Server (NTRS)
1981-01-01
Reasonable space systems concepts were systematically identified and defined and a total system was evaluated for the space disposal of nuclear wastes. Areas studied include space destinations, space transportation options, launch site options payload protection approaches, and payload rescue techniques. Systems level cost and performance trades defined four alternative space systems which deliver payloads to the selected 0.85 AU heliocentric orbit destination at least as economically as the reference system without requiring removal of the protective radiation shield container. No concepts significantly less costly than the reference concept were identified.
-
Childhood epilepsy: a critical review of cost-of-illness studies.
Argumosa, Ana; Herranz, Josè Luis
2004-03-01
Epilepsy is an illness with multiple consequences and costs for children, families and society. There are only a few studies published on the cost of childhood epilepsy. The different methodologies used in these studies make it difficult to compare them or even to compare the cost of childhood epilepsy treatment with that of adult epilepsy. Nevertheless, studies highlight important differences in the distribution of costs associated with childhood epilepsy and epilepsy in adults. It is understandable that direct costs represent the higher percentage of the total cost associated with childhood epilepsy treatment, given the higher number of hospital admissions and investigations, as well as the complexity of therapeutic trials, while indirect costs represent the greater proportion in adult epilepsy treatment. In addition to age, the total cost associated with epilepsy also depends on other factors such as seizure frequency, the moment at which the illness cost is estimated and the local health care system. In summary, chronic illnesses not only have an influence on the physical and psychological development of children, they also impose costs on the family and society. Childhood epilepsy has greater economic costs than those generated by more prevalent, chronic illnesses.
-
DoD Life Cycle Management (LCM) and Product Support Manager (PSM) Rapid Deployment Training
2010-10-01
fielding, sustainment, and disposal of a DOD system across its life cycle.” (JCIDS Operation Manual) • “The PM shall be the single point of...devote more funds to development and procurement in order to modernize weapon systems . But, in fact, growth in operating and support costs has limited the...Requirements Differently could Reduce Weapon Systems ’ Total Ownership Costs The DoD “Death Spiral” (Source: Dr. Jacques S. Gansler, USD(A&T
-
NASA Astrophysics Data System (ADS)
Dulǎu, Lucian Ioan
2015-12-01
This paper describes the simulation of a microgrid system with storage technologies. The microgrid comprises 6 distributed generators (DGs), 3 loads and a 150 kW storage unit. The installed capacity of the generators is 1100 kW, while the total load demand is 900 kW. The simulation is performed by using a SCADA software, considering the power generation costs, the loads demand and the system's power losses. The generators access the system in order of their power generation cost. The simulation is performed for the entire day.
-
Saperi, Bin Sulong; Ramli, Roszalina; Ahmed, Zafar; Muhd Nur, Amrizal; Ibrahim, Mohd Ismail; Rashdi, Muhd Fazlynizam; Nordin, Rifqah; Rahman, Normastura Abd; Yusoff, Azizah; Nazimi, Abd Jabar; Abdul Rahman, Roselinda; Abdul Razak, Noorhayati; Mohamed, Norlen
2017-01-01
Objective Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma. Materials and methods A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed. Results A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia. Conclusion Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia. PMID:28223831
-
Value Narratives: A Novel Method for Understanding High-Cost Pediatric Hospital Patients.
Smith, Andrew; Andrews, Seth; Wilkins, Victoria; De Beritto, Theodore; Jenkins, Stephen; Maloney, Christopher G
2016-10-01
To delineate the drivers of cost associated with the most-costly inpatients in a tertiary pediatric hospital. We identified the 10% most-costly inpatients treated at a large regional children's hospital in 2010. From this group we randomly selected, within representative specialties, 2 groups of 50 inpatients for detailed chart review. By using daily cost data and clinical records, 2 independent reviewers examined the clinical course of each patient to identify events that drove cost beyond that expected for standard of care. By using an iterative process, these events were grouped into themes or "cost drivers." Linear regression was used to measure the association of number of cost drivers and total 2010 inpatient cost. We identified 7 cost drivers: medical complications (49%), futile treatment (6%), failure to identify family care preferences (9%), system errors (65%), preventable admissions (21%), complex family dynamics (11%), and expensive diagnosis with no other cost driver (15%). Cost drivers were associated with increased total costs. We developed a novel method for understanding high-cost inpatients. This method allowed a more detailed understanding of cost drivers than could be achieved with administrative data alone. Many of these cost drivers were related to problems with communication. Copyright © 2016 by the American Academy of Pediatrics.
-
Performance simulation for the design of solar heating and cooling systems
NASA Technical Reports Server (NTRS)
Mccormick, P. O.
1975-01-01
Suitable approaches for evaluating the performance and the cost of a solar heating and cooling system are considered, taking into account the value of a computer simulation concerning the entire system in connection with the large number of parameters involved. Operational relations concerning the collector efficiency in the case of a new improved collector and a reference collector are presented in a graph. Total costs for solar and conventional heating, ventilation, and air conditioning systems as a function of time are shown in another graph.
-
Dalaba, Maxwell Ayindenaba; Akweongo, Patricia; Williams, John; Saronga, Happiness Pius; Tonchev, Pencho; Sauerborn, Rainer; Mensah, Nathan; Blank, Antje; Kaltschmidt, Jens; Loukanova, Svetla
2014-01-01
This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana. A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009-2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost. Twenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128-lower than the financial cost by 26.5%. The study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care.
-
40 CFR 1042.850 - Exemptions and hardship relief.
Code of Federal Regulations, 2010 CFR
2010-07-01
... regulations in this chapter to avoid the impending violation. (2) Send the Designated Compliance Officer a... without significant modification of your vessel, you may ask us to determine that a remanufacturing system is not considered available for your vessel because the cost would exceed the total marginal cost...
-
A Total Systems Approach: Reducing Workers' Compensation Costs at UC Davis.
ERIC Educational Resources Information Center
Kukulinsky, Janet C.
1993-01-01
The University of California (Davis) has revamped its workers' compensation program by improving accountability and safety, implementing safety training, informing workers of the costs of the workers' compensation program, designating a physician and physical therapist, giving light duty to injured employees, using sports medicine techniques, and…
-
Prometheus payment model: application to hip and knee replacement surgery.
Rastogi, Amita; Mohr, Beth A; Williams, Jeffery O; Soobader, Mah-Jabeen; de Brantes, Francois
2009-10-01
The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs. Of the 2076 commercially insured patients undergoing hip arthroplasty in our study, PAC costs totaled $7.8 million (14% of total costs; n = 699 index PAC stays). Similarly, PAC costs were $12.7 million (14% of total costs; n = 897 index PAC stays) for 3403 patients undergoing knee arthroplasty. By holding the providers clinically and financially responsible for PACs, and by segmenting and quantifying the type of PACs generated during and after the procedure, the Prometheus model creates an opportunity for providers to focus on the reduction of PACs, including readmissions, making the data actionable and turn the waste related to PAC costs into potential savings.
-
Weng, Yu-Chi; Fujiwara, Takeshi
2011-06-01
In order to develop a sound material-cycle society, cost-effective municipal solid waste (MSW) management systems are required for the municipalities in the context of the integrated accounting system for MSW management. Firstly, this paper attempts to establish an integrated cost-benefit analysis (CBA) framework for evaluating the effectiveness of MSW management systems. In this paper, detailed cost/benefit items due to waste problems are particularly clarified. The stakeholders of MSW management systems, including the decision-makers of the municipalities and the citizens, are expected to reconsider the waste problems in depth and thus take wise actions with the aid of the proposed CBA framework. Secondly, focusing on the financial cost, this study develops a generalized methodology to evaluate the financial cost-effectiveness of MSW management systems, simultaneously considering the treatment technological levels and policy effects. The impacts of the influencing factors on the annual total and average financial MSW operation and maintenance (O&M) costs are analyzed in the Taiwanese case study with a demonstrative short-term future projection of the financial costs under scenario analysis. The established methodology would contribute to the evaluation of the current policy measures and to the modification of the policy design for the municipalities. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.
-
Costs of dengue prevention and incremental cost of dengue outbreak control in Guantanamo, Cuba.
Baly, Alberto; Toledo, Maria E; Rodriguez, Karina; Benitez, Juan R; Rodriguez, Maritza; Boelaert, Marleen; Vanlerberghe, Veerle; Van der Stuyft, Patrick
2012-01-01
To assess the economic cost of routine Aedes aegypti control in an at-risk environment without dengue endemicity and the incremental costs incurred during a sporadic outbreak. The study was conducted in 2006 in the city of Guantanamo, Cuba. We took a societal perspective to calculate costs in months without dengue transmission (January-July) and during an outbreak (August-December). Data sources were bookkeeping records, direct observations and interviews. The total economic cost per inhabitant (p.i.) per month. (p.m.) increased from 2.76 USD in months without dengue transmission to 6.05 USD during an outbreak. In months without transmission, the routine Aedes control programme cost 1.67 USD p.i. p.m. Incremental costs during the outbreak were mainly incurred by the population and the primary/secondary level of the healthcare system, hardly by the vector control programme (1.64, 1.44 and 0.21 UDS increment p.i. p.m., respectively). The total cost for managing a hospitalized suspected dengue case was 296.60 USD (62.0% direct medical, 9.0% direct non-medical and 29.0% indirect costs). In both periods, the main cost drivers for the Aedes control programme, the healthcare system and the community were the value of personnel and volunteer time or productivity losses. Intensive efforts to keep A. aegypti infestation low entail important economic costs for society. When a dengue outbreak does occur eventually, costs increase sharply. In-depth studies should assess which mix of activities and actors could maximize the effectiveness and cost-effectiveness of routine Aedes control and dengue prevention. © 2011 Blackwell Publishing Ltd.
-
Patel, Twisha S; Kaakeh, Rola; Nagel, Jerod L; Newton, Duane W; Stevenson, James G
2017-01-01
Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. Copyright © 2016 American Society for Microbiology.
-
Twomey, Conal; Prina, A. Matthew; Baldwin, David S.; Das-Munshi, Jayati; Kingdon, David; Koeser, Leonardo; Prince, Martin J.; Stewart, Robert; Tulloch, Alex D.; Cieza, Alarcos
2016-01-01
Background Few countries have made much progress in implementing transparent and efficient systems for the allocation of mental health care resources. In England there are ongoing efforts by the National Health Service (NHS) to develop mental health ‘payment by results’ (PbR). The system depends on the ability of patient ‘clusters’ derived from the Health of the Nation Outcome Scales (HoNOS) to predict costs. We therefore investigated the associations of individual HoNOS items and the Total HoNOS score at baseline with mental health service costs at one year follow-up. Methods An historical cohort study using secondary care patient records from the UK financial year 2012–2013. Included were 1,343 patients with ‘common mental health problems’, represented by ICD-10 disorders between F32-48. Costs were based on patient contacts with community-based and hospital-based mental health services. The costs outcome was transformed into ‘high costs’ vs ‘regular costs’ in main analyses. Results After adjustment for covariates, 11 HoNOS items were not associated with costs. The exception was ‘self-injury’ with an odds ratio of 1.41 (95% CI 1.10–2.99). Population attributable fractions (PAFs) for the contribution of HoNOS items to high costs ranged from 0.6% (physical illness) to 22.4% (self-injury). After adjustment, the Total HoNOS score was not associated with costs (OR 1.03, 95% CI 0.99–1.07). However, the PAF (33.3%) demonstrated that it might account for a modest proportion of the incidence of high costs. Conclusions Our findings provide limited support for the utility of the self-injury item and Total HoNOS score in predicting costs. However, the absence of associations for the remaining HoNOS items indicates that current PbR clusters have minimal ability to predict costs, so potentially contributing to a misallocation of NHS resources across England. The findings may inform the development of mental health payment systems internationally, especially since the vast majority of countries have not progressed past the early stages of this development. Discrepancies between our findings with those from Australia and New Zealand point to the need for further international investigations. PMID:27902745
-
Cost estimate of electricity produced by TPV
NASA Astrophysics Data System (ADS)
Palfinger, Günther; Bitnar, Bernd; Durisch, Wilhelm; Mayor, Jean-Claude; Grützmacher, Detlev; Gobrecht, Jens
2003-05-01
A crucial parameter for the market penetration of TPV is its electricity production cost. In this work a detailed cost estimate is performed for a Si photocell based TPV system, which was developed for electrically self-powered operation of a domestic heating system. The results are compared to a rough estimate of cost of electricity for a projected GaSb based system. For the calculation of the price of electricity, a lifetime of 20 years, an interest rate of 4.25% per year and maintenance costs of 1% of the investment are presumed. To determine the production cost of TPV systems with a power of 12-20 kW, the costs of the TPV components and 100 EUR kW-1el,peak for assembly and miscellaneous were estimated. Alternatively, the system cost for the GaSb system was derived from the cost of the photocells and from the assumption that they account for 35% of the total system cost. The calculation was done for four different TPV scenarios which include a Si based prototype system with existing technology (etasys = 1.0%), leading to 3000 EUR kW-1el,peak, an optimized Si based system using conventional, available technology (etasys = 1.5%), leading to 900 EUR kW-1el,peak, a further improved system with future technology (etasys = 5%), leading to 340 EUR kW-1el,peak and a GaSb based system (etasys = 12.3% with recuperator), leading to 1900 EUR kW-1el,peak. Thus, prices of electricity from 6 to 25 EURcents kWh-1el (including gas of about 3.5 EURcents kWh-1) were calculated and compared with those of fuel cells (31 EURcents kWh-1) and gas engines (23 EURcents kWh-1).
-
Wu, Suo-Wei; Chen, Tong; Pan, Qi; Wei, Liang-Yu; Wang, Qin; Song, Jing-Chen; Li, Chao; Luo, Ji
2018-02-20
Cervical cancer shows a growing incidence and medical cost in recent years that has increased severe financial pressure on patients and medical insurance institutions. This study aimed to investigate the medical economic characteristics of cervical cancer patients with different payment modes within a Grade A tertiary hospital to provide evidence and suggestions for inpatient cost control and to verify the application of Gamma model in medical cost analysis. The basic and cost information of cervical cancer cases within a Grade A tertiary hospital in the year 2011-2016 were collected. The Gamma model was adopted to analyze the differences in each cost item between medical insured patient and uninsured patients. Meanwhile, the marginal means of different cost items were calculated to estimate the influence of payment modes toward different medical cost items among cervical cancer patients in the study. A total of 1321 inpatients with cervical cancer between the 2011 and 2016 were collected through the medical records system. Of the 1321 cases, 65.9% accounted for medical insured patients and 34.1% were uninsured patients. The total inpatient medical expenditure of insured patients was RMB 29,509.1 Yuan and uninsured patients was RMB 22,114.3 Yuan, respectively. Payment modes, therapeutic options as well as the recurrence and metastasis of tumor toward the inpatient medical expenditures between the two groups were statistically significant. To the specifics, drug costs accounted for 37.7% and 33.8% of the total, surgery costs accounted for 21.5% and 25.5%, treatment costs accounted for 18.7% and 16.4%, whereas the costs of imaging and laboratory examinations accounted for 16.4% and 15.2% for the insured patient and uninsured patients, respectively. As the effects of covariates were controlled, the total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs showed statistical significance. The total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs of insured patient were 1.33, 1.42, 1.52, and 1.44 times of uninsured patients. The analysis of different payment modes toward the medical economic characteristics based on Gamma model is basically rational. Medical payment modes are having certain influence toward the hospitalization expenses of cervical cancer patients in an extent, as drug costs, treatment costs, and examination costs appear to be the main causes.
-
Mvundura, Mercy; Kien, Vu Duy; Nga, Nguyen Tuyet; Robertson, Joanie; Cuong, Nguyen Van; Tung, Ho Thanh; Hong, Duong Thi; Levin, Carol
2014-02-07
Few studies document the costs of operating vaccine supply chains, but decision-makers need this information to inform cost projections for investments to accommodate new vaccine introduction. This paper presents empirical estimates of vaccine supply chain costs for Vietnam's Expanded Program on Immunization (EPI) for routine vaccines at each level of the supply chain, before and after the introduction of the pentavalent vaccine. We used micro-costing methods to collect resource-use data associated with storage and transportation of vaccines and immunization supplies at the national store, the four regional stores, and a sample of provinces, districts, and commune health centers. We collected stock ledger data on the total number of doses of vaccines handled by each facility during the assessment year. Total supply chain costs were estimated at approximately US$65,000 at the national store and an average of US$39,000 per region, US$5800 per province, US$2200 per district, and US$300 per commune health center. Across all levels, cold chain equipment capital costs and labor were the largest drivers of costs. The cost per dose delivered was estimated at US$0.19 before the introduction of pentavalent and US$0.24 cents after introduction. At commune health centers, supply chain costs were 104% of the value of vaccines before introduction of pentavalent vaccine and 24% after introduction, mainly due to the higher price per dose of the pentavalent vaccine. The aggregated costs at the last tier of the health system can be substantial because of the large number of facilities. Even in countries with high-functioning systems, empirical evidence on current costs from all levels of the system can help estimate resource requirements for expanding and strengthening resources to meet future immunization program needs. Other low- and middle-income countries can benefit from similar studies, in view of new vaccine introductions that will put strains on existing systems. Copyright © 2013 Elsevier Ltd. All rights reserved.
-
The choice: Welding with CO2 or Nd:YAG lasers
NASA Astrophysics Data System (ADS)
Leong, Keng H.
The recent commercial availability of multi-kilowatt Nd:YAG lasers has opened new avenues for rapid laser processing as well as intensified the competition (cost effectiveness) between CO2 and Nd:YAG laser systems. Vendors offering Nd:YAG laser systems may claim lower operating costs (than CO2) and fiberoptic beam delivery flexibility while CO2 systems vendors may emphasize lower capital cost and well established processing requirements and experience. The capital and operating costs of a laser system are impacted by demand and supply economics and technological advances. Frequently the total cost of a workcell using a laser for processing has to be considered rather than the laser system alone. Consequently it is not very practical to approach the selection of a laser system based on its capital cost and estimated operating cost only. This presentation describes a more pragmatic approach to aid the user in the selection of the optimal multi-kilowatt laser system for a particular processing requirement with emphasis on welding. CO2 laser systems are well established on the factory floor. Consequently, emphasis is given to the comparative application of Nd:YAG lasers, process requirements and performance. Requirements for the laser welding of different metals are examined in the context of hardware (laser system and beam delivery) selection and examples of welding speeds that can be achieved using CO2 and Nd:YAG lasers are examined.
-
Can IR scene projectors reduce total system cost?
NASA Astrophysics Data System (ADS)
Ginn, Robert; Solomon, Steven
2006-05-01
There is an incredible amount of system engineering involved in turning the typical infrared system needs of probability of detection, probability of identification, and probability of false alarm into focal plane array (FPA) requirements of noise equivalent irradiance (NEI), modulation transfer function (MTF), fixed pattern noise (FPN), and defective pixels. Unfortunately, there are no analytic solutions to this problem so many approximations and plenty of "seat of the pants" engineering is employed. This leads to conservative specifications, which needlessly drive up system costs by increasing system engineering costs, reducing FPA yields, increasing test costs, increasing rework and the never ending renegotiation of requirements in an effort to rein in costs. These issues do not include the added complexity to the FPA factory manager of trying to meet varied, and changing, requirements for similar products because different customers have made different approximations and flown down different specifications. Scene generation technology may well be mature and cost effective enough to generate considerable overall savings for FPA based systems. We will compare the costs and capabilities of various existing scene generation systems and estimate the potential savings if implemented at several locations in the IR system fabrication cycle. The costs of implementing this new testing methodology will be compared to the probable savings in systems engineering, test, rework, yield improvement and others. The diverse requirements and techniques required for testing missile warning systems, missile seekers, and FLIRs will be defined. Last, we will discuss both the hardware and software requirements necessary to meet the new test paradigm and discuss additional cost improvements related to the incorporation of these technologies.
-
Solar thermal electric power plants - Their performance characteristics and total social costs
NASA Technical Reports Server (NTRS)
Caputo, R. S.; Truscello, V. C.
1976-01-01
The central receiver (power tower) concept as a thermal conversion approach to the conversion of solar energy into electricity is compared to other solar power plant designs which feature distributed solar collection and use other types of solar collector configurations. A variety of solar thermal storage concepts are discussed and their impacts on system performance are assessed. Although a good deal of quantification is possible in a comparative study, the subjective judgments carry enormous weight in a socio-economic decision, the ultimate choice of central power plant being more a social than an economic or technical decision. Major elements of the total social cost of each type of central plant are identified as utility economic costs, R&D funds, health costs, and other relevant social impacts.
-
Effectiveness of Learning Process Using "Web Technology" in the Distance Learning System
ERIC Educational Resources Information Center
Killedar, Manoj
2008-01-01
Web is a globally distributed, still highly personalized media for cost-effective delivery of multimedia information and services. Web is expected to have a strong impact on almost every aspect of how we learn. "Total Quality" is the totality of features, as perceived by the customers of the product or service. Totality of features…
-
Ascher-Svanum, Haya; Nyhuis, Allen W; Faries, Douglas E; Ball, Daniel E; Kinon, Bruce J
2010-01-28
Individuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population, but there are limited data on such encounters and their attendant costs. This study assessed the prevalence of encounters with the criminal justice system, encounter types, and the estimated cost attributable to these encounters in the one-year treatment of persons with schizophrenia. This post-hoc analysis used data from a prospective one-year cost-effectiveness study of persons treated with antipsychotics for schizophrenia and related disorders in the United States. Criminal justice system involvement was assessed using the Schizophrenia Patients Outcome Research Team (PORT) client survey and the victimization subscale of the Lehman Quality of Life Interview (QOLI). Direct cost of criminal justice system involvement was estimated using previously reported costs per type of encounter. Patients with and without involvement were compared on baseline characteristics and direct annual health care and criminal justice system-related costs. Overall, 278 (46%) of 609 participants reported at least 1 criminal justice system encounter. They were more likely to be substance users and less adherent to antipsychotics compared to participants without involvement. The 2 most prevalent types of encounters were being a victim of a crime (67%) and being on parole or probation (26%). The mean annual per-patient cost of involvement was $1,429, translating to 6% of total annual direct health care costs for those with involvement (11% when excluding crime victims). Criminal justice system involvement appears to be prevalent and costly for persons treated for schizophrenia in the United States. Findings highlight the need to better understand the interface between the mental health and the criminal justice systems and the related costs, in personal, societal, and economic terms.
-
The economic costs of illness: A replication and update
Rice, Dorothy P.; Hodgson, Thomas A.; Kopstein, Andrea N.
1985-01-01
The economic burden resulting from illness, disability, and premature death is of major importance in the allocation of health care resources and in the evaluation of health research and programs. This article updates the 1963 and 1972 studies of the costs of illness. In 1980, the estimated total economic costs of illness were $455 billion: $211 billion for direct costs, $68 billion for morbidity, and $176 billion for mortality. Diseases of the circulatory system and injuries and poisonings were the most costly, with variations in the diagnostic distributions among the three types of costs and by age and sex. PMID:10311399
-
Performance appraisal of online MEDLINE access routes.
Walker, C. J.; McKibbon, K. A.; Haynes, R. B.; Johnston, M. E.
1992-01-01
OBJECTIVE: To compare the performance and cost of 11 online MEDLINE systems with MEDLINE at Elhill. DESIGN: Comparative study. SYSTEMS: Eleven online daytime systems commercially available in North America offering the MEDLINE database. MEASURES: Number of relevant citations, number of irrelevant citations, proportion of searches producing no relevant citations and cost per relevant citation were analyzed for each system. Relevance and cost for each system were compared with direct searching of MEDLINE through NLM for librarian and clinician search strategies for 18 clinical questions. The citations retrieved by both strategies were pooled and rated for relevance on a 7-point scale. RESULTS: Numbers of relevant and irrelevant citations and cost per relevant citation were higher for clinician searches than librarian searches, reflecting the higher total number of citations retrieved by the clinician approaches. A lower proportion of clinician searches produced no relevant citations than librarian searches. CONCLUSIONS: Eleven daytime MEDLINE systems performed similarly in terms of retrieval and cost within similar searching groups. Clinicians, however, tended to capture larger overall retrievals resulting in higher numbers of relevant and irrelevant citations than librarians. PMID:1482922
-
Optimal Operation System of the Integrated District Heating System with Multiple Regional Branches
NASA Astrophysics Data System (ADS)
Kim, Ui Sik; Park, Tae Chang; Kim, Lae-Hyun; Yeo, Yeong Koo
This paper presents an optimal production and distribution management for structural and operational optimization of the integrated district heating system (DHS) with multiple regional branches. A DHS consists of energy suppliers and consumers, district heating pipelines network and heat storage facilities in the covered region. In the optimal management system, production of heat and electric power, regional heat demand, electric power bidding and sales, transport and storage of heat at each regional DHS are taken into account. The optimal management system is formulated as a mixed integer linear programming (MILP) where the objectives is to minimize the overall cost of the integrated DHS while satisfying the operation constraints of heat units and networks as well as fulfilling heating demands from consumers. Piecewise linear formulation of the production cost function and stairwise formulation of the start-up cost function are used to compute nonlinear cost function approximately. Evaluation of the total overall cost is based on weekly operations at each district heat branches. Numerical simulations show the increase of energy efficiency due to the introduction of the present optimal management system.
-
Communications systems technology assessment study. Volume 2: Results
NASA Technical Reports Server (NTRS)
Kelley, R. L.; Khatri, R. K.; Kiesling, J. D.; Weiss, J. A.
1977-01-01
The cost and technology characteristics are examined for providing special satellite services at UHF, 2.5 GHz, and 14/12 GHz. Considered are primarily health, educational, informational and emergency disaster type services. The total cost of each configuration including space segment, earth station, installation operation and maintenance was optimized to reduce the user's total annual cost and establish preferred equipment performance parameters. Technology expected to be available between now and 1985 is identified and comparisons made between selected alternatives. A key element of the study is a survey of earth station equipment updating past work in the field, providing new insight into technology, and evaluating production and test methods that can reduce costs in large production runs. Various satellite configurations were examined. The cost impact of rain attenuation at Ku-band was evaluated. The factors affecting the ultimate capacity achievable with the available orbital arc and available bandwidth were analyzed.
-
NASA Technical Reports Server (NTRS)
1971-01-01
Individualized program direct costs for each satellite program are presented. This breakdown provides the activity level dependent costs for each satellite program. The activity level dependent costs, or, more simply, program direct costs, are comprised of the total payload costs (as these costs are strictly program dependent) and the direct launch vehicle costs. Only those incremental launch vehicle costs associated directly with the satellite program are considered. For expendable launch vehicles the direct costs include the vehicle investment hardware costs and the launch operations costs. For the reusable STS vehicles the direct costs include only the launch operations, recovery operations, command and control, vehicle maintenance, and propellant support. The costs associated with amortization of reusable vehicle investment, RDT&E range support, etc., are not included.
-
The burden of gunshot injuries on orthopaedic healthcare resources in South Africa.
Martin, Case; Thiart, Gerhard; McCollum, Graham; Roche, Stephen; Maqungo, Sithombo
2017-06-30
Injuries inflicted by gunshot wounds (GSWs) are an immense burden on the South African (SA) healthcare system. In 2005, Allard and Burch estimated SA state hospitals treated approximately 127 000 firearm victims annually and concluded that the cost of treating an abdominal GSW was approximately USD1 467 per patient. While the annual number of GSW injuries has decreased over the past decade, an estimated 54 870 firearm-related injuries occurred in SA in 2012. No study has estimated the burden of these GSWs from an orthopaedic perspective. To estimate the burden and average cost of treating GSW victims requiring orthopaedic interventions in an SA tertiary level hospital. This retrospective study surveyed more than 1 500 orthopaedic admissions over a 12-month period (2012) at Groote Schuur Hospital, Cape Town, SA. Chart review subsequently yielded data that allowed analysis of cost, theatre time, number and type of implants, duration of admission, diagnostic imaging studies performed, blood products used, laboratory studies ordered and medications administered. A total of 111 patients with an average age of 28 years (range 13 - 74) were identified. Each patient was hit by an average of 1.69 bullets (range 1 - 7). These patients sustained a total of 147 fractures, the majority in the lower extremities. Ninety-five patients received surgical treatment for a total of 135 procedures, with a cumulative surgical theatre time of >306 hours. Theatre costs, excluding implants, were in excess of USD94 490. Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional USD53 381 cumulatively, or USD667 per patient. Patients remained hospitalised for an average of 9.75 days, and total ward costs exceeded USD130 400. Individual patient costs averaged about USD2 940 (ZAR24 945) per patient. This study assessed the burden of orthopaedic firearm injuries in SA. It was estimated that on average, treating an orthopaedic GSW patient cost USD2 940, used just over 3 hours of theatre time per operation, and necessitated a hospital bed for an average period of 9.75 days. Improved understanding of the high incidence of orthopaedic GSWs treated in an SA tertiary care trauma centre and the costs incurred will help the state healthcare system better prioritise orthopaedic trauma funding and training opportunities, while also supporting cost-saving measures, including redirection of financial resources to primary prevention initiatives.
-
Cost of ownership for military cargo aircraft using a common versus disparate display configuration
NASA Astrophysics Data System (ADS)
Desjardins, Daniel D.; Most, Marvin C.
2010-04-01
A 2009 paper considered possibilities for applying a common display suite to various front-line bubble canopy fighters, whereas further research suggests the cost savings, post Milestone C production/deployment, might not be advantageous. The situation for military cargo and tanker aircraft, may offer a different paradigm. The primary objective of Defense acquisition is to acquire quality products that satisfy user needs with measurable improvements to mission capability and operational support, in a timely manner, and at a fair and reasonable price. DODD 5000.01 specifies that all participants in the acquisition system shall recognize the reality of fiscal constraints, viewing cost as an independent variable. DoD Components must therefore plan programs based on realistic projections of the dollars and manpower likely to be available in future years and also identify the total costs of ownership, as well as the major drivers of total ownership costs. In theory, therefore, this has already been done for existing cargo/tanker aircraft programs accommodating independent, disparate display suites. This paper goes beyond that stage by exploring total costs of ownership for a hypothetical common approach to cargo/tanker display avionics, bounded by looking at a limited number of such aircraft, e.g., C-5, C-17, C-130H (variants), and C-130J. It is the purpose of this paper to reveal whether there are total cost of ownership advantages for a common approach over and above the existing disparate approach. Aside from cost issues, other considerations, i.e., availability and supportability, may also be analyzed.
-
Direct medical cost of stroke in Singapore.
Ng, Charmaine Shuyu; Toh, Matthias Paul Han Sim; Ng, Jiaying; Ko, Yu
2015-10-01
Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P < 0·001) and intracerebral haemorrhage (P < 0·001), shorter poststroke period, more than one complications (P = 0·045), and a greater number of comorbidities (P = 0·001). There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority. © 2015 World Stroke Organization.
-
Chalmers, Jenny; Ritter, Alison
2012-11-01
Australian pharmacotherapy maintenance programs incur costs to patients. These dispensing fees represent a financial burden to patients and are inconsistent with Australian health-care principles. No previous work has examined the current costs nor the future predicted costs if government subsidised dispensing fees. A system dynamics model, which simulated the flow of patients into and out of methadone maintenance treatment, was developed. Costs were imputed from existing research data. The approach enabled simulation of possible behavioural responses to a fee subsidy (such as higher retention) and new estimates of costs were derived under such scenarios. Current modelled costs (AUS$11.73m per month) were largely borne by state/territory government (43%), with patients bearing one-third (33%) of the total costs and the Commonwealth one-quarter (24%). Assuming no behavioural changes associated with fee subsidies, the cost of subsidising the dispensing fees of Australian methadone patients would be $3.9m per month. If retention were improved as a result of fee subsidy, treatment numbers would increase and the model estimates an additional cost of $0.8m per month. If this was coupled with greater numbers entering treatment, the costs would increase by a further $0.4m per month. In total, full fee subsidy with modelled behavioural changes would increase per annum government expenditure by $81.8m to $175.8m. If government provided dispensing fee relief for methadone maintenance patients, it would be a costly exercise. However, these additional costs are offset by the social and health gains achieved from the methadone maintenance program. © 2012 Australasian Professional Society on Alcohol and other Drugs.
-
Study of turboprop systems reliability and maintenance costs
NASA Technical Reports Server (NTRS)
1978-01-01
The overall reliability and maintenance costs (R&MC's) of past and current turboprop systems were examined. Maintenance cost drivers were found to be scheduled overhaul (40%), lack of modularity particularly in the propeller and reduction gearbox, and lack of inherent durability (reliability) of some parts. Comparisons were made between the 501-D13/54H60 turboprop system and the widely used JT8D turbofan. It was found that the total maintenance cost per flight hour of the turboprop was 75% higher than that of the JT8D turbofan. Part of this difference was due to propeller and gearbox costs being higher than those of the fan and reverser, but most of the difference was in the engine core where the older technology turboprop core maintenance costs were nearly 70 percent higher than for the turbofan. The estimated maintenance cost of both the advanced turboprop and advanced turbofan were less than the JT8D. The conclusion was that an advanced turboprop and an advanced turbofan, using similar cores, will have very competitive maintenance costs per flight hour.
-
Cost of schizophrenia: direct costs and use of resources in the State of São Paulo.
Leitão, Raquel Jales; Ferraz, Marcos Bosi; Chaves, Ana Cristina; Mari, Jair J
2006-04-01
To estimate the direct costs of schizophrenia for the public sector. A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US $191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.
-
Economic Burden of Smoking in Iran: A Prevalence-Based Annual Cost Approach
Rezaei, Satar; Matin, Behzad Karami; Hajizadeh, Mohammad; Bazyar, Mohammad; Sari, Ali Akbari
2017-01-01
Objectives: The burden of smoking on the health system and society is significant. The current study aimed to estimate the annual direct and indirect costs of smoking in Iran for the year 2014. Methods: A prevalence-based disease-specific approach was used to determine costs associated with the three most common smoking-related diseases: lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). Data on healthcare utilization were obtained from an original survey, hospital records and questionnaires. The number of deaths was extracted from the global burden diseases study (GBD). The human capital approach was applied to estimate the costs of morbidity and mortality due to smoking-related diseases, classified as direct (hospitalization, outpatients and non-medical costs) and indirect (mortality and morbidity). Results: The total economic cost of the three most common smoking-attributable diseases in Iran was US$1.46 billion in 2014, including US$1.05 billion (71.7%) in indirect and US$0.41 billion (28.3%) in direct costs. Direct costs of the three smoking-related diseases accounted for 1.6% of total healthcare expenditures and total costs were about 0.26% of Iran’s gross domestic product (GDP) in 2014. Conclusions: Our study indicated that smoking places a substantial economic burden on Iranian society. Therefore, sustained smoking cessation interventions and tobacco control policies are required to reduce the magnitude and extent of smoking-attributable costs in Iran. PMID:29072438
-
Rousseau, Annick; Laroche, Marie-Laure; Venisse, Nicolas; Loichot-Roselmac, Cecile; Turcant, Alain; Hoizey, Guillaume; Compagnon, Patricia; Hary, Lionel; Debruyne, Danièle; Saivin, Sylvie; Jacqz-Aigrain, Evelyne; Buchler, Mathias; Villeneuve, Claire; Vergnenègre, Alain; Le Meur, Yannick; Marquet, Pierre
2010-05-27
In the prospective, randomized, multicenter APOMYGRE trial conducted in France, concentration-controlled mycophenolate mofetil (MMF) dosing based on mycophenolic acid (MPA) exposure significantly reduced the treatment failure and acute rejection during the first posttransplantation year compared with fixed-dose MMF. This analysis investigated the cost effectiveness of dose individualization. The study included 65 patients per group (intent-to-treat population). Treatment failure (primary efficacy endpoint) was defined as death, graft loss, acute rejection, or MMF discontinuation because of adverse effects. Data on hospitalizations, drugs prescribed, physicians' fees, laboratory expenses, ambulatory visits, and transportation were retrieved. Costs were calculated from the French National Health System perspective. The mean (95% confidence interval) total yearly cost per patient was Euro 47,477 (Euro 43,933; Euro 51,020) in the concentration-controlled group and Euro 46,783 ( Euro 44,152; Euro 49,414) in the fixed-dose group (P=0.7). The observed incremental cost-effectiveness ratio was Euro 3757 per treatment failure (Purchasing Power Parities United States/France: $4129). Hospitalization and drug costs accounted for approximately 50% and 25% of total costs, respectively. The cost for MPA area under the concentration-time curve and dose calculation was Euro 452 per patient, less than 1% of the total cost. In the APOMYGRE trial, therapeutic MPA monitoring using a limited sampling strategy reduced the risk of treatment failure and acute rejection in renal allograft recipients during the first 12 months posttransplantation, at neutral cost.
-
Economic evaluation of the societal costs of hepatitis B in South Korea.
Yang, B M; Paik, S W; Hahn, O S; Yi, D H; Choi, M S; Payne, S
2001-03-01
Hepatitis B (HBV) infection remains a major public health problem in South Korea, and accounts for considerable morbidity and mortality. At present, very little is known about the cost of HBV to the South Korean health-care system and society. The present study was therefore conducted to estimate the total annual cost of HBV infection in South Korea for a given year (1997). The study was conducted from the South Korean societal perspective, taking into account the direct and indirect costs of HBV vaccination programs (prevention costs), and those related to the treatment of acute and chronic hepatitis, cirrhosis and liver cancer (disease costs). Several assumptions were made in arriving to actual cost estimates. The total societal cost of HBV in 1997 was 1078.3 billion Won ($US 959.7 million), 142.3 billion Won or 13.2% being attributable to prevention costs and 225.4 billion Won or 20.9% being attributable to indirect costs of HBV-related diseases. The total cost (direct plus indirect) associated with HBV-related diseases to the South Korean society was 936.1 billion Won ($US 833.1 million), of which 45.3% was attributable to cirrhosis-related costs. In terms of disease-related direct costs alone (710.5 billion Won or $US 632.3 million), the estimated annual spending per patient was 1.37 million Won ($US 1219). The direct costs of the HBV disease (prevention and disease treatment, amounting to 782.2 billion Won or $US 696.2 million) is equivalent to 3.2% of the national health-care expenditure for 1997. This study confirms that HBV is a significant cost burden to the South Korean society, and in the absence of an effective cure reinforces the importance of continued disease prevention via vaccination.
-
Inohara, Taku; Numasawa, Yohei; Higashi, Takahiro; Ueda, Ikuko; Suzuki, Masahiro; Hayashida, Kentaro; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi; Kohsaka, Shun
2017-12-01
Percutaneous coronary intervention (PCI) is widely used; however, factors of high-cost care after PCI have not been thoroughly investigated. We sought to evaluate the in-hospital costs related to PCI and identify predictors of high costs. We extracted 2,354 consecutive PCI cases (1,243 acute cases, 52.8%) from 3 Japanese cardiovascular centers from 2011 to 2015. In-hospital complications were predefined under consensus definitions (eg, acute kidney injury [AKI]). We extracted the facility cost data for each patient's resource under the universal Japanese insurance system. We classified the patients into total cost quartiles and identified predictors for the highest quartile ("high-cost" group). In addition, incremental costs for procedure-related complications were calculated. During the study period, a total of 401 cases (17.0%) experienced procedure-related complications. The in-hospital acute and elective PCI costs per case were US $14,840 (interquartile range [IQR] 11,370-20,070) and US $11,030 (IQR 8929-14,670), respectively. After adjusting for baseline differences, any of the procedure-related complications remained an independent predictor of high costs (acute: odds ratio 1.66, 95% CIs 1.13-2.43; elective: odds ratio 3.73, 95% CIs 1.96-7.11). Notably, incremental costs were mainly attributed to AKI, which accounted for 37.5% of all incremental costs; it increased by US $9,840 for each AKI event, and the total cost increase reached US $2,588,035. Procedure-related complications, particularly postprocedural AKI, were associated with higher costs in PCI. Further studies are required to evaluate prospectively whether the preventive strategy with a personalized risk stratification for AKI could save costs. Copyright © 2017 Elsevier Inc. All rights reserved.
-
Using Cost as an Independent Variable (CAIV) to Reduce Total Ownership Cost
2006-01-31
and the online Guidebook’s best practices provide policy and process guidance for preparation of user-required capabilities (CJCS 3170 series ), along...of new JROC/JCIDS processes nor engendering full leadership support to reduce O&S costs. The Program Manager (PM) is responsible for developing and...warfighting systems? The Under Secretary of Defense for Acquisition, Technology and Logistics (USD (AT&L)) published new acquisition policy and
-
NASA Astrophysics Data System (ADS)
Mehrpooya, Mehdi; Ansarinasab, Hojat; Moftakhari Sharifzadeh, Mohammad Mehdi; Rosen, Marc A.
2017-10-01
An integrated power plant with a net electrical power output of 3.71 × 105 kW is developed and investigated. The electrical efficiency of the process is found to be 60.1%. The process includes three main sub-systems: molten carbonate fuel cell system, heat recovery section and cryogenic carbon dioxide capturing process. Conventional and advanced exergoeconomic methods are used for analyzing the process. Advanced exergoeconomic analysis is a comprehensive evaluation tool which combines an exergetic approach with economic analysis procedures. With this method, investment and exergy destruction costs of the process components are divided into endogenous/exogenous and avoidable/unavoidable parts. Results of the conventional exergoeconomic analyses demonstrate that the combustion chamber has the largest exergy destruction rate (182 MW) and cost rate (13,100 /h). Also, the total process cost rate can be decreased by reducing the cost rate of the fuel cell and improving the efficiency of the combustion chamber and heat recovery steam generator. Based on the total avoidable endogenous cost rate, the priority for modification is the heat recovery steam generator, a compressor and a turbine of the power plant, in rank order. A sensitivity analysis is done to investigate the exergoeconomic factor parameters through changing the effective parameter variations.
-
De Deyne, Cathy; Heylen, René
2004-01-01
Operating Room (OR) information systems should manage the OR time, assigned to every surgeon, thereby minimizing the sum of costs of unused OR time and minimizing the costs of elective cases performed outside normal allocated OR time (excess OR-time). The aim of this paper is to illustrate how the introduction of an OR information system influenced daily OR activity performance. Since January 2001, we introduced an OR information system with a visual, airport-like, screen as central part, displaying all scheduled OR activity linked in real-time activity with all OR theatres. For the aim of this paper, we compared all data of OR activity for elective abdominal surgery (EAS) for the first half of 2000 compared to the first half of 2001, after the introduction of our information system. In 2000, 764 elective cases were performed, compared to 815 cases in 2001. For both periods, the total OR time allocated to EAS for this 6 months period was 805 h. For 2000, the total duration of OR activity for EAS was 1044 h 50 min (implicating 239 h 50 min over-time), compared to 1127 h 35 min (implicating 322 h 35 min overtime) for 2001. For 2000, we recorded 147 h 20 min excess time (=exceeding the time limits of OR activity and inducing extra costs) and 46h45min unused OR time. For 2001, we recorded 123 h 04 min excess time and 35 h 21 min unused time. In conclusion, in 2001 we recorded an increase in total OR activity for elective abdominal surgery by 7% in number of procedures and by 8% in total duration. However, in 2001 we recorded a decrease in excess time by 16% (123 h 04 min vs 147 h 20 min), which was for a large part due to a 23% decrease in unused OR time in 2001 compared to 2000 (35 h 21min vs 46 h 45 min). Therefore, the introduction of an OR information system, with a real-time visual display of ongoing OR activity, resulted in a increased performance of OR activity, with more OR procedures performed despite less excess time and less extra costs.
-
Concepts for 18/30 GHz satellite communication system study. Executive summary
NASA Technical Reports Server (NTRS)
Baker, M.; Davies, R.; Cuccia, L.; Mitchell, C.
1979-01-01
An examination of a multiplicity of interconnected parameters ranging from specific technology details to total system economic costs for satellite communication systems at the 18/30 GHz transmission bands are presented. It was determined that K sub A band systems can incur a small communications outage during very heavy rainfall periods and that reducing the outage to zero would lead to prohibitive system costs. On the other hand, the economics of scale, ie, one spacecraft accommodating 2.5 GHz of bandwidth coupled with multiple beam frequency reuse, leads to very low costs for those users who can tolerate the 5 to 50 hours per year of downtime. A multiple frequency band satellite network can provide the ultimate optimized match to the consumer performance/economics demands.
-
Life support system definition for a low cost shuttle launched space station.
NASA Technical Reports Server (NTRS)
Nelson, W. G.; Cody, J.
1972-01-01
Discussion of the tradeoffs and EC/LS definition for a low cost shuttle launched space station to be launched in the late 1970s for use as a long-term manned scientific laboratory. The space station consists of 14-ft-diam modules, clustered together to support a six-man crew at the initial space station (ISS) level and a 12-man crew at the growth space station (GSS) level. Key design guidelines specify low initial cost and low total program cost and require two separate pressurized habitable compartments with independent lift support capability. The methodology used to select the EC/LS design consisted of systematically reducing quantitative parameters to a common denominator of cost. This approach eliminates many of the inconsistencies that can occur in such decision making. The EC/LS system selected is a partially closed system which recovers urine, condensate, and wash water and concentrates crew expired CO2 for use in a low thrust resistojet propulsion system.
-
Dullet, Navjit W; Geraghty, Estella M; Kaufman, Taylor; Kissee, Jamie L; King, Jesse; Dharmar, Madan; Smith, Anthony C; Marcin, James P
2017-04-01
The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO 2 , 50 metric tons of CO, 3.7 metric tons of NO x , and 5.5 metric tons of volatile organic compounds. This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
-
Cost analysis of oxygen recovery systems
NASA Technical Reports Server (NTRS)
Yakut, M. M.
1973-01-01
The design and development of equipment for flight use in earth-orbital programs, when optimally approached cost effectively, proceed through the following logical progression: (1) bench testing of breadboard designs, (2) the fabrication and evaluation of prototype equipment, (3) redesign to meet flight-imposed requirements, and (4) qualification and testing of a flight-ready system. Each of these steps is intended to produce the basic design information necessary to progress to the next step. The cost of each step is normally substantially less than that of the following step. An evaluation of the cost elements involved in each of the steps and their impact on total program cost are presented. Cost analyses of four leading oxygen recovery subsystems which include two carbon dioxide reduction subsystem, Sabatier and Bosch, and two water electrolysis subsystems, the solid polymer electrolyte and the circulating KOH electrolyte are described.
-
A system for the real time, direct measurement of natural gas flow
DOE Office of Scientific and Technical Information (OSTI.GOV)
Sowell, T.
1995-12-31
PMI/Badger Meter, Inc. with partial sponsorship from the Gas Research Institute, has designed and developed direct measurement total energy flow metering instrumentation. As industry demands for improved accuracy and speed of measurement have increased so has the complexity of the overall hardware and software systems. Considering traditional system approaches, few companies have the in house capability of maintaining a complete system. This paper addresses efforts to implement a direct, total gas energy flow metering system which is simple to use and cost effective.
-
Comparison of two total energy systems for a diesel power generation plant. [deep space network
NASA Technical Reports Server (NTRS)
Chai, V. W.
1979-01-01
The capabilities and limitations, as well as the associated costs for two total energy systems for a diesel power generation plant are compared. Both systems utilize waste heat from engine cooling water and waste heat from exhaust gases. Pressurized water heat recovery system is simple in nature and requires no engine modifications, but operates at lower temperature ranges. On the other hand, a two-phase ebullient system operates the engine at constant temperature, provides higher temperature water or steam to the load, but is more expensive.
-
Shikamura, Yoshiaki; Oyama, Akiko; Takahashi, Junichi; Akagi, Yuuki; Negishi, Kenichi; Ijyuin, Kazushige; Kamimura, Naoki; Aoyama, Takao
2012-01-01
This study examined the impact of pharmaceutical inquiries regarding prescriptions on drug costs by surveying the actual condition of inquiries at 13 pharmacies. The study also investigated the significance of inquiries from a medical economics perspective by calculating the medical cost savings realized by preventing adverse drug reactions (ADRs). As a result, the total change in drug costs for the 13 pharmacies after pharmaceutical inquiries represented an increase of ¥9,018/month. However, upon recalculating the cost of drugs by assuming that those with an "Incomplete entry in the prescription (compared with previous prescription, etc.)" should in fact have been prescribed, and excluding them, the total drug costs for the 13 pharmacies is decreased to ¥154,743/month, translating to a cost-savings of ¥7.2/prescription. The study then undertook a comprehensive assessment based on the Diagnosis Procedure Combination (DPC) system to determine the total medical cost-savings for 5 patients in whom ADRs could have occurred if the prescriptions had not been modified as a result of pharmaceutical inquiries. The obtained figure of ¥1,188,830 suggests that pharmaceutical inquiries contribute to reduced medical costs. The findings of this study indicate that pharmaceutical inquiries regarding prescriptions by staff pharmacists not only ensure the proper delivery of drug therapy to patients, but are also effective from a medical economics perspective.
-
Techno-economic and Monte Carlo probabilistic analysis of microalgae biofuel production system.
Batan, Liaw Y; Graff, Gregory D; Bradley, Thomas H
2016-11-01
This study focuses on the characterization of the technical and economic feasibility of an enclosed photobioreactor microalgae system with annual production of 37.85 million liters (10 million gallons) of biofuel. The analysis characterizes and breaks down the capital investment and operating costs and the production cost of unit of algal diesel. The economic modelling shows total cost of production of algal raw oil and diesel of $3.46 and $3.69 per liter, respectively. Additionally, the effects of co-products' credit and their impact in the economic performance of algal-to-biofuel system are discussed. The Monte Carlo methodology is used to address price and cost projections and to simulate scenarios with probabilities of financial performance and profits of the analyzed model. Different markets for allocation of co-products have shown significant shifts for economic viability of algal biofuel system. Copyright © 2016 Elsevier Ltd. All rights reserved.
-
Low Cost and Flexible UAV Deployment of Sensors
Sørensen, Lars Yndal; Jacobsen, Lars Toft; Hansen, John Paulin
2017-01-01
This paper presents a platform for airborne sensor applications using low-cost, open-source components carried by an easy-to-fly unmanned aircraft vehicle (UAV). The system, available in open-source , is designed for researchers, students and makers for a broad range of exploration and data-collection needs. The main contribution is the extensible architecture for modularized airborne sensor deployment and real-time data visualisation. Our open-source Android application provides data collection, flight path definition and map tools. Total cost of the system is below 800 dollars. The flexibility of the system is illustrated by mapping the location of Bluetooth beacons (iBeacons) on a ground field and by measuring water temperature in a lake. PMID:28098819
-
Low Cost and Flexible UAV Deployment of Sensors.
Sørensen, Lars Yndal; Jacobsen, Lars Toft; Hansen, John Paulin
2017-01-14
This paper presents a platform for airborne sensor applications using low-cost, open-source components carried by an easy-to-fly unmanned aircraft vehicle (UAV). The system, available in open-source , is designed for researchers, students and makers for a broad range of exploration and data-collection needs. The main contribution is the extensible architecture for modularized airborne sensor deployment and real-time data visualisation. Our open-source Android application provides data collection, flight path definition and map tools. Total cost of the system is below 800 dollars. The flexibility of the system is illustrated by mapping the location of Bluetooth beacons (iBeacons) on a ground field and by measuring water temperature in a lake.
-
NASA Astrophysics Data System (ADS)
De Cian, E.; Hof, A. F.; Marangoni, G.; Tavoni, M.; van Vuuren, D. P.
2016-07-01
Equity considerations play an important role in international climate negotiations. While policy analysis has often focused on equity as it relates to mitigation costs, there are large regional differences in adaptation costs and the level of residual damage. This paper illustrates the relevance of including adaptation and residual damage in equity considerations by determining how the allocation of emission allowances would change to counteract regional differences in total climate costs, defined as the costs of mitigation, adaptation, and residual damage. We compare emission levels resulting from a global carbon tax with two allocations of emission allowances under a global cap-and-trade system: one equating mitigation costs and one equating total climate costs as share of GDP. To account for uncertainties in both mitigation and adaptation, we use a model-comparison approach employing two alternative modeling frameworks with different damage, adaptation cost, and mitigation cost estimates, and look at two different climate goals. Despite the identified model uncertainties, we derive unambiguous results on the change in emission allowance allocation that could lessen the unequal distribution of adaptation costs and residual damages through the financial transfers associated with emission trading.
-
Significance of losses in water distribution systems in India
Raman, V.
1983-01-01
Effective management of water supply systems consists in supplying adequate quantities of clean water to the population. Detailed pilot studies of water distribution systems were carried out in 9 cities in India during 1971-81 to establish the feasibility of a programme of assessment, detection, and control of water losses from supply systems. A cost-benefit analysis was carried out. Water losses from mains and service pipes in the areas studied amounted to 20-35% of the total flow in the system. At a conservative estimate, the national loss of processed water through leaks in the water distribution systems amounts to 1012 litres per year, which is equivalent to 500 million rupees. It is possible to bring down the water losses in the pipe mains to 3-5% of the total flow, and the cost incurred on the control programme can be recovered in 6-18 months. Appropriate conservation measures will help in achieving the goals of the International Water Supply and Sanitation Decade to provide clean water for all. PMID:6418401
-
Significance of losses in water distribution systems in India.
Raman, V
1983-01-01
Effective management of water supply systems consists in supplying adequate quantities of clean water to the population. Detailed pilot studies of water distribution systems were carried out in 9 cities in India during 1971-81 to establish the feasibility of a programme of assessment, detection, and control of water losses from supply systems. A cost-benefit analysis was carried out. Water losses from mains and service pipes in the areas studied amounted to 20-35% of the total flow in the system. At a conservative estimate, the national loss of processed water through leaks in the water distribution systems amounts to 10(12) litres per year, which is equivalent to 500 million rupees.It is possible to bring down the water losses in the pipe mains to 3-5% of the total flow, and the cost incurred on the control programme can be recovered in 6-18 months. Appropriate conservation measures will help in achieving the goals of the International Water Supply and Sanitation Decade to provide clean water for all.
-
Impact of age cutoffs on a lynch syndrome screening program.
Gudgeon, James M; Belnap, Thomas W; Williams, Janet L; Williams, Marc S
2013-07-01
To determine the impact of applying an age cutoff to tumor-based Lynch syndrome (LS) screening, specifically focusing on changes in relative effectiveness, efficiency, and cost. The project was undertaken to answer questions about implementation of the LS screening program in an integrated health care delivery system. Clinical data extracted from an internal cancer registry, previous modeling efforts, published literature, and gray data were used to populate decision models designed to answer questions about the impact of age cutoffs in LS screening. Patients with colorectal cancer (CRC) were stratified at 10-year intervals from ages 50 to 80 years and compared with no age cutoff. Outcomes are reported for a cohort of 325 patients screened and includes total cost to screen, LS cases present in the cutoff category, number of LS cases expected to be identified by screening, cost per LS case detected, and total number and percentage of LS cases missed. Applying an age cutoff to an LS screening program has considerable potential for decreasing total screening costs and increasing efficiency, but at a loss of effectiveness. Imposing an age cutoff of 50 years reduces the cost of the screening program to 16% of a program with no age cutoff, but at the expense of missing more than half of the cases. Failure to identify LS cases is magnified by a cascade effect in family members. The results of this analysis influenced the final policy in our system.
-
Economic analysis of routine neuromonitoring of recurrent laryngeal nerve in total thyroidectomy.
Sanabria, Álvaro; Ramírez, Adonis
2015-01-01
Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country. We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.
-
Economic burden of malignant blood disorders across Europe: a population-based cost analysis.
Burns, Richeal; Leal, Jose; Sullivan, Richard; Luengo-Fernandez, Ramon
2016-08-01
Malignant blood disorders are a leading contributor to cancer incidence and mortality across Europe. Despite their burden, no study has assessed the economic effect of blood cancers in Europe. We aimed to assess the economic burden of malignant blood disorders across the 28 countries in the European Union (EU), Iceland, Norway, and Switzerland. Malignant blood disorder-related costs were estimated for 28 EU countries, Iceland, Norway, and Switzerland for 2012. Country-specific costs were estimated with aggregate data on morbidity, mortality, and health-care resource use obtained from international and national sources. Health-care costs were estimated from expenditure on primary, outpatient, emergency, inpatient care, and drugs. Costs of informal care and productivity losses due to morbidity and early death were also included. For countries in the EU, malignant blood disorders were compared with the economic burden of overall cancer. Malignant blood disorders cost the 31 European countries €12 billion in 2012. Health-care cost €7·3 billion (62% of total costs), productivity losses cost €3·6 billion (30%), and informal care cost €1 billion (8%). For the EU countries, malignant blood disorders cost €6·8 billion (12%) of the total health-care expenditure on cancer (€57 billion), with this proportion being second only to breast cancer. In terms of total cancer costs in the EU (€143 billion), malignant blood disorders cost €12 billion (8%). Malignant blood disorders represent a leading cause of death, health-care service use, and costs, not only to European health-care systems, but to society overall. Our results add to essential public health knowledge needed for effective national cancer-control planning and priorities for public research funding. European Hematology Association. Copyright © 2016 Elsevier Ltd. All rights reserved.
-
Lain, S J; Roberts, C L; Bond, D M; Smith, J; Morris, J M
2017-03-01
This study is an economic evaluation of immediate birth compared with expectant management in women with preterm prelabour rupture of the membranes near term (PPROMT). A cost-effectiveness analysis alongside the PPROMT randomised controlled trial. Obstetric departments in 65 hospitals across 11 countries. Women with a singleton pregnancy with ruptured membranes between 34 +0 and 36 +6 weeks gestation. Women were randomly allocated to immediate birth or expectant management. Costs to the health system were identified and valued. National hospital costing data from both the UK and Australia were used. Average cost per recruit in each arm was calculated and 95% confidence intervals were estimated using bootstrap re-sampling. Averages costs during antenatal care, delivery and postnatal care, and by country were estimated. Total mean cost difference between immediate birth and expectant management arms of the trial. From 11 countries 923 women were randomised to immediate birth and 912 were randomised to expectant management. Total mean costs per recruit were £8852 for immediate birth and £8740 for expectant delivery resulting in a mean difference in costs of £112 (95% CI: -431 to 662). The expectant management arm had significantly higher antenatal costs, whereas the immediate birth arm had significantly higher delivery and neonatal costs. There was large variation between total mean costs by country. This economic evaluation found no evidence that expectant management was more or less costly than immediate birth. Outpatient management may offer opportunities for cost savings for those women with delayed delivery. For women with preterm prelabour rupture of the membranes, the relative benefits and harms of immediate and expectant management should inform counselling as costs are similar. © 2016 Royal College of Obstetricians and Gynaecologists.
-
Cost effectiveness of a short-term pediatric neurosurgical brigade to Guatemala.
Davis, Matthew C; Than, Khoi D; Garton, Hugh J
2014-12-01
With subspecialty surgical care often unavailable to poor patients in developing countries, short-term brigades have filled a portion of the gap. We prospectively assessed the cost effectiveness of a pediatric neurosurgical brigade to Guatemala City, Guatemala. Data were collected on a weeklong annual pediatric neurosurgical brigade to Guatemala. Disability adjusted life-years (DALYs) averted were the metric of surgical effectiveness. Cost data included brigade expenses, as well as all costs incurred by the local health care system and patient families. During the mission, 17 pediatric neurosurgical interventions were performed. Conditions these patients suffered would result in 382 total DALYs. Using conservative values of surgical effectiveness, procedures performed averted 138.1 DALYs. Although all operative and postoperative costs were covered by the visiting surgical team, patients spent an average of $226 in U.S. dollars for preoperative workup, travel, food/lodging, and lost wages (range, $36-$538). The local health care system absorbed a total cost of $12,910. Complete mission costs were $53,152, for a cost effectiveness of $385 per DALY averted. To our knowledge, this is the first study evaluating cost effectiveness of a short-term neurosurgical brigade. Although surgical intervention is acknowledged as playing a crucial role in global health, subspecialty surgical care is still broadly perceived as a luxury. Although providing care through local surgeons is undeniably more efficient than bringing in foreign medical teams, such care is not universally available. This study argues that volunteer neurosurgical teams can provide high complexity care with a competitive cost-effective profile. Copyright © 2014 Elsevier Inc. All rights reserved.
-
Bradley, Steven M; O'Donnell, Colin I; Grunwald, Gary K; Liu, Chuan-Fen; Hebert, Paul L; Maddox, Thomas M; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S; Ho, P Michael
2015-07-14
Policies to reduce unnecessary hospitalizations after percutaneous coronary intervention (PCI) are intended to improve healthcare value by reducing costs while maintaining patient outcomes. Whether facility-level hospitalization rates after PCI are associated with cost of care is unknown. We studied 32,080 patients who received PCI at any 1 of 62 Veterans Affairs hospitals from 2008 to 2011. We identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. Compared with the risk-standardized average, 2 hospitals (3.2%) had a lower-than-expected hospitalization rate, and 2 hospitals (3.2%) had a higher-than-expected hospitalization rate. We observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 hospitals (27.4%) had lower-than-expected costs, and 14 hospitals (22.6%) had higher-than-expected costs. At the facility level, the index PCI accounted for 83.1% of the total cost (range, 60.3%-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range, 2.0%-12.7%) of the 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ=0.16; 95% confidence interval, -0.09 to 0.39; P=0.21). In this national study, hospitalizations in the 30 day after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates. This challenges the focus on reducing hospitalizations after PCI as an effective means of improving healthcare value. Opportunities remain to improve PCI value by reducing the variation in total cost of PCI without compromising patient outcomes. © 2015 American Heart Association, Inc.
-
DOT National Transportation Integrated Search
2010-10-01
Flight delay is a serious and widespread problem in the United States. Increasing flight delays place a significant strain on the US air travel system and cost airlines, passengers, and society at many billions of dollars each year. While a number of...
-
76 FR 70765 - National Endowment for the Arts; Submission of OMB Review: Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2011-11-15
... submission of responses. Agency: National Endowment for the Arts. Title: General Social Survey Arts... Annualized Capital/Startup Costs: 0. Total Annual Costs (Operating/Maintaining Systems or Purchasing Services): 0. This request is for clearance of an arts supplement for the 2012 General Social Survey (GSS), to...
-
Financial Aid Facts at California Community Colleges
ERIC Educational Resources Information Center
Institute for College Access & Success, 2010
2010-01-01
While California community college (CCC) system fees are much lower than tuition at community colleges in other states or other colleges in California, the total cost of attending a CCC--which includes books, housing, transportation, and food--is higher than most people realize. The illusion of low cost may lead CCC students to forgo valuable…
-
Kwak, Sang Hyun; Kim, Ji Hoon; Kim, Da Hee; Kim, Jung Min; Byeon, Hyung Kwon; Kim, Won Shik; Koh, Yoon Woo; Kim, Se-Heon; Choi, Eun Chang
2018-06-01
To report outcomes with regard to clinical aspects and medical costs of adenotonsillectomy and tonsillectomy at a single institution before and after implementation of the Diagnosis-Related Groups (DRG) payment system in Korea. We retrospectively reviewed the records of patients treated with adenotonsillectomy or tonsillectomy between July 2012 and June 2014. The Korean DRG payment system was applied to seven groups of specific diseases and surgeries including adenotonsillectomy and tonsillectomy from July 2013 at all hospitals in Korea. We divided patients into four groups according whether the fee-for-service (FFS) or DRG payment system was implemented and operation type (FFS-adenotonsillectomy (AT), DRG-AT, FFS-tonsillectomy (T), and DRG-T). A total of 1402 patients were included (485 FFS-AT, 490 DRG-AT, 203 FFS-T, and 223 DRG-T). The total medical cost of the DRG-AT group was significantly lower than that of the FFS-AT group (1191±404 vs. 1110±279 USD, P<0.05). There were no significant differences in length of hospital stay or postoperative complications among groups. The Korean DRG system for adenotonsillectomy and tonsillectomy reduced medical costs and clinical outcomes were not significantly altered by the adoption of the DRG system. 4. Copyright © 2017 Elsevier B.V. All rights reserved.
-
Mora, Claudia; González, Andrés; Díaz, Jorge; Quintana, Gerardo
2009-03-01
In Colombia, the cost burden of chronic diseases is not well known, either globally or in localized areas of the health system. Rheumatoid arthritis is one of most common chronic diseases, and represents a high cost for the health system. The direct medical costs were estimated for rheumatoid arthritis patients in the in the first year of diagnosis at a level 3 university hospital in Colombia. Three therapy settings for early rheumatoid arthritis patients were established in the first year of diagnosis according to national and international guidelines. Each setting included treatment with disease-modifying anti-rheumatic drugs or biologic therapy based on disease severity as measured by Disease Activity Score 28. All direct medical costs were included: specialized medical care, diagnostic tests and drugs. Cost information was obtained from the Central Military Hospital finance department in Bogotá and the national manual of drug prices based on the "Farmaprecios" 2007 guide, a reference in general use by health institutions. Results. The average of cost of medical care in patients with mild, moderate and severe disease was US $1689, $1805 and $23,441 respectively. The recommended retail prices of the medicines published in "Farmaprecios" was US $1418, $1821 and $31,931. When the charges levied by several major health institutions were compared, substantial increases were noted, US $4936, $7716 and $123,661, respectively. Drug costs represented 86% of total cost, laboratory costs were 10% and medical attention was only 4%. Drugs costs were the principal component of the total direct medical cost, and it increased 40 times when a biological therapy is used. Complete economic evaluation studies are necesary to estimate the viability and clinical relevance of biological therapy for early rheumatoid arthritis.
-
The Utility of Handheld Programmable Calculators in Aircraft Life Cycle Cost Estimation.
1982-09-01
are available for extended mem - ory, hardcopy printout, video interface, and special application software. Any calculator of comparable memory could...condi- tioning system. OG Total number of engine, air turbine motor (ATM) and auxiliary power unit (APU) driven generator/alternators. OHP Total number
-
Hubble, Michael W; Richards, Michael E; Wilfong, Denise A
2008-01-01
To estimate the cost-effectiveness of continuous positive airway pressure (CPAP) in managing prehospital acute pulmonary edema in an urban EMS system. Using estimates from published reports on prehospital and emergency department CPAP, a cost-effectiveness model of implementing CPAP in a typical urban EMS system was derived from the societal perspective as well as the perspective of the implementing EMS system. To assess the robustness of the model, a series of univariate and multivariate sensitivity analyses was performed on the input variables. The cost of consumables, equipment, and training yielded a total cost of $89 per CPAP application. The theoretical system would be expected to use CPAP 4 times per 1000 EMS patients and is expected to save 0.75 additional lives per 1000 EMS patients at a cost of $490 per life saved. CPAP is also expected to result in approximately one less intubation per 6 CPAP applications and reduce hospitalization costs by $4075 per year for each CPAP application. Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions. Previous studies have demonstrated the clinical effectiveness of CPAP in the management of acute pulmonary edema. Through a theoretical analysis which modeled the costs and clinical benefits of implementing CPAP in an urban EMS system, prehospital CPAP appears to be a cost-effective treatment.
-
Microgrid Analysis Tools Summary
DOE Office of Scientific and Technical Information (OSTI.GOV)
Jimenez, Antonio; Haase, Scott G; Mathur, Shivani
2018-03-05
The over-arching goal of the Alaska Microgrid Partnership is to reduce the use of total imported fuel into communities to secure all energy services by at least 50% in Alaska's remote microgrids without increasing system life cycle costs while also improving overall system reliability, security, and resilience. One goal of the Alaska Microgrid Partnership is to investigate whether a combination of energy efficiency and high-contribution (from renewable energy) power systems can reduce total imported energy usage by 50% while reducing life cycle costs and improving reliability and resiliency. This presentation provides an overview of the following four renewable energy optimizationmore » tools. Information is from respective tool websites, tool developers, and author experience. Distributed Energy Resources Customer Adoption Model (DER-CAM) Microgrid Design Toolkit (MDT) Renewable Energy Optimization (REopt) Tool Hybrid Optimization Model for Electric Renewables (HOMER).« less
-
Are Characteristics of the Medical Home Associated with Diabetes Care Costs?
Flottemesch, Thomas J.; Scholle, Sarah Hudson; O’Connor, Patrick J.; Solberg, Leif I.; Asche, Steve; Pawlson, L. Gregory
2015-01-01
Objective To examine the relationship between primary care medical home clinical practice systems (PCMH clinical practice systems) corresponding to the domains of the Chronic Care Model and diabetes-related healthcare costs incurred by members of a health plan who have diagnosed Type 2 diabetes and received care at one of 27 Minnesota-based medical groups over a 12-month period. Study Design Cross-sectional analysis of patient-level cost data in relation to the presence of PCMH clinical practice systems by Chronic Care Model domain using the Physician Practice Connections Readiness Survey (PPC-RS). Methods Multivariate regressions adjusting for patient demographics, health status and comorbidities estimated the relationship between the presence of PCMH clinical practice systems as measured by the PPC-RS and three outcomes: total diabetes-related healthcare costs, ambulatory care management costs, and potentially avoidable costs (e.g. unscheduled inpatient and emergency care). Results Two domains of PCMH clinical practice systems as measured by the PPC-RS were significantly associated with reductions in potentially avoidable costs. These were Health Care Organization (p=.04) and clinical reminder systems in the Decision Support domain (p=.01). Compared to medical groups with only quality improvement, those with improved Health Care Organization defined as performance measurement and individual provider feedback averaged $245/patient less. Similarly, medical groups with clinical reminders for counseling averaged $338/patient less. Conclusions PCMH clinical practice systems that correspond to some domains of the Chronic Care Model are related to reduced inpatient and emergency care costs. Further research is needed about how these systems impact costs over time. PMID:22710277
-
Jaworski, Rafał; Jankowska, Ewa A; Ponikowski, Piotr; Banasiak, Waldemar
2012-01-01
Treatment of coronary artery disease (CAD) generates the major part of public health expenditure in the developed countries. The aim of the study was to estimate costs associated with the diagnosis and treatment of patients with CAD in Poland. Costs were estimated in a representative sample of 2593 patients with CAD receiving general practitioner (n = 1977) or specialist care (n = 616) in 2005 (the multicenter RECENT study). Data from the National Health Fund, Social Insurance Institution, Central Statistical Office, and current literature were used. The total annual cost of CAD reached €2254.17 per patient, with 48% accounting for direct medical costs (drugs, medical consultations, laboratory tests, diagnostic procedures, invasive treatment, hospitalizations, emergency care) and 52% for indirect costs (related to absence at work and disability). Eighty-one percent of total direct medical costs were covered by the public payer (including 30% of pharmacological treatment costs). Direct medical costs covered by the public payer were higher in men and in patients with more severe angina symptoms (both P <0.05). In the model based on the lowest prevalence of CAD (estimated based on the real population of patients treated in 2005), direct medical costs covered by the public payer reached €617.6 million, i.e., around 7% of the total public health expenditure in Poland in 2005. Modern management of CAD imposes enormous economic burden on the public health system in Poland. There is a need to develop and implement strategies that would optimize health care costs associated with the treatment of CAD.
-
DOE Office of Scientific and Technical Information (OSTI.GOV)
Chatterton, Mike
The Recovery Act: Districtwide Geothermal Heating Conversion project performed by the Blaine County School District was part of a larger effort by the District to reduce operating costs, address deferred maintenance items, and to improve the learning environment of the students. This project evaluated three options for the ground source which were Open-Loop Extraction/Re-injection wells, Closed-Loop Vertical Boreholes, and Closed-Loop Horizontal Slinky approaches. In the end the Closed-Loop Horizontal Slinky approach had the lowest total cost of ownership but the majority of the sites associated with this project did not have enough available ground area to install the system somore » the second lowest option was used (Open-Loop). In addition to the ground source, this project looked at ways to retrofit existing HVAC systems with new high efficiency systems. The end result was the installation of distributed waterto- air heat pumps with water-to-water heat pumps installed to act as boilers/chillers for areas with a high ventilation demand such as they gymnasiums. A number of options were evaluated and the lowest total cost of ownership approach was implemented in the majority of the facilities. The facilities where the lowest total cost of ownership approaches was not selected were done to maintain consistency of the systems from facility to facility. This project had a number of other benefits to the Blaine County public. The project utilizes guaranteed energy savings to justify the levy funds expended. The project also developed an educational dashboard that can be used in the classrooms and to educate the community on the project and its performance. In addition, the majority of the installation work was performed by contractors local to Blaine County which acted as an economic stimulus to the area during a period of recession.« less