[Cost at the first level of care].

PubMed

Villarreal-Ríos, E; Montalvo-Almaguer, G; Salinas-Martínez, M; Guzmán-Padilla, J E; Tovar-Castillo, N H; Garza-Elizondo, M E

1996-01-01

To estimate the unit cost of 15 causes of demand for primary care per health clinic in an institutional (social security) health care system, and to determine the average cost at the state level. The cost of 80% of clinic visits was estimated in 35 of 40 clinics in the social security health care system in the state of Nuevo Leon, Mexico. The methodology for fixed costs consisted of: departmentalization, inputs, cost, weights and construction of matrices. Variable costs were estimated for standard patients by type of health care sought and with the consensus of experts; the sum of fixed and variable costs gave the unit cost. A computerized model was employed for data processing. A large variation in unit cost was observed between health clinics studied for all causes of demand, in both metropolitan and non-metropolitan areas. Prenatal care ($92.26) and diarrhea ($93.76) were the least expensive while diabetes ($240.42) and hypertension ($312.54) were the most expensive. Non-metropolitan costs were higher than metropolitan costs (p < 0.05); controlling for number of physician's offices showed that this was determined by medical units with only one physician's office. Knowledge of unit costs is a tool that, when used by medical administrators, allows adequate health care planning and efficient allocation of health resources.

The cost of blood collection in Greece: an economic analysis.

PubMed

Fragoulakis, Vassilis; Stamoulis, Kostas; Grouzi, Elisabeth; Maniadakis, Nikolaos

2014-07-01

The goal of this study was to estimate the cost of production of 1 unit of blood from a National Health Service perspective in Greece. In agreement with guidelines, the cost of blood production in this study accounted only for the resources expended for collection, processing, laboratory testing, and storage. Hence, the costs associated with donor recruitment, pretransfusion preparation, transfusion administration, follow-up management of adverse events, and other long-term relevant costs were not taken into consideration. The indirect cost of blood donations for donors (productivity loss) was also considered. A questionnaire was used to collect data regarding personnel time, annual blood quantities collected, percentage of wastage, utilization of consumables, institutional overhead, information technology expenditure, medical equipment utilized, nuclear acid tests, and other factors. Data gathered by 53 hospitals across the country were assessed. A model was constructed with economic data collected by the National School of Public Health and the Ministry of Health. All data refer to the year 2013. The weighted mean direct cost of producing 1 unit of blood was estimated at €131.49 (SD, €22.12; minimum/maximum, €94.96-€239.20). The mean total indirect cost was estimated at €34 per unit of blood. The cost distribution was positively skewed (skewness, 1.642 [0.327]). The major cost component was the cost of personnel, accounting for 32.5% of total costs, and the average of blood unit wastage was estimated at 4.90%. There were no differences between the cost of producing 1 unit of blood in Athens compared with the rest of the country (Mann-Whitney test, P = 0.341). This study suggests that the cost of producing 1 unit of blood is not insignificant. These figures need to be complemented with those concerning the cost of transfusion to have a complete picture of producing and using 1 unit of blood locally. Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.

Using Work Breakdown Structure Models to Develop Unit Treatment Costs

EPA Science Inventory

This article presents a new cost modeling approach called work breakdown structure (WBS), designed to develop unit costs for drinking water technologies. WBS involves breaking the technology into its discrete components for the purposes of estimating unit costs. The article dem...

Cost implications of implementation of pathogen-inactivated platelets

PubMed Central

McCullough, Jeffrey; Goldfinger, Dennis; Gorlin, Jed; Riley, William J; Sandhu, Harpreet; Stowell, Christopher; Ward, Dawn; Clay, Mary; Pulkrabek, Shelley; Chrebtow, Vera; Stassinopoulos, Adonis

2015-01-01

BACKGROUND Pathogen inactivation (PI) is a new approach to blood safety that may introduce additional costs. This study identifies costs that could be eliminated, thereby mitigating the financial impact. STUDY DESIGN AND METHODS Cost information was obtained from five institutions on tests and procedures (e.g., irradiation) currently performed, that could be eliminated. The impact of increased platelet (PLT) availability due to fewer testing losses, earlier entry into inventory, and fewer outdates with a 7-day shelf life were also estimated. Additional estimates include costs associated with managing 1) special requests and 2) test results, 3) quality control and proficiency testing, 4) equipment acquisition and maintenance, 5) replacement of units lost to positive tests, 6) seasonal or geographic testing, and 7) health department interactions. RESULTS All costs are mean values per apheresis PLT unit in USD ($/unit). The estimated test costs that could be eliminated are $71.76/unit and a decrease in transfusion reactions corresponds to $2.70/unit. Avoiding new tests (e.g., Babesia and dengue) amounts to $41.80/unit. Elimination of irradiation saves $8.50/unit, while decreased outdating with 7-day storage can be amortized to $16.89/unit. Total potential costs saved with PI is $141.65/unit. Costs are influenced by a variety of factors specific to institutions such as testing practices and the location in which such costs are incurred and careful analysis should be performed. Additional benefits, not quantified, include retention of some currently deferred donors and scheduling flexibility due to 7-day storage. CONCLUSIONS While PI implementation will result in additional costs, there are also potential offsetting cost reductions, especially after 7-day storage licensing. PMID:25989465

Cost implications of implementation of pathogen-inactivated platelets.

PubMed

McCullough, Jeffrey; Goldfinger, Dennis; Gorlin, Jed; Riley, William J; Sandhu, Harpreet; Stowell, Christopher; Ward, Dawn; Clay, Mary; Pulkrabek, Shelley; Chrebtow, Vera; Stassinopoulos, Adonis

2015-10-01

Pathogen inactivation (PI) is a new approach to blood safety that may introduce additional costs. This study identifies costs that could be eliminated, thereby mitigating the financial impact. Cost information was obtained from five institutions on tests and procedures (e.g., irradiation) currently performed, that could be eliminated. The impact of increased platelet (PLT) availability due to fewer testing losses, earlier entry into inventory, and fewer outdates with a 7-day shelf life were also estimated. Additional estimates include costs associated with managing (1) special requests and (2) test results, (3) quality control and proficiency testing, (4) equipment acquisition and maintenance, (5) replacement of units lost to positive tests, (6) seasonal or geographic testing, and (7) health department interactions. All costs are mean values per apheresis PLT unit in USD ($/unit). The estimated test costs that could be eliminated are $71.76/unit and a decrease in transfusion reactions corresponds to $2.70/unit. Avoiding new tests (e.g., Babesia and dengue) amounts to $41.80/unit. Elimination of irradiation saves $8.50/unit, while decreased outdating with 7-day storage can be amortized to $16.89/unit. Total potential costs saved with PI is $141.65/unit. Costs are influenced by a variety of factors specific to institutions such as testing practices and the location in which such costs are incurred and careful analysis should be performed. Additional benefits, not quantified, include retention of some currently deferred donors and scheduling flexibility due to 7-day storage. While PI implementation will result in additional costs, there are also potential offsetting cost reductions, especially after 7-day storage licensing. © 2015 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

Estimating the cost of delivering direct nutrition interventions at scale: national and subnational level insights from India.

PubMed

Menon, Purnima; McDonald, Christine M; Chakrabarti, Suman

2016-05-01

India's national nutrition and health programmes are largely designed to provide evidence-based nutrition-specific interventions, but intervention coverage is low due to a combination of implementation challenges, capacity and financing gaps. Global cost estimates for nutrition are available but national and subnational costs are not. We estimated national and subnational costs of delivering recommended nutrition-specific interventions using the Scaling Up Nutrition (SUN) costing approach. We compared costs of delivering the SUN interventions at 100% scale with those of nationally recommended interventions. Target populations (TP) for interventions were estimated using national population and nutrition data. Unit costs (UC) were derived from programmatic data. The cost of delivering an intervention at 100% coverage was calculated as (UC*projected TP). Cost estimates varied; estimates for SUN interventions were lower than estimates for nationally recommended interventions because of differences in choice of intervention, target group or unit cost. US$5.9bn/year are required to deliver a set of nationally recommended nutrition interventions at scale in India, while US$4.2bn are required for the SUN interventions. Cash transfers (49%) and food supplements (40%) contribute most to costs of nationally recommended interventions, while food supplements to prevent and treat malnutrition contribute most to the SUN costs. We conclude that although such costing is useful to generate broad estimates, there is an urgent need for further costing studies on the true unit costs of the delivery of nutrition-specific interventions in different local contexts to be able to project accurate national and subnational budgets for nutrition in India. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.

PubMed

Michaelidis, Constantinos I; Fine, Michael J; Lin, Chyongchiou Jeng; Linder, Jeffrey A; Nowalk, Mary Patricia; Shields, Ryan K; Zimmerman, Richard K; Smith, Kenneth J

2016-11-08

Ambulatory antibiotic prescribing contributes to the development of antibiotic resistance and increases societal costs. Here, we estimate the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. In an exploratory analysis, we used published data to develop point and range estimates for the hidden societal cost of antibiotic resistance (SCAR) attributable to each ambulatory antibiotic prescription in the United States. We developed four estimation methods that focused on the antibiotic-resistance attributable costs of hospitalization, second-line inpatient antibiotic use, second-line outpatient antibiotic use, and antibiotic stewardship, then summed the estimates across all methods. The total SCAR attributable to each ambulatory antibiotic prescription was estimated to be $13 (range: $3-$95). The greatest contributor to the total SCAR was the cost of hospitalization ($9; 69 % of the total SCAR). The costs of second-line inpatient antibiotic use ($1; 8 % of the total SCAR), second-line outpatient antibiotic use ($2; 15 % of the total SCAR) and antibiotic stewardship ($1; 8 %). This apperars to be an error.; of the total SCAR) were modest contributors to the total SCAR. Assuming an average antibiotic cost of $20, the total SCAR attributable to each ambulatory antibiotic prescription would increase antibiotic costs by 65 % (range: 15-475 %) if incorporated into antibiotic costs paid by patients or payers. Each ambulatory antibiotic prescription is associated with a hidden SCAR that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.

[Cost-benefit analysis of the implementation of automated drug-dispensing systems in Critical Care and Emergency Units].

PubMed

Poveda Andrés, J L; García Gómez, C; Hernández Sansalvador, M; Valladolid Walsh, A

2003-01-01

To determine monetary impact when traditional drug floor stocks are replaced by Automated Drug Dispensing Systems (ADDS) in the Medical Intensive Care Unit, Surgical Intensive Care Unit and the Emergency Room. We analysed four different flows considered to be determinant when implementing ADDS in a hospital environment: capital investment, staff costs, inventory costs and costs related to drug use policies. Costs were estimated by calculation of the current net value. Its analysis shows that those expenses derived from initial investment are compensated by the three remaining flows, with costs related to drug use policies showing the most substantial savings. Five years after initial investment, global cash-flows have been estimated at 300.525 euros. Replacement of traditional floor stocks by ADDS in the Medical Intensive Care Unit, Surgery Intensive Care Unit and the Emergency Room produces a positive benefit/cost ratio (1.95).

Mitigating climate change through afforestation: new cost estimates for the United States

Treesearch

Anne Sofie Elberg Nielsen; Andrew J. Plantinga; Ralph J. Alig

2014-01-01

We provide new cost estimates for carbon sequestration through afforestation in the U.S. We extend existing studies of carbon sequestration costs in several important ways, while ensuring the transparency of our approach. Our costs estimates have five distinguishing features: (1) we estimate costs for each county in the contiguous U.S., (2) we include afforestation of...

The Economic Burden of Vision Loss and Eye Disorders among the United States Population Younger than 40 Years

PubMed Central

Wittenborn, John S.; Zhang, Xinzhi; Feagan, Charles W.; Crouse, Wesley L.; Shrestha, Sundar; Kemper, Alex R.; Hoerger, Thomas J.; Saaddine, Jinan B.

2017-01-01

Objective To estimate the economic burden of vision loss and eye disorders in the United States population younger than 40 years in 2012. Design Econometric and statistical analysis of survey, commercial claims, and census data. Participants The United States population younger than 40 years in 2012. Methods We categorized costs based on consensus guidelines. We estimated medical costs attributable to diagnosed eye-related disorders, undiagnosed vision loss, and medical vision aids using Medical Expenditure Panel Survey and MarketScan data. The prevalence of vision impairment and blindness were estimated using National Health and Nutrition Examination Survey data. We estimated costs from lost productivity using Survey of Income and Program Participation. We estimated costs of informal care, low vision aids, special education, school screening, government spending, and transfer payments based on published estimates and federal budgets. We estimated quality-adjusted life years (QALYs) lost based on published utility values. Main Outcome Measures Costs and QALYs lost in 2012. Results The economic burden of vision loss and eye disorders among the United States population younger than 40 years was $27.5 billion in 2012 (95% confidence interval, $21.5–$37.2 billion), including $5.9 billion for children and $21.6 billion for adults 18 to 39 years of age. Direct costs were $14.5 billion, including $7.3 billion in medical costs for diagnosed disorders, $4.9 billion in refraction correction, $0.5 billion in medical costs for undiagnosed vision loss, and $1.8 billion in other direct costs. Indirect costs were $13 billion, primarily because of $12.2 billion in productivity losses. In addition, vision loss cost society 215 000 QALYs. Conclusions We found a substantial burden resulting from vision loss and eye disorders in the United States population younger than 40 years, a population excluded from previous studies. Monetizing quality-of-life losses at $50 000 per QALY would add $10.8 billion in additional costs, indicating a total economic burden of $38.2 billion. Relative to previously reported estimates for the population 40 years of age and older, more than one third of the total cost of vision loss and eye disorders may be incurred by persons younger than 40 years. PMID:23631946

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

Synthesis on construction unit cost development : technical report.

DOT National Transportation Integrated Search

2009-01-01

Availability of historical unit cost data is an important factor in developing accurate project cost estimates. : State highway agencies (SHAs) collect data on historical bids and/or production rates, crew sizes and mixes, : material costs, and equip...

Comparison of vials and prefilled pens of a rapid-acting insulin analog on pharmacy budgets in a long-term care setting.

PubMed

Eby, Elizabeth L; Smolen, Lee J; Pitts, Amber C; Krueger, Linda A; Andrews, Jeffrey Scott

2014-12-01

Estimate budgetary impact for skilled nursing facility converting from individual patient supply (IPS) delivery of rapid-acting insulin analog (RAIA) 10-mL vials or 3-mL prefilled pens to 3-mL vials. A budget-impact model used insulin volume purchased and assumptions of length of stay (LOS), daily RAIA dose, and delivery protocol to estimate the cost impact of using 3-mL vials. Skilled nursing facility. Medicare Part A patients. Simulations conducted using 12-month current and future scenarios. Comparisons of RAIA use for 13- and 28-day LOS. RAIA costs and savings, waste reduction. For patients with 13-day LOS using 20 units/day of IPS insulin, the model estimated a 70% reduction in RAIA costs and units purchased and a 95% waste reduction for the 3-mL vial compared with the 10-mL vial. The estimated costs for prefilled pen use were 58% lower than for use of 10-mL vials. The incremental savings associated with 3-mL vial use instead of prefilled pens was 28%, attributable to differences in per-unit cost of insulin in vials versus prefilled pens. Using a more conservative scenario of 28-day LOS at 20 units/day, the model estimated a 40% reduction in RAIA costs and units purchased, resulting in a 91% reduction in RAIA waste for the 3-mL vial, compared with 10-mL vial. Budget-impact analysis of conversion from RAIA 10-mL vials or 3-mL prefilled pens to 3-mL vials estimated reductions in both insulin costs and waste across multiple scenarios of varying LOS and patient daily doses for skilled nursing facility stays.

Cost and price estimate of Brayton and Stirling engines in selected production volumes

NASA Technical Reports Server (NTRS)

Fortgang, H. R.; Mayers, H. F.

1980-01-01

The methods used to determine the production costs and required selling price of Brayton and Stirling engines modified for use in solar power conversion units are presented. Each engine part, component and assembly was examined and evaluated to determine the costs of its material and the method of manufacture based on specific annual production volumes. Cost estimates are presented for both the Stirling and Brayton engines in annual production volumes of 1,000, 25,000, 100,000 and 400,000. At annual production volumes above 50,000 units, the costs of both engines are similar, although the Stirling engine costs are somewhat lower. It is concluded that modifications to both the Brayton and Stirling engine designs could reduce the estimated costs.

Explaining the heterogeneity in average costs per HIV/AIDS patient in Nigeria: The role of supply-side and service delivery characteristics

PubMed Central

Amanze, Ogbonna O.; La Hera-Fuentes, Gina; Silverman-Retana, Omar; Contreras-Loya, David; Ashefor, Gregory A.; Ogungbemi, Kayode M.

2018-01-01

Objective We estimated the average annual cost per patient of ART per facility (unit cost) in Nigeria, described the variation in costs across facilities, and identified factors associated with this variation. Methods We used facility-level data of 80 facilities in Nigeria, collected between December 2014 and May 2015. We estimated unit costs at each facility as the ratio of total costs (the sum of costs of staff, recurrent inputs and services, capital, training, laboratory tests, and antiretroviral and TB treatment drugs) divided by the annual number of patients. We applied linear regressions to estimate factors associated with ART cost per patient. Results The unit ART cost in Nigeria was $157 USD nationally and the facility-level mean was $231 USD. The study found a wide variability in unit costs across facilities. Variations in costs were explained by number of patients, level of care, task shifting (shifting tasks from doctors to less specialized staff, mainly nurses, to provide ART) and provider´s competence. The study illuminated the potentially important role that management practices can play in improving the efficiency of ART services. Conclusions Our study identifies characteristics of services associated with the most efficient implementation of ART services in Nigeria. These results will help design efficient program scale-up to deliver comprehensive HIV services in Nigeria by distinguishing features linked to lower unit costs. PMID:29718906

Societal costs of exposure to toxic substances: economic and health costs of four case studies that are candidates for environmental causation.

PubMed Central

Muir, T; Zegarac, M

2001-01-01

Four outcomes that evidence suggests are candidates for "environmental causation" were chosen for analysis: diabetes, Parkinson's disease (PD), neurodevelopmental effects and hypothyroidism, and deficits in intelligence quotient (IQ). These are an enormous burden in the United States, Canada, and other industrial countries. We review findings on actual social and economic costs, construct estimates of some of the costs from pertinent sources, and provide several hypothetical examples consistent with published evidence. Many detailed costs are estimated, but these are fragmented and missing in coverage and jurisdiction. Nonetheless, the cumulative costs identified are very large, totaling $568 billion to $793 billion per year for Canada and the United States combined. Partial Canadian costs alone are $46 billion to $52 billion per year. Specifics include diabetes (United States and Canada), $128 billion per year; PD in the United States, $13 billion to $28.5 billion per year; neurodevelopmental deficits and hypothryoidism are endemic and, including estimates of costs of childhood disorders that evidence suggests are linked, amount to $81.5 billion to $167 billion per year for the United States and $2 billion per year in Ontario; loss of 5 IQ points cost $30 billion per year in Canada and $275 billion to $326 billion per year in the United States; and hypothetical dynamic economic impacts cost another $19 billion to $92 billion per year for the United States and Canada combined. Reasoned arguments based on the weight of evidence can support the hypothesis that at least 10%, up to 50% of these costs are environmentally induced--between $57 billion and $397 billion per year. PMID:11744507

Economic costs of nonmedical use of prescription opioids.

PubMed

Hansen, Ryan N; Oster, Gerry; Edelsberg, John; Woody, George E; Sullivan, Sean D

2011-01-01

Although the economic costs of substance misuse have been extensively examined in the published literature, information on the costs of nonmedical use of prescription opioids is much more limited, despite being a significant and rapidly growing problem in the United States. We estimated the current economic burden of nonmedical use of prescription opioids in the United States in terms of direct substance abuse treatment, medical complications, productivity loss, and criminal justice. We distributed our broad cost estimates among the various drugs of misuse, including prescription opioids, down to the individual drug level. In 2006, the estimated total cost in the United States of nonmedical use of prescription opioids was $53.4 billion, of which $42 billion (79%) was attributable to lost productivity, $8.2 billion (15%) to criminal justice costs, $2.2 billion (4%) to drug abuse treatment, and $944 million to medical complications (2%). Five drugs--OxyContin, oxycodone, hydrocodone, propoxyphene, and methadone--accounted for two-thirds of the total economic burden. The economic cost of nonmedical use of prescription opioids in the United States totals more than $50 billion annually; lost productivity and crime account for the vast majority (94%) of these costs.

Price Estimation Guidelines

NASA Technical Reports Server (NTRS)

Chamberlain, R. G.; Aster, R. W.; Firnett, P. J.; Miller, M. A.

1985-01-01

Improved Price Estimation Guidelines, IPEG4, program provides comparatively simple, yet relatively accurate estimate of price of manufactured product. IPEG4 processes user supplied input data to determine estimate of price per unit of production. Input data include equipment cost, space required, labor cost, materials and supplies cost, utility expenses, and production volume on industry wide or process wide basis.

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

PubMed Central

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

2013-01-01

Objectives To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. Methods This study used the best available secondary data to develop cost per case estimates. For each cost category, the paper used attributable costs whenever possible. For those categories that attributable cost data were not available, costs were estimated as the product of incremental effect of child maltreatment on a specific outcome multiplied by the estimated cost associated with that outcome. The estimate of the aggregate lifetime cost of child maltreatment in 2008 was obtained by multiplying per-victim lifetime cost estimates by the estimated cases of new child maltreatment in 2008. Results The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in 2010 dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion. In sensitivity analysis, the total burden is estimated to be as large as $585 billion. Conclusions Compared with other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment. PMID:22300910

Lost in Translation: Public Policies, Evidence-Based Practice, and Autism Spectrum Disorder

ERIC Educational Resources Information Center

Dillenburger, Karola; McKerr, Lyn; Jordan, Julie-Ann

2014-01-01

Prevalence rates of autism spectrum disorder have risen dramatically over the past few decades (now estimated at 1:50 children). The estimated total annual cost to the public purse in the United States is US$137 billion, with an individual lifetime cost in the United Kingdom estimated at between £0.8 million and £1.23 million depending on the…

Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception.

PubMed

Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

2013-02-01

This study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all women requiring reversible contraception in the US: the pattern of contraceptive use and the rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Annual medical costs of UP in the United States were estimated to be $4.6 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20-29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Imperfect contraceptive adherence leads to substantial UP and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. Copyright © 2013 Elsevier Inc. All rights reserved.

Burden of unintended pregnancy in the United States: Potential savings with increased use of long-acting reversible contraception

PubMed Central

Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

2013-01-01

Background This study evaluated the total costs of unintended pregnancy (UP) in the United States from a third -party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. Study Design An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all US women requiring reversible contraception: the pattern of contraceptive use and rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Results Annual medical costs of UP in the United States were estimated to be $4.5 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20–29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Conclusions Imperfect contraceptive adherence leads to substantial unintended pregnancy and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. PMID:22959904

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

ERIC Educational Resources Information Center

Phelps, Richard P.

2000-01-01

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

Estimating Power Outage Cost based on a Survey for Industrial Customers

NASA Astrophysics Data System (ADS)

Yoshida, Yoshikuni; Matsuhashi, Ryuji

A survey was conducted on power outage cost for industrial customers. 5139 factories, which are designated energy management factories in Japan, answered their power consumption and the loss of production value due to the power outage in an hour in summer weekday. The median of unit cost of power outage of whole sectors is estimated as 672 yen/kWh. The sector of services for amusement and hobbies and the sector of manufacture of information and communication electronics equipment relatively have higher unit cost of power outage. Direct damage cost from power outage in whole sectors reaches 77 billion yen. Then utilizing input-output analysis, we estimated indirect damage cost that is caused by the repercussion of production halt. Indirect damage cost in whole sectors reaches 91 billion yen. The sector of wholesale and retail trade has the largest direct damage cost. The sector of manufacture of transportation equipment has the largest indirect damage cost.

Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom

PubMed Central

2010-01-01

Background To estimate life years and quality-adjusted life years (QALYs) lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom including healthcare and non-healthcare costs from a societal perspective. Methods All UK residents in 2005 with aSAH (International Classification of Diseases 10th revision (ICD-10) code I60). Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL) data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death. Results A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS) £168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be £23,294. The total economic burden (including informal care and using the human capital method to estimate production losses) of a SAH in the United Kingdom was estimated to be £510 million annually. Conclusion The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories. PMID:20423472

[Cost-effectiveness analysis and diet quality index applied to the WHO Global Strategy].

PubMed

Machado, Flávia Mori Sarti; Simões, Arlete Naresse

2008-02-01

To test the use of cost-effectiveness analysis as a decision making tool in the production of meals for the inclusion of the recommendations published in the World Health Organization's Global Strategy. Five alternative options for breakfast menu were assessed previously to their adoption in a food service at a university in the state of Sao Paulo, Southeastern Brazil, in 2006. Costs of the different options were based on market prices of food items (direct cost). Health benefits were estimated based on adaptation of the Diet Quality Index (DQI). Cost-effectiveness ratios were estimated by dividing benefits by costs and incremental cost-effectiveness ratios were estimated as cost differential per unit of additional benefit. The meal choice was based on health benefit units associated to direct production cost as well as incremental effectiveness per unit of differential cost. The analysis showed the most simple option with the addition of a fruit (DQI = 64 / cost = R$ 1.58) as the best alternative. Higher effectiveness was seen in the options with a fruit portion (DQI1=64 / DQI3=58 / DQI5=72) compared to the others (DQI2=48 / DQI4=58). The estimate of cost-effectiveness ratio allowed to identifying the best breakfast option based on cost-effectiveness analysis and Diet Quality Index. These instruments allow easy application easiness and objective evaluation which are key to the process of inclusion of public or private institutions under the Global Strategy directives.

Manufacturing Cost Levelization Model – A User’s Guide

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

Morrow, William R.; Shehabi, Arman; Smith, Sarah Josephine

The Manufacturing Cost Levelization Model is a cost-performance techno-economic model that estimates total large-scale manufacturing costs for necessary to produce a given product. It is designed to provide production cost estimates for technology researchers to help guide technology research and development towards an eventual cost-effective product. The model presented in this user’s guide is generic and can be tailored to the manufacturing of any product, including the generation of electricity (as a product). This flexibility, however, requires the user to develop the processes and process efficiencies that represents a full-scale manufacturing facility. The generic model is comprised of several modulesmore » that estimate variable costs (material, labor, and operating), fixed costs (capital & maintenance), financing structures (debt and equity financing), and tax implications (taxable income after equipment and building depreciation, debt interest payments, and expenses) of a notional manufacturing plant. A cash-flow method is used to estimate a selling price necessary for the manufacturing plant to recover its total cost of production. A levelized unit sales price ($ per unit of product) is determined by dividing the net-present value of the manufacturing plant’s expenses ($) by the net present value of its product output. A user defined production schedule drives the cash-flow method that determines the levelized unit price. In addition, an analyst can increase the levelized unit price to include a gross profit margin to estimate a product sales price. This model allows an analyst to understand the effect that any input variables could have on the cost of manufacturing a product. In addition, the tool is able to perform sensitivity analysis, which can be used to identify the key variables and assumptions that have the greatest influence on the levelized costs. This component is intended to help technology researchers focus their research attention on tasks that offer the greatest opportunities for cost reduction early in the research and development stages of technology invention.« less

Lunar base scenario cost estimates: Lunar base systems study task 6.1

NASA Technical Reports Server (NTRS)

1988-01-01

The projected development and production costs of each of the Lunar Base's systems are described and unit costs are estimated for transporting the systems to the lunar surface and for setting up the system.

The role of community acceptance over time for costs of HIV and STI prevention interventions: analysis of the Masaka Intervention Trial, Uganda, 1996-1999.

PubMed

Terris-Prestholt, Fern; Kumaranayake, Lilani; Foster, Susan; Kamali, Anatoli; Kinsman, John; Basajja, Vincent; Nalweyso, Nora; Quigley, Maria; Kengeya-Kayondo, Jane; Whitworth, James

2006-10-01

The objective of this study is to estimate the annual costs of information, education, and communication (IEC), both community- and school-based; strengthened public and private sexually transmitted infections treatment; condom social marketing (CSM); and voluntary counseling and testing (VCT) implemented in Masaka, Uganda, over 4 years, and to explore how unit costs change with varying population use/uptake. Total economic provider's costs and intervention outputs were collected annually to estimate annual unit costs between 1996 and 1999. In early intervention years, uptake of all activities grew dramatically and continued to grow for public STI treatment, CSM, and VCT. Attendance at IEC performances started to drop in year 4. Unit costs dropped rapidly with increasing uptake of and participation in interventions. When implementing long-term community-based interventions, it is important to take into account that it takes time for communities to scale up their participation, since this can lead to large variations in unit costs.

Cost of vaccinating refugees overseas versus after arrival in the United States, 2005.

PubMed

2008-03-07

Since 2000, approximately 50,000 refugees have entered the United States each year from various regions of the world. Although persons with immigrant status are legally required to be vaccinated before entering the United States, this requirement does not extend to U.S.-bound persons with refugee status. After 1 year in the United States, refugees can apply for a change of status to that of legal permanent resident, at which time they are required to be fully vaccinated in accordance with recommendations of the Advisory Committee on Immunization Practices (ACIP). A potentially less costly alternative might be to vaccinate U.S.-bound refugees overseas routinely, before they depart from refugee camps. To compare the cost of vaccinating refugees overseas versus after their arrival in the United States, CDC analyzed 2005 data on the number of refugees, cost of vaccine, and cost of vaccine administration. This report summarizes the results of that analysis, which suggested that, in 2005, vaccinating 50,787 refugees overseas would have cost an estimated $7.7 million, less than one third of the estimated $26.0 million cost of vaccinating in the United States. Costs were calculated from the perspective of the U.S. health-care system. To achieve public health cost savings, routine overseas vaccination of U.S.-bound refugees should be considered.

Cost-effectiveness analysis of microscopic observation drug susceptibility test versus Xpert MTB/Rif test for diagnosis of pulmonary tuberculosis in HIV patients in Uganda.

PubMed

Walusimbi, Simon; Kwesiga, Brendan; Rodrigues, Rashmi; Haile, Melles; de Costa, Ayesha; Bogg, Lennart; Katamba, Achilles

2016-10-10

Microscopic Observation Drug Susceptibility (MODS) and Xpert MTB/Rif (Xpert) are highly sensitive tests for diagnosis of pulmonary tuberculosis (PTB). This study evaluated the cost effectiveness of utilizing MODS versus Xpert for diagnosis of active pulmonary TB in HIV infected patients in Uganda. A decision analysis model comparing MODS versus Xpert for TB diagnosis was used. Costs were estimated by measuring and valuing relevant resources required to perform the MODS and Xpert tests. Diagnostic accuracy data of the tests were obtained from systematic reviews involving HIV infected patients. We calculated base values for unit costs and varied several assumptions to obtain the range estimates. Cost effectiveness was expressed as costs per TB patient diagnosed for each of the two diagnostic strategies. Base case analysis was performed using the base estimates for unit cost and diagnostic accuracy of the tests. Sensitivity analysis was performed using a range of value estimates for resources, prevalence, number of tests and diagnostic accuracy. The unit cost of MODS was US$ 6.53 versus US$ 12.41 of Xpert. Consumables accounted for 59 % (US$ 3.84 of 6.53) of the unit cost for MODS and 84 % (US$10.37 of 12.41) of the unit cost for Xpert. The cost effectiveness ratio of the algorithm using MODS was US$ 34 per TB patient diagnosed compared to US$ 71 of the algorithm using Xpert. The algorithm using MODS was more cost-effective compared to the algorithm using Xpert for a wide range of different values of accuracy, cost and TB prevalence. The cost (threshold value), where the algorithm using Xpert was optimal over the algorithm using MODS was US$ 5.92. MODS versus Xpert was more cost-effective for the diagnosis of PTB among HIV patients in our setting. Efforts to scale-up MODS therefore need to be explored. However, since other non-economic factors may still favour the use of Xpert, the current cost of the Xpert cartridge still needs to be reduced further by more than half, in order to make it economically competitive with MODS.

Cost Allocation Issues in Interlibrary Systems.

ERIC Educational Resources Information Center

Alexander, Ernest R.

1985-01-01

In comparing methods of allocating service transaction costs among member libraries of interlibrary systems, questions of how costs are to be estimated, and what cost elements are to be included are critical. Different approaches of estimation yield varying results. Actual distribution of units accounts for greatest variance in allocations. (CDD)

Taking ART to Scale: Determinants of the Cost and Cost-Effectiveness of Antiretroviral Therapy in 45 Clinical Sites in Zambia

PubMed Central

Marseille, Elliot; Giganti, Mark J.; Mwango, Albert; Chisembele-Taylor, Angela; Mulenga, Lloyd; Over, Mead; Kahn, James G.; Stringer, Jeffrey S. A.

2012-01-01

Background We estimated the unit costs and cost-effectiveness of a government ART program in 45 sites in Zambia supported by the Centre for Infectious Disease Research Zambia (CIDRZ). Methods We estimated per person-year costs at the facility level, and support costs incurred above the facility level and used multiple regression to estimate variation in these costs. To estimate ART effectiveness, we compared mortality in this Zambian population to that of a cohort of rural Ugandan HIV patients receiving co-trimoxazole (CTX) prophylaxis. We used micro-costing techniques to estimate incremental unit costs, and calculated cost-effectiveness ratios with a computer model which projected results to 10 years. Results The program cost $69.7 million for 125,436 person-years of ART, or $556 per ART-year. Compared to CTX prophylaxis alone, the program averted 33.3 deaths or 244.5 disability adjusted life-years (DALYs) per 100 person-years of ART. In the base-case analysis, the net cost per DALY averted was $833 compared to CTX alone. More than two-thirds of the variation in average incremental total and on-site cost per patient-year of treatment is explained by eight determinants, including the complexity of the patient-case load, the degree of adherence among the patients, and institutional characteristics including, experience, scale, scope, setting and sector. Conclusions and Significance The 45 sites exhibited substantial variation in unit costs and cost-effectiveness and are in the mid-range of cost-effectiveness when compared to other ART programs studied in southern Africa. Early treatment initiation, large scale, and hospital setting, are associated with statistically significantly lower costs, while others (rural location, private sector) are associated with shifting cost from on- to off-site. This study shows that ART programs can be significantly less costly or more cost-effective when they exploit economies of scale and scope, and initiate patients at higher CD4 counts. PMID:23284843

Taking ART to scale: determinants of the cost and cost-effectiveness of antiretroviral therapy in 45 clinical sites in Zambia.

PubMed

Marseille, Elliot; Giganti, Mark J; Mwango, Albert; Chisembele-Taylor, Angela; Mulenga, Lloyd; Over, Mead; Kahn, James G; Stringer, Jeffrey S A

2012-01-01

We estimated the unit costs and cost-effectiveness of a government ART program in 45 sites in Zambia supported by the Centre for Infectious Disease Research Zambia (CIDRZ). We estimated per person-year costs at the facility level, and support costs incurred above the facility level and used multiple regression to estimate variation in these costs. To estimate ART effectiveness, we compared mortality in this Zambian population to that of a cohort of rural Ugandan HIV patients receiving co-trimoxazole (CTX) prophylaxis. We used micro-costing techniques to estimate incremental unit costs, and calculated cost-effectiveness ratios with a computer model which projected results to 10 years. The program cost $69.7 million for 125,436 person-years of ART, or $556 per ART-year. Compared to CTX prophylaxis alone, the program averted 33.3 deaths or 244.5 disability adjusted life-years (DALYs) per 100 person-years of ART. In the base-case analysis, the net cost per DALY averted was $833 compared to CTX alone. More than two-thirds of the variation in average incremental total and on-site cost per patient-year of treatment is explained by eight determinants, including the complexity of the patient-case load, the degree of adherence among the patients, and institutional characteristics including, experience, scale, scope, setting and sector. The 45 sites exhibited substantial variation in unit costs and cost-effectiveness and are in the mid-range of cost-effectiveness when compared to other ART programs studied in southern Africa. Early treatment initiation, large scale, and hospital setting, are associated with statistically significantly lower costs, while others (rural location, private sector) are associated with shifting cost from on- to off-site. This study shows that ART programs can be significantly less costly or more cost-effective when they exploit economies of scale and scope, and initiate patients at higher CD4 counts.

Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities.

PubMed

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.

Energy System and Thermoeconomic Analysis of Combined Heat and Power High Temperature Proton Exchange Membrane Fuel Cell Systems for Light Commercial Buildings

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

Colella, Whitney G.; Pilli, Siva Prasad

2015-06-01

The United States (U.S.) Department of Energy (DOE)’s Pacific Northwest National Laboratory (PNNL) is spearheading a program with industry to deploy and independently monitor five kilowatt-electric (kWe) combined heat and power (CHP) fuel cell systems (FCSs) in light commercial buildings. This publication discusses results from PNNL’s research efforts to independently evaluate manufacturer-stated engineering, economic, and environmental performance of these CHP FCSs at installation sites. The analysis was done by developing parameters for economic comparison of CHP installations. Key thermodynamic terms are first defined, followed by an economic analysis using both a standard accounting approach and a management accounting approach. Keymore » economic and environmental performance parameters are evaluated, including (1) the average per unit cost of the CHP FCSs per unit of power, (2) the average per unit cost of the CHP FCSs per unit of energy, (3) the change in greenhouse gas (GHG) and air pollution emissions with a switch from conventional power plants and furnaces to CHP FCSs; (4) the change in GHG mitigation costs from the switch; and (5) the change in human health costs related to air pollution. From the power perspective, the average per unit cost per unit of electrical power is estimated to span a range from $15–19,000/ kilowatt-electric (kWe) (depending on site-specific changes in installation, fuel, and other costs), while the average per unit cost of electrical and heat recovery power varies between $7,000 and $9,000/kW. From the energy perspective, the average per unit cost per unit of electrical energy ranges from $0.38 to $0.46/kilowatt-hour-electric (kWhe), while the average per unit cost per unit of electrical and heat recovery energy varies from $0.18 to $0.23/kWh. These values are calculated from engineering and economic performance data provided by the manufacturer (not independently measured data). The GHG emissions were estimated to decrease by one-third by shifting from a conventional energy system to a CHP FCS system. The GHG mitigation costs were also proportional to the changes in the GHG gas emissions. Human health costs were estimated to decrease significantly with a switch from a conventional system to a CHP FCS system.« less

Total Lifetime and Cancer-related Costs for Elderly Patients Diagnosed With Anal Cancer in the United States.

PubMed

Deshmukh, Ashish A; Zhao, Hui; Franzini, Luisa; Lairson, David R; Chiao, Elizabeth Y; Das, Prajnan; Swartz, Michael D; Giordano, Sharon H; Cantor, Scott B

2018-02-01

To determine the lifetime and phase-specific cost of anal cancer management and the economic burden of anal cancer care in elderly (66 y and older) patients in the United States. For this study, we used Surveillance Epidemiology and End Results-Medicare linked database (1992 to 2009). We matched newly diagnosed anal cancer patients (by age and sex) to noncancer controls. We estimated survival time from the date of diagnosis until death. Lifetime and average annual cost by stage and age at diagnosis were estimated by combining survival data with Medicare claims. The average lifetime cost, proportion of patients who were elderly, and the number of incident cases were used to estimate the economic burden. The average lifetime cost for patients with anal cancer was US$50,150 (N=2227) (2014 US dollars). The average annual cost in men and women was US$8025 and US$5124, respectively. The overall survival after the diagnosis of cancer was 8.42 years. As the age and stage at diagnosis increased, so did the cost of cancer-related care. The anal cancer-related lifetime economic burden in Medicare patients in the United States was US$112 million. Although the prevalence of anal cancer among the elderly in the United States is small, its economic burden is considerable.

Cost and Cost-Effectiveness Assessments of Newborn Screening for Critical Congenital Heart Disease Using Pulse Oximetry: A Review.

PubMed

Grosse, Scott D; Peterson, Cora; Abouk, Rahi; Glidewell, Jill; Oster, Matthew E

2017-01-01

Screening newborns for critical congenital heart disease (CCHD) using pulse oximetry is recommended to allow for the prompt diagnosis and prevention of life-threatening crises. The present review summarizes and critiques six previously published estimates of the costs or cost-effectiveness of CCHD screening from the United Kingdom, United States, and China. Several elements that affect CCHD screening costs were assessed in varying numbers of studies, including screening staff time, instrumentation, and consumables, as well as costs of diagnosis and treatment. A previous US study that used conservative assumptions suggested that CCHD screening is likely to be considered cost-effective from the healthcare sector perspective. Newly available estimates of avoided infant CCHD deaths in several US states that implemented mandatory CCHD screening policies during 2011-2013 suggest a substantially larger reduction in deaths than was projected in the previous US cost-effectiveness analysis. Taking into account these new estimates, we estimate that cost per life-year gained could be as low as USD 12,000. However, that estimate does not take into account future costs of health care and education for surviving children with CCHD nor the costs incurred by health departments to support and monitor CCHD screening policies and programs.

Cost and Cost-Effectiveness Assessments of Newborn Screening for Critical Congenital Heart Disease Using Pulse Oximetry: A Review

PubMed Central

Grosse, Scott D.; Peterson, Cora; Abouk, Rahi; Glidewell, Jill; Oster, Matthew E.

2018-01-01

Screening newborns for critical congenital heart disease (CCHD) using pulse oximetry is recommended to allow for the prompt diagnosis and prevention of life-threatening crises. The present review summarizes and critiques six previously published estimates of the costs or cost-effectiveness of CCHD screening from the United Kingdom, United States, and China. Several elements that affect CCHD screening costs were assessed in varying numbers of studies, including screening staff time, instrumentation, and consumables, as well as costs of diagnosis and treatment. A previous US study that used conservative assumptions suggested that CCHD screening is likely to be considered cost-effective from the healthcare sector perspective. Newly available estimates of avoided infant CCHD deaths in several US states that implemented mandatory CCHD screening policies during 2011–2013 suggest a substantially larger reduction in deaths than was projected in the previous US cost-effectiveness analysis. Taking into account these new estimates, we estimate that cost per life-year gained could be as low as USD 12,000. However, that estimate does not take into account future costs of health care and education for surviving children with CCHD nor the costs incurred by health departments to support and monitor CCHD screening policies and programs. PMID:29376140

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.

PARVCOST : a particleboard variable cost program

Treesearch

Peter J. Ince; George B. Harpole

1977-01-01

PARVCOST, a FORTRAN program, was designed to develop economic and financial analyses of systems for manufacturing particleboard. In the program, costs and requirements of wood are calculated as are chemicals and energy per unit of finished board products. Estimates are made of sensitivity of the finished product costs to changes in unit costs of energy and raw...

Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs

PubMed Central

Trasande, Leonardo; Malecha, Patrick; Attina, Teresa M.

2016-01-01

Background: Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States. Objectives: We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010. Methods: Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07–1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars. Results: An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43–9.66 B], of which $760 million were spent for medical care (SA: $362 M–1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States. Conclusions: PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy. Citation: Trasande L, Malecha P, Attina TM. 2016. Particulate matter exposure and preterm birth: estimates of U.S. attributable burden and economic costs. Environ Health Perspect 124:1913–1918; http://dx.doi.org/10.1289/ehp.1510810 PMID:27022947

Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs.

PubMed

Trasande, Leonardo; Malecha, Patrick; Attina, Teresa M

2016-12-01

Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States. We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010. Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07-1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars. An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43-9.66 B], of which $760 million were spent for medical care (SA: $362 M-1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States. PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy. Citation: Trasande L, Malecha P, Attina TM. 2016. Particulate matter exposure and preterm birth: estimates of U.S. attributable burden and economic costs. Environ Health Perspect 124:1913-1918; http://dx.doi.org/10.1289/ehp.1510810.

Estimating the costs of psychiatric hospital services at a public health facility in Nigeria.

PubMed

Ezenduka, Charles; Ichoku, Hyacinth; Ochonma, Ogbonnia

2012-09-01

Information on the cost of mental health services in Africa is very limited even though mental health disorders represent a significant public health concern, in terms of health and economic impact. Cost analysis is important for planning and for efficiency in the provision of hospital services. The study estimated the total and unit costs of psychiatric hospital services to guide policy and psychiatric hospital management efficiency in Nigeria. The study was exploratory and analytical, examining 2008 data. A standard costing methodology based on ingredient approach was adopted combining top-down method with step-down approach to allocate resources (overhead and indirect costs) to the final cost centers. Total and unit cost items related to the treatment of psychiatric patients (including the costs of personnel, overhead and annualised costs of capital items) were identified and measured on the basis of outpatients' visits, inpatients' days and inpatients' admissions. The exercise reflected the input-output process of hospital services where inputs were measured in terms of resource utilisation and output measured by activities carried out at both the outpatient and inpatient departments. In the estimation process total costs were calculated at every cost center/department and divided by a measure of corresponding patient output to produce the average cost per output. This followed a stepwise process of first allocating the direct costs of overhead to the intermediate and final cost centers and from intermediate cost centers to final cost centers for the calculation of total and unit costs. Costs were calculated from the perspective of the healthcare facility, and converted to the US Dollars at the 2008 exchange rate. Personnel constituted the greatest resource input in all departments, averaging 80% of total hospital cost, reflecting the mix of capital and recurrent inputs. Cost per inpatient day, at $56 was equivalent to 1.4 times the cost per outpatient visit at $41, while cost per emergency visit was about two times the cost per outpatient visit. The cost of one psychiatric inpatient admission averaged $3,675, including the costs of drugs and laboratory services, which was equivalent to the cost of 90 outpatients' visits. Cost of drugs was about 4.4% of the total costs and each prescription averaged $7.48. The male ward was the most expensive cost center. Levels of subsidization for inpatient services were over 90% while ancillary services were not subsidized hence full cost recovery. The hospital costs were driven by personnel which reflected the mix of inputs that relied most on technical manpower. The unit cost estimates are significantly higher than the upper limit range for low income countries based on the WHO-CHOICE estimates. Findings suggest a scope for improving efficiency of resource use given the high proportion of fixed costs which indicates excess capacity. Adequate research is needed for effective comparisons and valid assessment of efficiency in psychiatric hospital services in Africa. The unit cost estimates will be useful in making projections for total psychiatric hospital package and a basis for determining the cost of specific neuropsychiatric cases.

Learning/cost-improvement curves

NASA Technical Reports Server (NTRS)

Delionback, L. M.

1976-01-01

Review guide is an aid to manager or engineer who must determine production costs for components, systems, or services. Methods are described by which manufacturers may use historical data, task characteristics, and current cost data to estimate unit prices as function of number of units to be produced.

COST ESTIMATION MODELS FOR DRINKING WATER TREATMENT UNIT PROCESSES

EPA Science Inventory

Cost models for unit processes typically utilized in a conventional water treatment plant and in package treatment plant technology are compiled in this paper. The cost curves are represented as a function of specified design parameters and are categorized into four major catego...

Cryptococcal Meningitis Treatment Strategies Affected by the Explosive Cost of Flucytosine in the United States: A Cost-effectiveness Analysis.

PubMed

Merry, Matthew; Boulware, David R

2016-06-15

In the United States, cryptococcal meningitis causes approximately 3400 hospitalizations and approximately 330 deaths annually. The US guidelines recommend treatment with amphotericin B plus flucytosine for at least 2 weeks, followed by fluconazole for a minimum of 8 weeks. Due to generic drug manufacturer monopolization, flucytosine currently costs approximately $2000 per day in the United States, with a 2-week flucytosine treatment course costing approximately $28 000. The daily flucytosine treatment cost in the United Kingdom is approximately $22. Cost-effectiveness analysis was performed to determine the value of flucytosine relative to alternative regimens. We estimated the incremental cost-effectiveness ratio (ICER) of 3 cryptococcal induction regimens: (1) amphotericin B deoxycholate for 4 weeks; (2) amphotericin and flucytosine (100 mg/kg/day) for 2 weeks; and (3) amphotericin and fluconazole (800 mg/day) for 2 weeks. Costs of care were calculated using 2015 US prices and the medication costs. Survival estimates were derived from a randomized trial and scaled relative to published US survival data. Cost estimates were $83 227 for amphotericin monotherapy, $75 121 for amphotericin plus flucytosine, and $44 605 for amphotericin plus fluconazole. The ICER of amphotericin plus flucytosine was $23 842 per quality-adjusted life-year. Flucytosine is currently cost-effective in the United States despite a dramatic increase in price in recent years. Combination therapy with amphotericin and flucytosine is the most attractive treatment strategy for cryptococcal meningitis, though the rising price may be creating access issues that will exacerbate if the trend of profiteering continues. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Structural interventions to prevent HIV/sexually transmitted disease: are they cost-effective for women in the southern United States?

PubMed

Cohen, Deborah A; Wu, Shin-Yi; Farley, Thomas A

2006-07-01

Structural interventions are theoretically promising for populations with a low prevalence of HIV, because they can reach large numbers of people to influence their social norms and collective risky behaviors for a relatively low cost per person. Because HIV transmission is continuing to increase among women in the southern United States, interventions to stem this epidemic are particularly warranted. This study explores whether structural interventions may be a cost-effective way to prevent HIV in this population. We used the cost-effectiveness estimator, "Maximizing the Benefit" to determine the relative cost-effectiveness of 6 structural HIV prevention interventions. "Maximizing the Benefit" is a spreadsheet tool using mathematical models to estimate the cost per HIV infection prevented taking into account the epidemiologic contexts, behavioral change as a result of an intervention, and the costs of intervention. We applied estimates of HIV prevalence related to blacks in the southern United States. All the structural interventions were cost-effective compared with average lifetime treatment costs of HIV, but mass media, condom availability, and alcohol taxes theoretically prevented the largest numbers of HIV infections. Although the assumptions used in cost-effectiveness estimates have many limitations, they do allow for a relative comparison of different interventions and help to inform policy decisions related to the allocation of HIV prevention resources. Structural interventions hold the greatest promise in reducing HIV transmission among low-prevalence populations.

Estimated cost of overactive bladder in Thailand.

PubMed

Prasopsanti, Kriangsak; Santi-Ngamkun, Apirak; Pornprasit, Kanokwan

2007-11-01

To estimate the annual direct and indirect costs of overactive bladder (OAB) in indigenous Thai people aged 18 years and over in the year 2005. Economically based models using diagnostic and treatment algorithms from clinical practice guidelines and current disease prevalence data were used to estimate direct and indirect costs of OAB. Prevalence and event probability estimates were obtained from the literature, national data sets, and expert opinion. Costs were estimated from a small survey using a cost questionnaire and from unit costs of King Chulalongkorn Memorial Hospital. The annual cost of OAB in Thailand is estimated as 1.9 billion USD. It is estimated to consume 1.14% of national GDP The cost includes 0.33 billion USD for direct medical costs, 1.3 billion USD for direct, nonmedical costs and 0.29 billion USD for indirect costs of lost productivity. The largest costs category was direct treatment costs of comorbidities associated with OAB. Costs of OAB medication accountedfor 14% of the total costs ofOAB.

Six climate change-related events in the United States accounted for about $14 billion in lost lives and health costs.

PubMed

Knowlton, Kim; Rotkin-Ellman, Miriam; Geballe, Linda; Max, Wendy; Solomon, Gina M

2011-11-01

The future health costs associated with predicted climate change-related events such as hurricanes, heat waves, and floods are projected to be enormous. This article estimates the health costs associated with six climate change-related events that struck the United States between 2000 and 2009. The six case studies came from categories of climate change-related events projected to worsen with continued global warming-ozone pollution, heat waves, hurricanes, infectious disease outbreaks, river flooding, and wildfires. We estimate that the health costs exceeded $14 billion, with 95 percent due to the value of lives lost prematurely. Actual health care costs were an estimated $740 million. This reflects more than 760,000 encounters with the health care system. Our analysis provides scientists and policy makers with a methodology to use in estimating future health costs related to climate change and highlights the growing need for public health preparedness.

Occupational injury and illness in the United States. Estimates of costs, morbidity, and mortality.

PubMed

Leigh, J P; Markowitz, S B; Fahs, M; Shin, C; Landrigan, P J

1997-07-28

To estimate the annual incidence, the mortality and the direct and indirect costs associated with occupational injuries and illnesses in the United States in 1992. Aggregation and analysis of national and large regional data sets collected by the Bureau of Labor Statistics, the National Council on Compensation Insurance, the National Center for Health Statistics, the Health Care Financing Administration, and other governmental bureaus and private firms. To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from national surveys and applied an attributable risk proportion method. To assess costs, we used the human capital method that decomposes costs into direct categories such as medical and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from the literature while others were generated within this study. Total costs were calculated by multiplying average costs by the number of injuries and illnesses in each diagnostic category. Approximately 6500 job-related deaths from injury, 13.2 million nonfatal injuries, 60,300 deaths from disease, and 862,200 illnesses are estimated to occur annually in the civilian American workforce. The total direct ($65 billion) plus indirect ($106 billion) costs were estimated to be $171 billion. Injuries cost $145 billion and illnesses $26 billion. These estimates are likely to be low, because they ignore costs associated with pain and suffering as well as those of within-home care provided by family members, and because the numbers of occupational injuries and illnesses are likely to be undercounted. The costs of occupational injuries and illnesses are high, in sharp contrast to the limited public attention and societal resources devoted to their prevention and amelioration. Occupational injuries and illnesses are an insufficiently appreciated contributor to the total burden of health care costs in the United States.

A brief review of the estimated economic burden of sexually transmitted diseases in the United States: inflation-adjusted updates of previously published cost studies.

PubMed

Chesson, Harrell W; Gift, Thomas L; Owusu-Edusei, Kwame; Tao, Guoyu; Johnson, Ana P; Kent, Charlotte K

2011-10-01

We conducted a literature review of studies of the economic burden of sexually transmitted diseases in the United States. The annual direct medical cost of sexually transmitted diseases (including human immunodeficiency virus) has been estimated to be $16.9 billion (range: $13.9-$23.0 billion) in 2010 US dollars.

A simplified economic filter for open-pit mining and heap-leach recovery of copper in the United States

USGS Publications Warehouse

Long, Keith R.; Singer, Donald A.

2001-01-01

Determining the economic viability of mineral deposits of various sizes and grades is a critical task in all phases of mineral supply, from land-use management to mine development. This study evaluates two simple tools for estimating the economic viability of porphyry copper deposits mined by open-pit, heap-leach methods when only limited information on these deposits is available. These two methods are useful for evaluating deposits that either (1) are undiscovered deposits predicted by a mineral resource assessment, or (2) have been discovered but for which little data has been collected or released. The first tool uses ordinary least-squared regression analysis of cost and operating data from selected deposits to estimate a predictive relationship between mining rate, itself estimated from deposit size, and capital and operating costs. The second method uses cost models developed by the U.S. Bureau of Mines (Camm, 1991) updated using appropriate cost indices. We find that the cost model method works best for estimating capital costs and the empirical model works best for estimating operating costs for mines to be developed in the United States.

24 CFR Appendix to Part 971 - Methodology of Comparing Cost of Public Housing With Cost of Tenant-Based Assistance

Code of Federal Regulations, 2012 CFR

2012-04-01

... bills directly to the utility company, then the development's monthly operating cost per occupied unit... Authority and its affected developments. c. As an example of estimating development operating costs from PHA... divided by 270, the product of 22.5 and 12, to give a cost per unit month of $222. C. Accrual The monthly...

A novel methodology for estimating upper limits of major cost drivers for profitable conceptual launch system architectures

NASA Astrophysics Data System (ADS)

Rhodes, Russel E.; Byrd, Raymond J.

1998-01-01

This paper presents a ``back of the envelope'' technique for fast, timely, on-the-spot, assessment of affordability (profitability) of commercial space transportation architectural concepts. The tool presented here is not intended to replace conventional, detailed costing methodology. The process described enables ``quick look'' estimations and assumptions to effectively determine whether an initial concept (with its attendant cost estimating line items) provides focus for major leapfrog improvement. The Cost Charts Users Guide provides a generic sample tutorial, building an approximate understanding of the basic launch system cost factors and their representative magnitudes. This process will enable the user to develop a net ``cost (and price) per payload-mass unit to orbit'' incorporating a variety of significant cost drivers, supplemental to basic vehicle cost estimates. If acquisition cost and recurring cost factors (as a function of cost per payload-mass unit to orbit) do not meet the predetermined system-profitability goal, the concept in question will be clearly seen as non-competitive. Multiple analytical approaches, and applications of a variety of interrelated assumptions, can be examined in a quick, (on-the-spot) cost approximation analysis as this tool has inherent flexibility. The technique will allow determination of concept conformance to system objectives.

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

PubMed

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

2005-12-15

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

40 CFR 258.71 - Financial assurance for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

....71 Section 258.71 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... closure. (a) The owner or operator must have a detailed written estimate, in current dollars, of the cost.... (1) The cost estimate must equal the cost of closing the largest area of all MSWLF unit ever...

40 CFR 258.71 - Financial assurance for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

....71 Section 258.71 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... closure. (a) The owner or operator must have a detailed written estimate, in current dollars, of the cost.... (1) The cost estimate must equal the cost of closing the largest area of all MSWLF unit ever...

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs

PubMed Central

Grosse, Scott D.; Nelson, Richard E.; Nyarko, Kwame A.; Richardson, Lisa C.; Raskob, Gary E.

2015-01-01

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is an important cause of preventable mortality and morbidity. In this study, we summarize estimates of per-patient and aggregate medical costs or expenditures attributable to incident VTE in the United States. Per-patient estimates of incremental costs can be calculated as the difference in costs between patients with and without an event after controlling for differences in underlying health status. We identified estimates of the incremental per-patient costs of acute VTEs and VTE-related complications, including recurrent VTE, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension, and anticoagulation-related adverse drug events. Based on the studies identified, treatment of an acute VTE on average appears to be associated with incremental direct medical costs of $12,000 to $15,000 (2014 US dollars) among first-year survivors, controlling for risk factors. Subsequent complications are conservatively estimated to increase cumulative costs to $18,000–23,000 per incident case. Annual incident VTE events conservatively cost the US healthcare system $7–10 billion each year for 375,000 to 425,000 newly diagnosed, medically treated incident VTE cases. Future studies should track long-term costs for cohorts of people with incident VTE, control for comorbid conditions that have been shown to be associated with VTE, and estimate incremental medical costs for people with VTE who do not survive. The costs associated with treating VTE can be used to assess the potential economic benefit and cost-savings from prevention efforts, although costs will vary among different patient groups. PMID:26654719

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs.

PubMed

Grosse, Scott D; Nelson, Richard E; Nyarko, Kwame A; Richardson, Lisa C; Raskob, Gary E

2016-01-01

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is an important cause of preventable mortality and morbidity. In this study, we summarize estimates of per-patient and aggregate medical costs or expenditures attributable to incident VTE in the United States. Per-patient estimates of incremental costs can be calculated as the difference in costs between patients with and without an event after controlling for differences in underlying health status. We identified estimates of the incremental per-patient costs of acute VTEs and VTE-related complications, including recurrent VTE, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension, and anticoagulation-related adverse drug events. Based on the studies identified, treatment of an acute VTE on average appears to be associated with incremental direct medical costs of $12,000 to $15,000 (2014 US dollars) among first-year survivors, controlling for risk factors. Subsequent complications are conservatively estimated to increase cumulative costs to $18,000-23,000 per incident case. Annual incident VTE events conservatively cost the US healthcare system $7-10 billion each year for 375,000 to 425,000 newly diagnosed, medically treated incident VTE cases. Future studies should track long-term costs for cohorts of people with incident VTE, control for comorbid conditions that have been shown to be associated with VTE, and estimate incremental medical costs for people with VTE who do not survive. The costs associated with treating VTE can be used to assess the potential economic benefit and cost-savings from prevention efforts, although costs will vary among different patient groups. Published by Elsevier Ltd.

Economic Indicators of the Farm Sector. Costs of Production, 1986.

ERIC Educational Resources Information Center

Economic Research Service (USDA), Washington, DC.

This report contains 121 tables that estimate the costs of production of various commodities on United States farms in 1986. The report first assesses costs and returns on a per-unit basis, such as one acre or one animal, under three sections of a budget: cash receipts, cash expenses, and economic costs. The budgets are based on national…

Economic and workflow analysis of a blood bank automated system.

PubMed

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.

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

ERIC Educational Resources Information Center

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

2012-01-01

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

The economic costs of chronic pain among a cohort of treatment seeking adolescents in the United States

PubMed Central

Groenewald, Cornelius B.; Essner, Bonnie S.; Wright, Davene; Fesinmeyer, Megan D.; Palermo, Tonya M.

2014-01-01

The aim of this study was to assess the economic cost of chronic pain among adolescents receiving interdisciplinary pain treatment. Information was gathered from 149 adolescents (ages 10-17) presenting for evaluation and treatment at interdisciplinary pain clinics in the United States. Parents completed a validated measure of family economic attributes, the Client Service Receipt Inventory, to report on health service use and productivity losses due to their child's chronic pain retrospectively over 12 months. Health care costs were calculated by multiplying reported utilization estimates by unit visit costs from the 2010 Medical Expenditure Panel Survey. The estimated mean and median costs per participant were $11,787 and $6,770 respectively. Costs were concentrated in a small group of participants, the top 5 % of those patients incurring the highest costs accounted for 30 % of total costs while the lower 75 % of participants accounted for only 34 % of costs. Total costs to society for adolescents with moderate to severe chronic pain were extrapolated to $19.5 billion annually in the U.S. The cost of childhood chronic pain presents a substantial economic burden to families and society. Future research should focus on predictors of increased health services use and costs in adolescents with chronic pain. Perspective This cost of illness study comprehensively estimates the economic costs of chronic pain in a cohort of treatment-seeking adolescents. The primary driver of costs was direct medical costs followed by productivity losses. Because of its economic impact, policy makers should invest resources in the prevention, diagnosis, and treatment of chronic pediatric pain. PMID:24953887

Climate change trade measures : estimating industry effects

DOT National Transportation Integrated Search

2009-06-01

Estimating the potential effects of domestic emissions pricing for industries in the United States is complex. If the United States were to regulate greenhouse gas emissions, production costs could rise for certain industries and could cause output, ...

Costs of Crashes to Government, United States, 2008

PubMed Central

Miller, Ted R; Bhattacharya, Soma; Zaloshnja, Eduard; Taylor, Dexter; Bahar, Geni; David, Iuliana

2011-01-01

We estimated how much the Federal government and state/local government pay for different kinds of crashes in the United States. Government costs include reductions in an array of public services (emergency, incident management, vocational rehabilitation, coroner court processing of liability litigation), medical payments, social safety net assistance to the injured and their families, and taxes foregone because victims miss work. Government also pays when its employees crash while working and covers fringe benefits for crash-involved employees and their benefit-eligible dependents in non-work hours. We estimated government shares of crash costs by component. We applied those estimates to existing US Department of Transportation estimates of crash costs to society and employers. Government pays an estimated $35 billion annually because of crashes, an estimated 12.6% of the economic cost of crashes (Federal 7.1%, State/local 5.5%). Government bears a higher percentage of the monetary costs of injury crashes than fatal crashes or crashes involving property damage only. Government is increasingly recovering the medical cost of crashes from auto insurers. Nevertheless, medical costs and income and sales tax losses account for 75% of government's crash costs. For State/local government to break even on a 100%-State funded investment in road safety, the intervention would need to have an unrealistically high benefit-cost ratio of 34. Government invests in medical treatment of illness to save lives and improve quality of life. Curing a child's leukemia, for example, is not less costly than leaving that leukemia untreated. Safety should not be held to a different standard. PMID:22105409

Space Programs: Nasa’s Independent Cost Estimating Capability Needs Improvement

DTIC Science & Technology

1992-11-01

AD--A2?t59 263 DTJC 93-01281 I I !:ig’ i ~I1 V:II oz ’~ -A e•, 2.JQ For United States NTISAO General Accounting Office Wto faB Washington, D.C...advisory committee’s recommendation to strengthen NASA’s independent cost estimating capability. Congress and the executive branch need accurate cost ...estimates in deciding whether to undertake or continue space programs which often cost millions or even billions of dollars. In December 1990, the

Index cost estimate based BIM method - Computational example for sports fields

NASA Astrophysics Data System (ADS)

Zima, Krzysztof

2017-07-01

The paper presents an example ofcost estimation in the early phase of the project. The fragment of relative database containing solution, descriptions, geometry of construction object and unit cost of sports facilities was shown. The Index Cost Estimate Based BIM method calculationswith use of Case Based Reasoning were presented, too. The article presentslocal and global similarity measurement and example of BIM based quantity takeoff process. The outcome of cost calculations based on CBR method was presented as a final result of calculations.

Accurate costs of blood transfusion: a microcosting of administering blood products in the United Kingdom National Health Service.

PubMed

Stokes, Elizabeth A; Wordsworth, Sarah; Staves, Julie; Mundy, Nicola; Skelly, Jane; Radford, Kelly; Stanworth, Simon J

2018-04-01

In an environment of limited health care resources, it is crucial for health care systems which provide blood transfusion to have accurate and comprehensive information on the costs of transfusion, incorporating not only the costs of blood products, but also their administration. Unfortunately, in many countries accurate costs for administering blood are not available. Our study aimed to generate comprehensive estimates of the costs of administering transfusions for the UK National Health Service. A detailed microcosting study was used to cost two key inputs into transfusion: transfusion laboratory and nursing inputs. For each input, data collection forms were developed to capture staff time, equipment, and consumables associated with each step in the transfusion process. Costing results were combined with costs of blood product wastage to calculate the cost per unit transfused, separately for different blood products. Data were collected in 2014/15 British pounds and converted to US dollars. A total of 438 data collection forms were completed by 74 staff. The cost of administering blood was $71 (£49) per unit for red blood cells, $84 (£58) for platelets, $55 (£38) for fresh-frozen plasma, and $72 (£49) for cryoprecipitate. Blood administration costs add substantially to the costs of the blood products themselves. These are frequently incurred costs; applying estimates to the blood components supplied to UK hospitals in 2015, the annual cost of blood administration, excluding blood products, exceeds $175 (£120) million. These results provide more accurate estimates of the total costs of transfusion than those previously available. © 2018 AABB.

Comprehensive cost analysis of sentinel node biopsy in solid head and neck tumors using a time-driven activity-based costing approach.

PubMed

Crott, Ralph; Lawson, Georges; Nollevaux, Marie-Cécile; Castiaux, Annick; Krug, Bruno

2016-09-01

Head and neck cancer (HNC) is predominantly a locoregional disease. Sentinel lymph node (SLN) biopsy offers a minimally invasive means of accurately staging the neck. Value in healthcare is determined by both outcomes and the costs associated with achieving them. Time-driven activity-based costing (TDABC) may offer more precise estimates of the true cost. Process maps were developed for nuclear medicine, operating room and pathology care phases. TDABC estimates the costs by combining information about the process with the unit cost of each resource used. Resource utilization is based on observation of care and staff interviews. Unit costs are calculated as a capacity cost rate, measured as a Euros/min (2014), for each resource consumed. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost for each phase of care. Three time equations with six different scenarios were modeled based on the type of camera, the number of SLN and the type of staining used. Total times for different SLN scenarios vary between 284 and 307 min, respectively, with a total cost between 2794 and 3541€. The unit costs vary between 788€/h for the intraoperative evaluation with a gamma-probe and 889€/h for a preoperative imaging with a SPECT/CT. The unit costs for the lymphadenectomy and the pathological examination are, respectively, 560 and 713€/h. A 10 % increase of time per individual activity generates only 1 % change in the total cost. TDABC evaluates the cost of SLN in HNC. The total costs across all phases which varied between 2761 and 3744€ per standard case.

Preliminary estimates of the economic implications of addiction in the United Arab Emirates.

PubMed

Doran, C M

2017-01-23

This study aimed to provide preliminary estimates of the economic implications of addiction in the United Arab Emirates (UAE). Local and international data sources were used to derive estimates of substancerelated healthcare costs, lost productivity and criminal behaviour. From an estimated population of 8.26 million: ~1.47 million used tobacco (20.5% of adults); 380 085 used cannabis (> 5%); 14 077 used alcohol in a harmful manner (0.2%); and 1408 used opiates (0.02%). The cost of addiction was estimated at US$ 5.47 billion in 2012, equivalent to 1.4% of gross domestic product. Productivity costs were the largest contributor at US$ 4.79 billion (88%) followed by criminal behaviour at US$ 0.65 billion (12%). There were no data to estimate cost of: treating tobacco-related diseases, community education and prevention efforts, or social disharmony. Current data collection efforts are limited in their capacity to fully inform an appropriate response to addiction in the UAE. Resources are required to improve indicators of drug use, monitor harm and evaluate treatment.

Hospital costs estimation and prediction as a function of patient and admission characteristics.

PubMed

Ramiarina, Robert; Almeida, Renan Mvr; Pereira, Wagner Ca

2008-01-01

The present work analyzed the association between hospital costs and patient admission characteristics in a general public hospital in the city of Rio de Janeiro, Brazil. The unit costs method was used to estimate inpatient day costs associated to specific hospital clinics. With this aim, three "cost centers" were defined in order to group direct and indirect expenses pertaining to the clinics. After the costs were estimated, a standard linear regression model was developed for correlating cost units and their putative predictors (the patients gender and age, the admission type (urgency/elective), ICU admission (yes/no), blood transfusion (yes/no), the admission outcome (death/no death), the complexity of the medical procedures performed, and a risk-adjustment index). Data were collected for 3100 patients, January 2001-January 2003. Average inpatient costs across clinics ranged from (US$) 1135 [Orthopedics] to 3101 [Cardiology]. Costs increased according to increases in the risk-adjustment index in all clinics, and the index was statistically significant in all clinics except Urology, General surgery, and Clinical medicine. The occupation rate was inversely correlated to costs, and age had no association with costs. The (adjusted) per cent of explained variance varied between 36.3% [Clinical medicine] and 55.1% [Thoracic surgery clinic]. The estimates are an important step towards the standardization of hospital costs calculation, especially for countries that lack formal hospital accounting systems.

Enhancing Groundwater Cost Estimation with the Interpolation of Water Tables across the United States

NASA Astrophysics Data System (ADS)

Rosli, A. U. M.; Lall, U.; Josset, L.; Rising, J. A.; Russo, T. A.; Eisenhart, T.

2017-12-01

Analyzing the trends in water use and supply across the United States is fundamental to efforts in ensuring water sustainability. As part of this, estimating the costs of producing or obtaining water (water extraction) and the correlation with water use is an important aspect in understanding the underlying trends. This study estimates groundwater costs by interpolating the depth to water level across the US in each county. We use Ordinary and Universal Kriging, accounting for the differences between aquifers. Kriging generates a best linear unbiased estimate at each location and has been widely used to map ground-water surfaces (Alley, 1993).The spatial covariates included in the universal Kriging were land-surface elevation as well as aquifer information. The average water table is computed for each county using block kriging to obtain a national map of groundwater cost, which we compare with survey estimates of depth to the water table performed by the USDA. Groundwater extraction costs were then assumed to be proportional to water table depth. Beyond estimating the water cost, the approach can provide an indication of groundwater-stress by exploring the historical evolution of depth to the water table using time series information between 1960 and 2015. Despite data limitations, we hope to enable a more compelling and meaningful national-level analysis through the quantification of cost and stress for more economically efficient water management.

Cost analysis of once-daily ISMN versus twice-daily ISMN or transdermal patch for nitrate prophylaxis.

PubMed

Brown, R E; Kendall, M J; Halpern, M T

1997-02-01

To compare the costs and outcomes of treating exercise-induced angina with once- or twice-daily isosorbide mononitrate (ISMN) or transdermal patch. A decision-analytic model was designed based on published literature showing compliance and increasing symptoms and estimates from physicians on treatment patterns and worsening symptoms. Data show that patients are more compliant with once-daily ISMN (Imdur, Astra Hässle, Mölndal, Sweden) and patch regimens than with twice-daily dose. Based upon the assumption that more compliant patients are better controlled, the model found that fewer medical care resources were consumed by patients treated with the once-daily and the patch regimens. The unit cost of the twice-daily ISMN regimen is 40% of the unit cost of the once-daily. Annual costs of treating an exercise-induced angina patient are 248 pounds for Imdur compared to 250 pounds for the twice-daily ISMN and 299 pounds for the transdermal patch. Unit prices alone are not good indicators for estimating medical management costs.

Analysis of Unit Costs in a University. The Fribourg Example. Program on Institutional Management in Higher Education.

ERIC Educational Resources Information Center

Pasquier, Jacques; Sachse, Matthias

Costing principles are applied to a university by estimating unit costs and their component factors for the university's different inputs, activities, and outputs. The information system used is designed for Fribourg University but could be applicable to other Swiss universities and could serve Switzerland's universities policy. In general, it…

Crash costs by body part injured, fracture involvement, and threat-to-life severity. United States, 2000.

PubMed

Zaloshnja, Eduard; Miller, Ted; Romano, Eduardo; Spicer, Rebecca

2004-05-01

This paper presents costs per US motor vehicle crash victim differentiated into many more diagnostic categories than prior estimates. These unit costs, which include the first keyed to the 1990 edition of Abbreviated Injury Scale (AIS) threat-to-life severity scores, are reported by body part, whether a fracture/dislocation was involved, and the maximum AIS score among the victim's injuries. This level of detail allows for a more accurate estimation of the social costs of motor vehicle crashes. It also allows for reliable analyses of interventions targeting narrow ranges of injuries. The paper updates the medical care data underlying the US crash costs from 1979 to 1986 to the mid 1990s and improves on prior productivity cost estimates. In addition to presenting the latest generation of crash victim costs, this paper analyzes the effects of applying injury costs classified by AIS code from the 1985 edition to injury incidence data coded with the 1990 edition of AIS. This long-standing practice results in inaccurate cost-benefit analyses that typically overestimate benefits. This problem is more acute when old published costs adjusted for inflation are used rather than the recent costs.

Estimating the Medical Care Costs of Obesity in the United States: Systematic Review, Meta-Analysis, and Empirical Analysis.

PubMed

Kim, David D; Basu, Anirban

2016-01-01

The prevalence of adult obesity exceeds 30% in the United States, posing a significant public health concern as well as a substantial financial burden. Although the impact of obesity on medical spending is undeniably significant, the estimated magnitude of the cost of obesity has varied considerably, perhaps driven by different study methodologies. To document variations in study design and methodology in existing literature and to understand the impact of those variations on the estimated costs of obesity. We conducted a systematic review of the twelve recently published articles that reported costs of obesity and performed a meta-analysis to generate a pooled estimate across those studies. Also, we performed an original analysis to understand the impact of different age groups, statistical models, and confounder adjustment on the magnitude of estimated costs using the nationally representative Medical Expenditure Panel Surveys from 2008-2010. We found significant variations among cost estimates in the existing literature. The meta-analysis found that the annual medical spending attributable to an obese individual was $1901 ($1239-$2582) in 2014 USD, accounting for $149.4 billion at the national level. The two most significant drivers of variability in the cost estimates were age groups and adjustment for obesity-related comorbid conditions. It would be important to acknowledge variations in the magnitude of the medical cost of obesity driven by different study design and methodology. Researchers and policy-makers need to be cautious on determining appropriate cost estimates according to their scientific and political questions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost savings through implementation of an integrated home-based record: a case study in Vietnam.

PubMed

Aiga, Hirotsugu; Pham Huy, Tuan Kiet; Nguyen, Vinh Duc

2018-03-01

In Vietnam, there are three major home-based records (HBRs) for maternal and child health (MCH) that have been already nationally scaled up, i.e., Maternal and Child Health Handbook (MCH Handbook), Child Vaccination Handbook, and Child Growth Monitoring Chart. The MCH Handbook covers all the essential recording items that are included in the other two. This overlapping of recording items between the HBRs is likely to result in inefficient use of both financial and human resources. This study is aimed at estimating the magnitude of cost savings that are expected to be realized through implementing exclusively the MCH Handbook by terminating the other two. Secondary data collection and analyses on HBR production and distribution costs and health workers' opportunity costs. Through multiplying the unit costs by their respective quantity multipliers, recurrent costs of operations of three HBRs were estimated. Moreover, magnitude of cost savings likely to be realized was estimated, by calculating recurrent costs overlapping between the three HBRs. It was estimated that implementing exclusively the MCH Handbook would lead to cost savings of United States dollar 3.01 million per annum. The amount estimated is minimum cost savings because only recurrent cost elements (HBR production and distribution costs and health workers' opportunity costs) were incorporated into the estimation. Further indirect cost savings could be expected through reductions in health expenditures, as the use of the MCH Handbook would contribute to prevention of maternal and child illnesses by increasing antenatal care visits and breastfeeding practices. To avoid wasting financial and human resources, the MCH Handbook should be exclusively implemented by abolishing the other two HBRs. This study is globally an initial attempt to estimate cost savings to be realized through avoiding overlapping operations between multiple HBRs for MCH. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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

ERIC Educational Resources Information Center

Lipford, Jody W.; Slice, Jerry K.

2017-01-01

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

Cost of Screening, Brief Intervention, and Referral to Treatment in Health Care Settings.

PubMed

Barbosa, Carolina; Cowell, Alexander J; Landwehr, Justin; Dowd, William; Bray, Jeremy W

2016-01-01

This study analyzed service unit and annual costs of substance abuse screening, brief intervention, and referral to treatment (SBIRT) programs implemented in emergency department (ED), inpatient, and outpatient medical settings in three U.S. states and one tribal organization. Unit costs and annual costs were estimated from the perspective of service providers. Data for unit costs came from 26 performance sites, and data for annual costs came from 10 programs. A bottom-up approach was used to derive unit costs and included labor, space, and materials used in each SBIRT activity. Activities included direct SBIRT services and activities that support direct service delivery. Labor time spent in each activity was collected by trained observers using a time-and-motion approach. A top-down approach used cost questionnaires completed by program administrators to calculate annual costs and included labor, space, contracted services, overhead, training, travel, equipment, and supplies and materials. Costs were estimated in 2012 U.S. dollars. Average unit costs for prescreening, screening, brief intervention, brief treatment, and referral to treatment were $0.61, $6.59, $10.48, $22.63, and $12.06 in ED; $0.86, $6.33, $9.07, $27.61, and $8.03 in inpatient; and $0.84, $3.98, $7.81, $27.94, and $9.23 in outpatient settings, respectively; over half of the costs were attributable to support activities. Across all settings, the average cost to provide SBIRT per positive screen, for 1year, was about $400. Support activities comprise a large proportion of costs. Health administrators can use the results to budget and compare how much sites are reimbursed for SBIRT to how much services actually cost. Copyright © 2015 Elsevier Inc. All rights reserved.

Cost Analysis of an Air Brayton Receiver for a Solar Thermal Electric Power System in Selected Annual Production Volumes

NASA Technical Reports Server (NTRS)

1981-01-01

Pioneer Engineering and Manufacturing Company estimated the cost of manufacturing and Air Brayton Receiver for a Solar Thermal Electric Power System as designed by the AiResearch Division of the Garrett Corporation. Production costs were estimated at annual volumes of 100; 1,000; 5,000; 10,000; 50,000; 100,000 and 1,000,000 units. These costs included direct labor, direct material and manufacturing burden. A make or buy analysis was made of each part of each volume. At high volumes special fabrication concepts were used to reduce operation cycle times. All costs were estimated at an assumed 100% plant capacity. Economic feasibility determined the level of production at which special concepts were to be introduced. Estimated costs were based on the economics of the last half of 1980. Tooling and capital equipment costs were estimated for ach volume. Infrastructure and personnel requirements were also estimated.

Estimating procedure for major highway construction bid item cost : final report.

DOT National Transportation Integrated Search

1978-06-01

The present procedure for estimating construction bid item cost makes use of the quarterly weighted average unit price report coupled with engineering judgement. The limitation to this method is that this report format provides only the lowest bid da...

Comparison of prescription drug costs in the United States and the United Kingdom, Part 1: statins.

PubMed

Jick, Hershel; Wilson, Andrew; Wiggins, Peter; Chamberlin, Douglas P

2012-01-01

To compare the annual cost of statins in the United States and in the United Kingdom. Matched-cohort cost analysis. U.K. General Practice Research Database (GPRD), and MarketScan Commercial Claims and Encounters Database, a large, U.S. self-insured medical claims database. We initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 280,000 people aged 55-64 years from each country in 2005 were prescribed at least one drug. Of these, 91,474 (33%) in the U.S. were prescribed a statin compared with 68,217 (24%) in the U.K. After excluding those who did not receive statins continuously or who switched statins during the year, there remained 61,470 in the U.S. and 45,788 in the U.K. who were prescribed a single statin preparation continuously during 2005 (annual statin users). We estimated and compared drug costs (presented in 2005 U.S. dollars) separately in the two countries. Estimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $313 for generic lovastatin to $1428 for nongeneric simvastatin. In the U.K., annual costs/patient ranged from $164 for generic simvastatin to $509 for nongeneric atorvastatin. The total annual cost of the continuous receipt of statins in the U.S. was $64.9 million compared with $15.7 million in the U.K. In June 2006, after our study results were analyzed, the U.S. Food and Drug Administration approved generic simvastatin. We thus derived cost estimates for simvastatin use during 2006 and found that more than 60% of simvastatin users switched to the generic product, which reduced the cost/pill by more than 50%. The cost paid for statins in the U.S. for people younger than 65 years, who were insured by private companies, was approximately 400% higher than comparable costs paid by the government in the U.K. Available generic statins were substantially less expensive than those that were still under patent in both countries. © 2012, Pharmacotherapy Publications, Inc.

Carbapenemase-producing Acinetobacter baumannii: An outbreak report with special highlights on economic burden.

PubMed

Gagnaire, J; Gagneux-Brunon, A; Pouvaret, A; Grattard, F; Carricajo, A; Favier, H; Mattei, A; Pozzetto, B; Nuti, C; Lucht, F; Berthelot, P; Botelho-Nevers, E

2017-06-01

We aimed to describe the management of a carbapenemase-producing Acinetobacter baumannii (CP-AB) outbreak using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. We also aimed to evaluate the cost of the outbreak and simulate costs if a dedicated unit to manage such outbreak had been set-up. We performed a prospective epidemiological study. Multiple interventions were implemented including cohorting measures and limitation of admissions. Cost estimation was performed using administrative local data. Five patients were colonized with CP-AB and hospitalized in the neurosurgery ward. The index case was a patient who had been previously hospitalized in Portugal. Four secondary colonized patients were further observed within the unit. The strains of A. baumannii were shown to belong to the same clone and all of them produced an OXA-23 carbapenemase. The closure of the ward associated with the discharge of the five patients in a cohorting area of the Infectious Diseases Unit with dedicated staff put a stop to the outbreak. The estimated cost of this 17-week outbreak was $474,474. If patients had been managed in a dedicated unit - including specific area for cohorting of patients and dedicated staff - at the beginning of the outbreak, the estimated cost would have been $189,046. Controlling hospital outbreaks involving multidrug-resistant bacteria requires a rapid cohorting of patients. Using simulation, we highlighted cost gain when using a dedicated cohorting unit strategy for such an outbreak. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

The economic burden of skin disease in the United States.

PubMed

Dehkharghani, Seena; Bible, Jason; Chen, John G; Feldman, Steven R; Fleischer, Alan B

2003-04-01

Skin diseases and their complications are a significant burden on the nation, both in terms of acute and chronic morbidities and their related expenditures for care. Because accurately calculating the cost of skin disease has proven difficult in the past, we present here multiple comparative techniques allowing a more expanded approach to estimating the overall economic burden. Our aims were to (1) determine the economic burden of primary diseases falling within the realm of skin disease, as defined by modern clinical disease classification schemes and (2) identify the specific contribution of each component of costs to the overall expense. Costs were taken as the sum of several factors, divided into direct and indirect health care costs. The direct costs included inpatient hospital costs, ambulatory visit costs (further divided into physician's office visits, outpatient department visits, and emergency department visits), prescription drug costs, and self-care/over-the-counter drug costs. Indirect costs were calculated as the outlay of days of work lost because of skin diseases. The economic burden of skin disease in the United States is large, estimated at approximately $35.9 billion for 1997, including $19.8 billion (54%) in ambulatory care costs; $7.2 billion (20.2%) in hospital inpatient charges; $3.0 billion (8.2%) in prescription drug costs; $4.3 billion (11.7%) in over-the-counter preparations; and $1.6 billion (6.0%) in indirect costs attributable to lost workdays. Our determination of the economic burden of skin care in the United States surpasses past estimates several-fold, and the model presented for calculating cost of illness allows for tracking changes in national expenses for skin care in future studies. The amount of estimated resources devoted to skin disease management is far more than required to treat conditions such as urinary incontinence ($16 billion) and hypertension ($23 billion), but far less than required to treat musculoskeletal conditions ($193 billion).

Cost comparison of unit dose and traditional drug distribution in a long-term-care facility.

PubMed

Lepinski, P W; Thielke, T S; Collins, D M; Hanson, A

1986-11-01

Unit dose and traditional drug distribution systems were compared in a 352-bed long-term-care facility by analyzing nursing time, medication-error rate, medication costs, and waste. Time spent by nurses in preparing, administering, charting, and other tasks associated with medications was measured with a stop-watch on four different nursing units during six-week periods before and after the nursing home began using unit dose drug distribution. Medication-error rate before and after implementation of the unit dose system was determined by patient profile audits and medication inventories. Medication costs consisted of patient billing costs (acquisition cost plus fee) and cost of medications destroyed. The unit dose system required a projected 1507.2 hours less nursing time per year. Mean medication-error rates were 8.53% and 0.97% for the traditional and unit dose systems, respectively. Potential annual savings because of decreased medication waste with the unit dose system were $2238.72. The net increase in cost for the unit dose system was estimated at $615.05 per year, or approximately $1.75 per patient. The unit dose system appears safer and more time-efficient than the traditional system, although its costs are higher.

Recommended Financial Plan for the Construction of a Permanent Campus for San Joaquin Delta College.

ERIC Educational Resources Information Center

Bortolazzo, Julio L.

The financial plan for the San Joaquin Delta College (California) permanent campus is presented in a table showing the gross square footage, the unit cost (including such fixed equipment as workbenches, laboratory tables, etc.), and the estimated total cost for each department. The unit costs per square foot vary from $18.00 for warehousing to…

Working paper : national costs of the metropolitan ITS infrastructure : update to the FHWA 1995 report

DOT National Transportation Integrated Search

2001-07-01

This working paper has been prepared to provide new estimates of the costs to deploy Intelligent Transportation System (ITS) infrastructure elements in the largest metropolitan areas in the United States. It builds upon estimates that were distribute...

Working Paper : national costs of the metropolitan ITS infrastructure : update to the FHWA 1995 report

DOT National Transportation Integrated Search

2000-08-01

This working paper has been prepared to provide new estimates of the costs to deploy Intelligent Transportation System (ITS) infrastructure elements in the largest metropolitan areas in the United States. It builds upon estimates that were distribute...

Estimating the cost of production stoppage

NASA Technical Reports Server (NTRS)

Delionback, L. M.

1979-01-01

Estimation model considers learning curve quantities, and time of break to forecast losses due to break in production schedule. Major parameters capable of predicting costs are number of units made prior to production sequence, length of production break, and slope of learning curve produced prior to break.

Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association.

PubMed

Heidenreich, Paul A; Albert, Nancy M; Allen, Larry A; Bluemke, David A; Butler, Javed; Fonarow, Gregg C; Ikonomidis, John S; Khavjou, Olga; Konstam, Marvin A; Maddox, Thomas M; Nichol, Graham; Pham, Michael; Piña, Ileana L; Trogdon, Justin G

2013-05-01

Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed.

Forecasting the Impact of Heart Failure in the United States

PubMed Central

Heidenreich, Paul A.; Albert, Nancy M.; Allen, Larry A.; Bluemke, David A.; Butler, Javed; Fonarow, Gregg C.; Ikonomidis, John S.; Khavjou, Olga; Konstam, Marvin A.; Maddox, Thomas M.; Nichol, Graham; Pham, Michael; Piña, Ileana L.; Trogdon, Justin G.

2013-01-01

Background Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. Methods and Results We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). Conclusions The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed. PMID:23616602

Economic burden of seasonal influenza in the United States.

PubMed

Putri, Wayan C W S; Muscatello, David J; Stockwell, Melissa S; Newall, Anthony T

2018-05-22

Seasonal influenza is responsible for a large disease and economic burden. Despite the expanding recommendation of influenza vaccination, influenza has continued to be a major public health concern in the United States (U.S.). To evaluate influenza prevention strategies it is important that policy makers have current estimates of the economic burden of influenza. To provide an updated estimate of the average annual economic burden of seasonal influenza in the U.S. population in the presence of vaccination efforts. We evaluated estimates of age-specific influenza-attributable outcomes (ill-non medically attended, office-based outpatient visit, emergency department visits, hospitalizations and death) and associated productivity loss. Health outcome rates were applied to the 2015 U.S. population and multiplied by the relevant estimated unit costs for each outcome. We evaluated both direct healthcare costs and indirect costs (absenteeism from paid employment) reporting results from both a healthcare system and societal perspective. Results were presented in five age groups (<5 years, 5-17 years, 18-49 years, 50-64 years and ≥65 years of age). The estimated average annual total economic burden of influenza to the healthcare system and society was $11.2 billion ($6.3-$25.3 billion). Direct medical costs were estimated to be $3.2 billion ($1.5-$11.7 billion) and indirect costs $8.0 billion ($4.8-$13.6 billion). These total costs were based on the estimated average numbers of (1) ill-non medically attended patients (21.6 million), (2) office-based outpatient visits (3.7 million), (3) emergency department visit (0.65 million) (4) hospitalizations (247.0 thousand), (5) deaths (36.3 thousand) and (6) days of productivity lost (20.1 million). This study provides an updated estimate of the total economic burden of influenza in the U.S. Although we found a lower total cost than previously estimated, our results confirm that influenza is responsible for a substantial economic burden in the U.S. Copyright © 2018. Published by Elsevier Ltd.

Study on highway transportation greenhouse effect external cost estimation in China

NASA Astrophysics Data System (ADS)

Chu, Chunchao; Pan, Fengming

2017-03-01

This paper focuses on estimating highway transportation greenhouse gas emission volume and greenhouse gas external cost in China. At first, composition and characteristics of greenhouse gases were analysed about highway transportation emissions. Secondly, an improved model of emission volume was presented on basis of highway transportation energy consumption, which may be calculated by virtue of main affecting factors such as the annual average operation miles of each type of the motor vehicles and the unit consumption level. the model of emission volume was constructed which considered not only the availability of energy consumption statistics of highway transportation but also the greenhouse gas emission factors of various fuel types issued by IPCC. Finally, the external cost estimation model was established about highway transportation greenhouse gas emission which combined emission volume with the unit external cost of CO2 emissions. An example was executed to confirm presented model which ranged from 2011 to 2015 Year in China. The calculated result shows that the highway transportation total emission volume and greenhouse gas external cost are growing up, but the unit turnover external cost is steadily declining. On the whole overall, the situation is still grim about highway transportation greenhouse gas emission, and the green transportation strategy should be put into effect as soon as possible.

The cost of karst subsidence and sinkhole collapse in the United States compared with other natural hazards

USGS Publications Warehouse

Weary, David J.

2015-01-01

Rocks with potential for karst formation are found in all 50 states. Damage due to karst subsidence and sinkhole collapse is a natural hazard of national scope. Repair of damage to buildings, highways, and other infrastructure represents a significant national cost. Sparse and incomplete data show that the average cost of karst-related damages in the United States over the last 15 years is estimated to be at least $300,000,000 per year and the actual total is probably much higher. This estimate is lower than the estimated annual costs for other natural hazards; flooding, hurricanes and cyclonic storms, tornadoes, landslides, earthquakes, or wildfires, all of which average over $1 billion per year. Very few state organizations track karst subsidence and sinkhole damage mitigation costs; none occurs at the Federal level. Many states discuss the karst hazard in their State hazard mitigation plans, but seldom include detailed reports of subsidence incidents or their mitigation costs. Most State highway departments do not differentiate karst subsidence or sinkhole collapse from other road repair costs. Amassing of these data would raise the estimated annual cost considerably. Information from insurance organizations about sinkhole damage claims and payouts is also not readily available. Currently there is no agency with a mandate for developing such data. If a more realistic estimate could be made, it would illuminate the national scope of this hazard and make comparison with costs of other natural hazards more realistic.

Cost-effectiveness of alternative changes to a national blood collection service.

PubMed

Willis, S; De Corte, K; Cairns, J A; Zia Sadique, M; Hawkins, N; Pennington, M; Cho, G; Roberts, D J; Miflin, G; Grieve, R

2018-05-16

To evaluate the cost-effectiveness of changing opening times, introducing a donor health report and reducing the minimum inter-donation interval for donors attending static centres. Evidence is required about the effect of changes to the blood collection service on costs and the frequency of donation. This study estimated the effect of changes to the blood collection service in England on the annual number of whole-blood donations by current donors. We used donors' responses to a stated preference survey, donor registry data on donation frequency and deferral rates from the INTERVAL trial. Costs measured were those anticipated to differ between strategies. We reported the cost per additional unit of blood collected for each strategy versus current practice. Strategies with a cost per additional unit of whole blood less than £30 (an estimate of the current cost of collection) were judged likely to be cost-effective. In static donor centres, extending opening times to evenings and weekends provided an additional unit of whole blood at a cost of £23 and £29, respectively. Introducing a health report cost £130 per additional unit of blood collected. Although the strategy of reducing the minimum inter-donation interval had the lowest cost per additional unit of blood collected (£10), this increased the rate of deferrals due to low haemoglobin (Hb). The introduction of a donor health report is unlikely to provide a sufficient increase in donation frequency to justify the additional costs. A more cost-effective change is to extend opening hours for blood collection at static centres. © 2018 The Authors. Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society.

Direct medical costs associated with atopic diseases among young children in Thailand.

PubMed

Ngamphaiboon, Jarungchit; Kongnakorn, Thitima; Detzel, Patrick; Sirisomboonwong, Krittawan; Wasiak, Radek

2012-01-01

Allergic diseases are the most common childhood illness in Thailand. Their prevalence has been rising over time, with several studies having revealed substantial economic burden. However, no such study had yet been conducted for Thailand. The aim of this study was to estimate direct medical costs associated with atopic diseases among children aged 0-5 years in Thailand. A cost-of-illness model was constructed to estimate the total direct medical costs of atopic diseases comprising atopic dermatitis, chronic rhinitis, asthma (i.e., recurrent wheeze), and cow's milk allergy. The model employed a prevalence-based approach, considering a total number of atopic cases in 2010. Direct medical costs were estimated using a bottom-up analysis with the estimation of the quantity of healthcare resource use and the unit costs. Epidemiological data were obtained from literature and Thai surveys, whereas treatment unit costs were from either a hospital database or Thai standard cost list. Expert opinion informed type, frequency, and quantity of medical resources utilized. Key limitations included lack of data-driven evidences on severity distribution for this particular age group, indirect costs, and medical resource use associated with each condition. Total direct cost was estimated to be THB 27.8 billion (US$899 million). Treatments contributed largest to the total costs (46%), followed by inpatient care (37%), outpatient care (12%), and monitoring and labs (5%). Costs per treated patient were highest in cow's milk allergy (THB 64,383; US$2077), followed by rhinitis (THB 12,669; US$409), asthma (THB 9633; US$312), and atopic dermatitis (THB 5432; US$175). Atopic diseases in young children are associated with substantial burden in direct medical costs to Thailand. These costs can be diminished through nutritional intervention recognized to effectively decrease the incidence of atopic diseases.

User guide for HCR Estimator 2.0: software to calculate cost and revenue thresholds for harvesting small-diameter ponderosa pine.

Treesearch

Dennis R. Becker; Debra Larson; Eini C. Lowell; Robert B. Rummer

2008-01-01

The HCR (Harvest Cost-Revenue) Estimator is engineering and financial analysis software used to evaluate stand-level financial thresholds for harvesting small-diameter ponderosa pine (Pinus ponderosa Dougl. ex Laws.) in the Southwest United States. The Windows-based program helps contractors and planners to identify costs associated with tree...

Estimating the unit costs of public hospitals and primary healthcare centers.

PubMed

Younis, Mustafa Z; Jaber, Samer; Mawson, Anthony R; Hartmann, Michael

2013-01-01

Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation criteria devised to resemble as closely as possible the actual use of resources by each of the departments. The data were analyzed using spss. Data cleaning was carried out by cross-validating the results through conducting cross-tabulations between the hospital/center and section/program to identify errors from the data collection or entry process. Depreciation of assets and the consumption of capital costs are ignored in this study, as it is difficult to evaluate the MOH facilities owing to a lack of recording of depreciation of assets or other costs of servicing capital assets. Inpatient costs contributed about 75% of all costs, whereas outpatient services contributed the remaining 25% of total costs. The average cost per visit was $13.00 for outpatient departments, whereas the average cost per patient day for inpatient departments was $90.00. As for the unit cost for each department, intensive care unit and intermediate care unit services were the highest among all categories of daily hospital services ($208.00). This is in contrast to surgical operations ($124.00), specialized surgeries ($106.00), delivery department ($99.00), orthopedics ($98.50) and general surgery ($85.00). The lowest unit cost was found in the neonatology department ($72.00). In PHCs, the unit cost per visit was highest for psychiatry programs ($26.00), followed by other programs ($21.50), chronic diseases ($21.00), maternal and child health ($11.50), preventive programs ($9.00) and general medicine ($6.50). The exchange rate listed by The Wall Street Journal as of Wednesday August 25, 2010 is 1 US dollar = 3.82 new Israeli shekel (NIS). The findings have implications for policy and decision making in the health sector in Palestine concerning the cost of services provided by hospitals and PHCs. The availability of a standardized data set for cost assessment would greatly enhance and improve the quality of financial information as well as efficiency in the use of scarce resources. Copyright © 2012 John Wiley & Sons, Ltd.

Cost-effectiveness of pazopanib versus sunitinib for metastatic renal cell carcinoma in the United Kingdom

PubMed Central

Amdahl, Jordan; Diaz, Jose; Sharma, Arati; Park, Jinhee; Chandiwana, David

2017-01-01

Background Sunitinib and pazopanib are the only two targeted therapies for the first-line treatment of locally advanced or metastatic renal cell carcinoma (mRCC) recommended by the United Kingdom’s National Institute for Health and Care Excellence. Pazopanib demonstrated non-inferior efficacy and a differentiated safety profile versus sunitinib in the phase III COMPARZ trial. The current analysis provides a direct comparison of the cost-effectiveness of pazopanib versus sunitinib from the perspective of the United Kingdom’s National Health Service based on data from COMPARZ and other sources. Methods A partitioned-survival analysis model with three health states (alive with no progression, alive with progression, or dead) was used to estimate the incremental cost per quality-adjusted life-year (QALY) gained for pazopanib versus sunitinib over five years (duration of follow-up for final survival analysis in COMPARZ). The proportion of patients in each health state over time was based on Kaplan–Meier distributions for progression-free and overall survival from COMPARZ. Utility values were based on EQ-5D data from the pivotal study of pazopanib versus placebo. Costs were based on medical resource utilisation data from COMPARZ and unit costs from secondary sources. Probabilistic and deterministic sensitivity analyses were conducted to assess uncertainty of model results. Results In the base case, pazopanib was estimated to provide more QALYs (0.0565, 95% credible interval [CrI]: −0.0920 to 0.2126) at a lower cost (−£1,061, 95% CrI: −£4,328 to £2,067) versus sunitinib. The probability that pazopanib yields more QALYs than sunitinib was estimated to be 76%. For a threshold value of £30,000 per QALY gained, the probability that pazopanib is cost-effective versus sunitinib was estimated to be 95%. Pazopanib was dominant in most scenarios examined in deterministic sensitivity analyses. Conclusions Pazopanib is likely to be a cost-effective treatment option compared with sunitinib as first-line treatment of mRCC in the United Kingdom. PMID:28636648

Retrospective cost-effectiveness analyses for polio vaccination in the United States.

PubMed

Thompson, Kimberly M; Tebbens, Radboud J Duintjer

2006-12-01

The history of polio vaccination in the United States spans 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of resources. We estimated cost-effectiveness ratios and assessed the net benefits of polio vaccination applicable at various points in time from the societal perspective and we discounted these back to appropriate points in time. We reconstructed vaccine price data from available sources and used these to retrospectively estimate the total costs of the U.S. historical polio vaccination strategies (all costs reported in year 2002 dollars). We estimate that the United States invested approximately US dollars 35 billion (1955 net present value, discount rate of 3%) in polio vaccines between 1955 and 2005 and will invest approximately US dollars 1.4 billion (1955 net present value, or US dollars 6.3 billion in 2006 net present value) between 2006 and 2015 assuming a policy of continued use of inactivated poliovirus vaccine (IPV) for routine vaccination. The historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths (1955 net present values of approximately 480,000 cases and 73,000 deaths). Due to treatment cost savings, the investment implies net benefits of approximately US dollars 180 billion (1955 net present value), even without incorporating the intangible costs of suffering and death and of averted fear. Retrospectively, the U.S. investment in polio vaccination represents a highly valuable, cost-saving public health program. Observed changes in the cost-effectiveness ratio estimates over time suggest the need for living economic models for interventions that appropriately change with time. This article also demonstrates that estimates of cost-effectiveness ratios at any single time point may fail to adequately consider the context of the investment made to date and the importance of population and other dynamics, and shows the importance of dynamic modeling.

A probabilistic method for the estimation of residual risk in donated blood.

PubMed

Bish, Ebru K; Ragavan, Prasanna K; Bish, Douglas R; Slonim, Anthony D; Stramer, Susan L

2014-10-01

The residual risk (RR) of transfusion-transmitted infections, including the human immunodeficiency virus and hepatitis B and C viruses, is typically estimated by the incidence[Formula: see text]window period model, which relies on the following restrictive assumptions: Each screening test, with probability 1, (1) detects an infected unit outside of the test's window period; (2) fails to detect an infected unit within the window period; and (3) correctly identifies an infection-free unit. These assumptions need not hold in practice due to random or systemic errors and individual variations in the window period. We develop a probability model that accurately estimates the RR by relaxing these assumptions, and quantify their impact using a published cost-effectiveness study and also within an optimization model. These assumptions lead to inaccurate estimates in cost-effectiveness studies and to sub-optimal solutions in the optimization model. The testing solution generated by the optimization model translates into fewer expected infections without an increase in the testing cost. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Use of cost-effectiveness analysis to determine inventory size for a national cord blood bank.

PubMed

Howard, David H; Meltzer, David; Kollman, Craig; Maiers, Martin; Logan, Brent; Gragert, Loren; Setterholm, Michelle; Horowitz, Mary M

2008-01-01

Transplantation with stem cells from stored umbilical cord blood units is an alternative to living unrelated bone marrow transplantation. The larger the inventory of stored cord units, the greater the likelihood that transplant candidates will match to a unit, but storing units is costly. The authors present the results of a study, commissioned by the Institute of Medicine, as part of a report on the establishment of a national cord blood bank, examining the optimal inventory level. They emphasize the unique challenges of undertaking cost-effectiveness analysis in this field and the contribution of the analysis to policy. The authors estimate the likelihood that transplant candidates will match to a living unrelated marrow donor or a cord blood unit as a function of cord blood inventory and then calculate the life-years gained for each transplant type by match level using historical data. They develop a model of the cord blood inventory level to estimate total costs as a function of the number of stored units. The cost per life-year gained associated with increasing inventory from 50,000 to 100,000 units is $44,000 to $86,000 and from 100,000 to 150,000 units is $64,000 to $153,000, depending on the assumption about the degree to which survival rates for cord transplants vary by match quality. Expanding the cord blood inventory above current levels is cost-effective by conventional standards. The analysis helped shape the Institute of Medicine's report, but it is difficult to determine the extent to which the analysis influenced subsequent congressional legislation.

Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States

PubMed Central

Chang, Chongwon; Lee, Seung-Mi; Choi, Byoung-Whui; Song, Jong-hwa; Song, Hee; Jung, Sujin; Bai, Yoon Kyeong; Park, Haedong; Jeung, Seungwon

2017-01-01

Purpose To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. Materials and Methods This study was conducted using the 2003–2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. Results Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861–$895] and $257 (95% CI: $251–$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253–$260) and $26 (95% CI: $26–$27) per person per year, respectively. Conclusion Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma. PMID:27873513

Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States.

PubMed

Chang, Chongwon; Lee, Seung Mi; Choi, Byoung Whui; Song, Jong Hwa; Song, Hee; Jung, Sujin; Bai, Yoon Kyeong; Park, Haedong; Jeung, Seungwon; Suh, Dong Churl

2017-01-01

To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. This study was conducted using the 2003-2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861-$895] and $257 (95% CI: $251-$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253-$260) and $26 (95% CI: $26-$27) per person per year, respectively. Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.

Reference Model 5 (RM5): Oscillating Surge Wave Energy Converter

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

Yu, Y. H.; Jenne, D. S.; Thresher, R.

This report is an addendum to SAND2013-9040: Methodology for Design and Economic Analysis of Marine Energy Conversion (MEC) Technologies. This report describes an Oscillating Water Column Wave Energy Converter (OSWEC) reference model design in a complementary manner to Reference Models 1-4 contained in the above report. A conceptual design for a taut moored oscillating surge wave energy converter was developed. The design had an annual electrical power of 108 kilowatts (kW), rated power of 360 kW, and intended deployment at water depths between 50 m and 100 m. The study includes structural analysis, power output estimation, a hydraulic power conversionmore » chain system, and mooring designs. The results were used to estimate device capital cost and annual operation and maintenance costs. The device performance and costs were used for the economic analysis, following the methodology presented in SAND2013-9040 that included costs for designing, manufacturing, deploying, and operating commercial-scale MEC arrays up to 100 devices. The levelized cost of energy estimated for the Reference Model 5 OSWEC, presented in this report, was for a single device and arrays of 10, 50, and 100 units, and it enabled the economic analysis to account for cost reductions associated with economies of scale. The baseline commercial levelized cost of energy estimate for the Reference Model 5 device in an array comprised of 10 units is $1.44/kilowatt-hour (kWh), and the value drops to approximately $0.69/kWh for an array of 100 units.« less

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

PubMed

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

2016-12-01

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

Analysis of area level and unit level models for small area estimation in forest inventories assisted with LiDAR auxiliary information.

PubMed

Mauro, Francisco; Monleon, Vicente J; Temesgen, Hailemariam; Ford, Kevin R

2017-01-01

Forest inventories require estimates and measures of uncertainty for subpopulations such as management units. These units often times hold a small sample size, so they should be regarded as small areas. When auxiliary information is available, different small area estimation methods have been proposed to obtain reliable estimates for small areas. Unit level empirical best linear unbiased predictors (EBLUP) based on plot or grid unit level models have been studied more thoroughly than area level EBLUPs, where the modelling occurs at the management unit scale. Area level EBLUPs do not require a precise plot positioning and allow the use of variable radius plots, thus reducing fieldwork costs. However, their performance has not been examined thoroughly. We compared unit level and area level EBLUPs, using LiDAR auxiliary information collected for inventorying 98,104 ha coastal coniferous forest. Unit level models were consistently more accurate than area level EBLUPs, and area level EBLUPs were consistently more accurate than field estimates except for large management units that held a large sample. For stand density, volume, basal area, quadratic mean diameter, mean height and Lorey's height, root mean squared errors (rmses) of estimates obtained using area level EBLUPs were, on average, 1.43, 2.83, 2.09, 1.40, 1.32 and 1.64 times larger than those based on unit level estimates, respectively. Similarly, direct field estimates had rmses that were, on average, 1.37, 1.45, 1.17, 1.17, 1.26, and 1.38 times larger than rmses of area level EBLUPs. Therefore, area level models can lead to substantial gains in accuracy compared to direct estimates, and unit level models lead to very important gains in accuracy compared to area level models, potentially justifying the additional costs of obtaining accurate field plot coordinates.

Analysis of area level and unit level models for small area estimation in forest inventories assisted with LiDAR auxiliary information

PubMed Central

Monleon, Vicente J.; Temesgen, Hailemariam; Ford, Kevin R.

2017-01-01

Forest inventories require estimates and measures of uncertainty for subpopulations such as management units. These units often times hold a small sample size, so they should be regarded as small areas. When auxiliary information is available, different small area estimation methods have been proposed to obtain reliable estimates for small areas. Unit level empirical best linear unbiased predictors (EBLUP) based on plot or grid unit level models have been studied more thoroughly than area level EBLUPs, where the modelling occurs at the management unit scale. Area level EBLUPs do not require a precise plot positioning and allow the use of variable radius plots, thus reducing fieldwork costs. However, their performance has not been examined thoroughly. We compared unit level and area level EBLUPs, using LiDAR auxiliary information collected for inventorying 98,104 ha coastal coniferous forest. Unit level models were consistently more accurate than area level EBLUPs, and area level EBLUPs were consistently more accurate than field estimates except for large management units that held a large sample. For stand density, volume, basal area, quadratic mean diameter, mean height and Lorey’s height, root mean squared errors (rmses) of estimates obtained using area level EBLUPs were, on average, 1.43, 2.83, 2.09, 1.40, 1.32 and 1.64 times larger than those based on unit level estimates, respectively. Similarly, direct field estimates had rmses that were, on average, 1.37, 1.45, 1.17, 1.17, 1.26, and 1.38 times larger than rmses of area level EBLUPs. Therefore, area level models can lead to substantial gains in accuracy compared to direct estimates, and unit level models lead to very important gains in accuracy compared to area level models, potentially justifying the additional costs of obtaining accurate field plot coordinates. PMID:29216290

Factors associated with variations in hospital expenditures for acute heart failure in the United States.

PubMed

Ziaeian, Boback; Sharma, Puza P; Yu, Tzy-Chyi; Johnson, Katherine Waltman; Fonarow, Gregg C

2015-02-01

Relatively little contemporary data are available that describe differences in acute heart failure (AHF) hospitalization expenditures as a function of patient and hospital characteristics, especially from a population-based investigation. This study aimed to evaluate factors associated with variations in hospital expenditures for AHF in the United States. A cross-sectional analysis using discharge data from the 2011 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, was conducted. Discharges with primary International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes for AHF in adults were included. Costs were estimated by converting Nationwide Inpatient Sample charge data using the Healthcare Cost and Utilization Project Cost-to-Charge Ratio File. Discharges with highest (≥80th percentile) versus lowest (≤20th percentile) costs were compared for patient characteristics, hospital characteristics, utilization of procedures, and outcomes. Of the estimated 1 million AHF hospital discharges, the mean cost estimates were $10,775 per episode. Younger age, higher percentage of obesity, atrial fibrillation, pulmonary disease, fluid/electrolyte disturbances, renal insufficiency, and greater number of cardiac/noncardiac procedures were observed in stays with highest versus lowest costs. Highest-cost discharges were more likely to be observed in urban and teaching hospitals. Highest-cost AHF discharges also had 5 times longer length of stay, were 9 times more costly, and had higher in-hospital mortality (5.6% vs 3.5%) compared with discharges with lowest costs (all P < .001). Acute heart failure hospitalizations are costly. Expenditures vary markedly among AHF hospitalizations in the United States, with substantial differences in patient and hospital characteristics, procedures, and in-hospital outcomes among discharges with highest compared with lowest costs. Copyright © 2014 Elsevier Inc. All rights reserved.

RESEARCH: An Ecoregional Approach to the Economic Valuation of Land- and Water-Based Recreation in the United States

PubMed

Bhat; Bergstrom; Teasley; Bowker; Cordell

1998-01-01

/ This paper describes a framework for estimating the economic value of outdoor recreation across different ecoregions. Ten ecoregions in the continental United States were defined based on similarly functioning ecosystem characters. The individual travel cost method was employed to estimate recreation demand functions for activities such as motor boating and waterskiing, developed and primitive camping, coldwater fishing, sightseeing and pleasure driving, and big game hunting for each ecoregion. While our ecoregional approach differs conceptually from previous work, our results appear consistent with the previous travel cost method valuation studies.KEY WORDS: Recreation; Ecoregion; Travel cost method; Truncated Poisson model

The benefits of transit in the United States : a review and analysis of benefit-cost studies.

DOT National Transportation Integrated Search

2015-07-01

This white paper presents the findings from a review and analysis of the available literature on benefit-cost (b-c) estimates of : existing U.S. transit systems. Following an inventory of the literature, the b-c estimates from each study were organiz...

Plantation thinning systems in the Southern United States

Treesearch

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...

The potential impact of reducing indoor tanning on melanoma prevention and treatment costs in the United States: An economic analysis.

PubMed

Guy, Gery P; Zhang, Yuanhui; Ekwueme, Donatus U; Rim, Sun Hee; Watson, Meg

2017-02-01

Indoor tanning is associated with an increased risk of melanoma. The US Food and Drug Administration proposed prohibiting indoor tanning among minors younger than 18 years. We sought to estimate the health and economic benefits of reducing indoor tanning in the United States. We used a Markov model to estimate the expected number of melanoma cases and deaths averted, life-years saved, and melanoma treatment costs saved by reducing indoor tanning. We examined 5 scenarios: restricting indoor tanning among minors younger than 18 years, and reducing the prevalence by 20%, 50%, 80%, and 100%. Restricting indoor tanning among minors younger than 18 years was estimated to prevent 61,839 melanoma cases, prevent 6735 melanoma deaths, and save $342.9 million in treatment costs over the lifetime of the 61.2 million youth age 14 years or younger in the United States. The estimated health and economic benefits increased as indoor tanning was further reduced. Limitations include the reliance on available data and not examining compliance to indoor tanning laws. Reducing indoor tanning has the potential to reduce melanoma incidence, mortality, and treatment costs. These findings help quantify and underscore the importance of continued efforts to reduce indoor tanning and prevent melanoma. Published by Elsevier Inc.

Years of potential life lost and productivity costs because of cancer mortality and for specific cancer sites where human papillomavirus may be a risk factor for carcinogenesis-United States, 2003.

PubMed

Ekwueme, Donatus U; Chesson, Harrell W; Zhang, Kevin B; Balamurugan, Appathurai

2008-11-15

Although years of potential life lost (YPLL) and mortality-related productivity costs comprise a substantial portion of the burden of cancers where human papillomavirus (HPV) may be a risk factor for carcinogenesis (called HPV-associated cancers in this report), estimates of these costs are limited. The authors estimated the mortality-related burden (in terms of YPLL and productivity costs) of HPV-associated cancers (without regard to the percentage of each of these cancers that could be attributed to HPV) and all malignant cancers in the United States in 2003. The authors used 2003 national mortality data and US life tables to estimate YPLL for HPV-associated cancers and all malignant cancers. YPLL was estimated by using the life expectancy method. The human capital approach was used to estimate the value of the expected future lifetime productivity losses caused by premature deaths from HPV-associated cancers and all malignant cancers. Indirect mortality costs were estimated as the product of the number of deaths and the expected value of individuals' future earnings, including an imputed value of housekeeping services. In 2003, HPV-associated cancers accounted for 181,026 YPLL, which represented 2.4% of the estimated 7.5 million YPLL attributable to all malignant cancers in the United States. The average number of YPLL was 21.8 per HPV-associated cancer death and 16.3 per death from overall malignant cancers. Overall, HPV-associated cancers had the largest relative contribution to YPLL in women ages 30 to 34 years. The lifetime productivity cost from mortality in 2003 was $3.7 billion for HPV-associated cancer mortality and $133.5 billion for overall malignant cancer mortality. HPV-associated cancers impose a considerable burden in terms of premature deaths and productivity losses.

A cost simulation for mammography examinations taking into account equipment failures and resource utilization characteristics.

PubMed

Coelli, Fernando C; Almeida, Renan M V R; Pereira, Wagner C A

2010-12-01

This work develops a cost analysis estimation for a mammography clinic, taking into account resource utilization and equipment failure rates. Two standard clinic models were simulated, the first with one mammography equipment, two technicians and one doctor, and the second (based on an actually functioning clinic) with two equipments, three technicians and one doctor. Cost data and model parameters were obtained by direct measurements, literature reviews and other hospital data. A discrete-event simulation model was developed, in order to estimate the unit cost (total costs/number of examinations in a defined period) of mammography examinations at those clinics. The cost analysis considered simulated changes in resource utilization rates and in examination failure probabilities (failures on the image acquisition system). In addition, a sensitivity analysis was performed, taking into account changes in the probabilities of equipment failure types. For the two clinic configurations, the estimated mammography unit costs were, respectively, US$ 41.31 and US$ 53.46 in the absence of examination failures. As the examination failures increased up to 10% of total examinations, unit costs approached US$ 54.53 and US$ 53.95, respectively. The sensitivity analysis showed that type 3 (the most serious) failure increases had a very large impact on the patient attendance, up to the point of actually making attendance unfeasible. Discrete-event simulation allowed for the definition of the more efficient clinic, contingent on the expected prevalence of resource utilization and equipment failures. © 2010 Blackwell Publishing Ltd.

Economic cost of primary prevention of cardiovascular diseases in Tanzania

PubMed Central

Ngalesoni, Frida; Ruhago, George; Norheim, Ole F; Robberstad, Bjarne

2015-01-01

Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)’s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers’ costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30–41 to US$52–71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO’s absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers’ costs were estimated from two main viewpoints: ‘what is’, that is the current practice, and ‘what if’, reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression analysis; further research on the influence of other provider characteristics on these costs is important. PMID:25113027

A cost-benefit analysis of a proposed overseas refugee latent tuberculosis infection screening and treatment program.

PubMed

Wingate, La'Marcus T; Coleman, Margaret S; de la Motte Hurst, Christopher; Semple, Marie; Zhou, Weigong; Cetron, Martin S; Painter, John A

2015-12-01

This study explored the effect of screening and treatment of refugees for latent tuberculosis infection (LTBI) before entrance to the United States as a strategy for reducing active tuberculosis (TB). The purpose of this study was to estimate the costs and benefits of LTBI screening and treatment in United States bound refugees prior to arrival. Costs were included for foreign and domestic LTBI screening and treatment and the domestic treatment of active TB. A decision tree with multiple Markov nodes was developed to determine the total costs and number of active TB cases that occurred in refugee populations that tested 55, 35, and 20 % tuberculin skin test positive under two models: no overseas LTBI screening and overseas LTBI screening and treatment. For this analysis, refugees that tested 55, 35, and 20 % tuberculin skin test positive were divided into high, moderate, and low LTBI prevalence categories to denote their prevalence of LTBI relative to other refugee populations. For a hypothetical 1-year cohort of 100,000 refugees arriving in the United States from regions with high, moderate, and low LTBI prevalence, implementation of overseas screening would be expected to prevent 440, 220, and 57 active TB cases in the United States during the first 20 years after arrival. The cost savings associated with treatment of these averted cases would offset the cost of LTBI screening and treatment for refugees from countries with high (net cost-saving: $4.9 million) and moderate (net cost-saving: $1.6 million) LTBI prevalence. For low LTBI prevalence populations, LTBI screening and treatment exceed expected future TB treatment cost savings (net cost of $780,000). Implementing LTBI screening and treatment for United States bound refugees from countries with high or moderate LTBI prevalence would potentially save millions of dollars and contribute to United States TB elimination goals. These estimates are conservative since secondary transmission from tuberculosis cases in the United States was not considered in the model.

Costs along the service cascades for HIV testing and counselling and prevention of mother-to-child transmission

PubMed Central

Bautista-Arredondo, Sergio; Sosa-Rubí, Sandra G.; Opuni, Marjorie; Contreras-Loya, David; Kwan, Ada; Chaumont, Claire; Chompolola, Abson; Condo, Jeanine; Galárraga, Omar; Martinson, Neil; Masiye, Felix; Nsanzimana, Sabin; Ochoa-Moreno, Ivan; Wamai, Richard; Wang’ombe, Joseph

2016-01-01

Objective: We estimate facility-level average annual costs per client along the HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) service cascades. Design: Data collected covered the period 2011–2012 in 230 HTC and 212 PMTCT facilities in Kenya, Rwanda, South Africa, and Zambia. Methods: Input quantities and unit prices were collected, as were output data. Annual economic costs were estimated from the service providers’ perspective using micro-costing. Average annual costs per client in 2013 United States dollars (US$) were estimated along the service cascades. Results: For HTC, average cost per client tested ranged from US$5 (SD US$7) in Rwanda to US$31 (SD US$24) in South Africa, whereas average cost per client diagnosed as HIV-positive ranged from US$122 (SD US$119) in Zambia to US$1367 (SD US$2093) in Rwanda. For PMTCT, average cost per client tested ranged from US$18 (SD US$20) in Rwanda to US$89 (SD US$56) in South Africa; average cost per client diagnosed as HIV-positive ranged from US$567 (SD US$417) in Zambia to US$2021 (SD US$3210) in Rwanda; average cost per client on antiretroviral prophylaxis ranged from US$704 (SD US$610) in South Africa to US$2314 (SD US$3204) in Rwanda; and average cost per infant on nevirapine ranged from US$888 (SD US$884) in South Africa to US$2359 (SD US$3257) in Rwanda. Conclusion: We found important differences in unit costs along the HTC and PMTCT service cascades within and between countries suggesting that more efficient delivery of these services is possible. PMID:27753679

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

PubMed

2009-03-01

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

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

PubMed

Cuckle, Howard; Benn, Peter; Pergament, Eugene

2013-07-01

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

Improved rapid magnitude estimation for a community-based, low-cost MEMS accelerometer network

USGS Publications Warehouse

Chung, Angela I.; Cochran, Elizabeth S.; Kaiser, Anna E.; Christensen, Carl M.; Yildirim, Battalgazi; Lawrence, Jesse F.

2015-01-01

Immediately following the Mw 7.2 Darfield, New Zealand, earthquake, over 180 Quake‐Catcher Network (QCN) low‐cost micro‐electro‐mechanical systems accelerometers were deployed in the Canterbury region. Using data recorded by this dense network from 2010 to 2013, we significantly improved the QCN rapid magnitude estimation relationship. The previous scaling relationship (Lawrence et al., 2014) did not accurately estimate the magnitudes of nearby (<35  km) events. The new scaling relationship estimates earthquake magnitudes within 1 magnitude unit of the GNS Science GeoNet earthquake catalog magnitudes for 99% of the events tested, within 0.5 magnitude units for 90% of the events, and within 0.25 magnitude units for 57% of the events. These magnitudes are reliably estimated within 3 s of the initial trigger recorded on at least seven stations. In this report, we present the methods used to calculate a new scaling relationship and demonstrate the accuracy of the revised magnitude estimates using a program that is able to retrospectively estimate event magnitudes using archived data.

Cost awareness of physicians in intensive care units: a multicentric national study.

PubMed

Hernu, Romain; Cour, Martin; de la Salle, Sylvie; Robert, Dominique; Argaud, Laurent

2015-08-01

Physicians play an important role in strategies to control health care spending. Being aware of the cost of prescriptions is surely the first step to incorporating cost-consciousness into medical practice. The aim of this study was to evaluate current intensivists' knowledge of the costs of common prescriptions and to identify factors influencing the accuracy of cost estimations. Junior and senior physicians in 99 French intensive care units were asked, by questionnaire, to estimate the true hospital costs of 46 selected prescriptions commonly used in critical care practice. With an 83% response rate, 1092 questionnaires were examined, completed by 575 (53%) and 517 (47%) junior and senior intensivists, respectively. Only 315 (29%) of the overall estimates were within 50% of the true cost. Response errors included a 14,756 ± 301 € underestimation, i.e., -58 ± 1% of the total sum (25,595 €). High-cost drugs (>1000 €) were significantly (p < 0.001) the most underestimated prescriptions (-67 ± 1%). Junior grade physicians underestimated more costs than senior physicians (p < 0.001). Using multivariate analysis, junior physicians [odds ratio (OR), 2.1; 95% confidence interval (95% CI), 1.43-3.08; p = 0.0002] and female gender (OR, 1.4; 95% CI, 1.04-1.89; p = 0.02) were both independently associated with incorrect cost estimations. ICU physicians have a poor awareness of prescriptions costs, especially with regards to high-cost drugs. Considerable emphasis and effort are still required to integrate the cost-containment problem into the daily prescriptions in ICUs.

NATO Independent Cost Estimating and the Role of Life Cycle Cost Analysis in Managing the Defence Enterprise (Estimation independante des couts de l’OTAN et role de l’analyse des couts globaux de possesssion au sen de l’OTAN)

DTIC Science & Technology

2012-08-01

Command NBCD Nuclear, Biological, and Chemical Defence NCCA U.S. Naval Center for Cost Analysis NGISSI Northrop Grumman Integrated Systems...analysis (CPA) in the United States which investigated how costs, capabilities, and risks could be examined together in an attempt to engen - der more

The Role of Inflation and Price Escalation Adjustments in Properly Estimating Program Costs: F-35 Case Study

DTIC Science & Technology

2016-03-01

regression models that yield hedonic price indexes is closely related to standard techniques for developing cost estimating relationships ( CERs ...October 2014). iii analysis) and derives a price index from the coefficients on variables reflecting the year of purchase. In CER development, the...index. The relevant cost metric in both cases is unit recurring flyaway (URF) costs. For the current project, we develop a “Baseline” CER model, taking

Economic burden of occupational injury and illness in the United States.

PubMed

Leigh, J Paul

2011-12-01

The allocation of scarce health care resources requires a knowledge of disease costs. Whereas many studies of a variety of diseases are available, few focus on job-related injuries and illnesses. This article provides estimates of the national costs of occupational injury and illness among civilians in the United States for 2007. This study provides estimates of both the incidence of fatal and nonfatal injuries and nonfatal illnesses and the prevalence of fatal diseases as well as both medical and indirect (productivity) costs. To generate the estimates, I combined primary and secondary data sources with parameters from the literature and model assumptions. My primary sources were injury, disease, employment, and inflation data from the U.S. Bureau of Labor Statistics (BLS) and the Centers for Disease Control and Prevention (CDC) as well as costs data from the National Council on Compensation Insurance and the Healthcare Cost and Utilization Project. My secondary sources were the National Academy of Social Insurance, literature estimates of Attributable Fractions (AF) of diseases with occupational components, and national estimates for all health care costs. Critical model assumptions were applied to the underreporting of injuries, wage-replacement rates, and AFs. Total costs were calculated by multiplying the number of cases by the average cost per case. A sensitivity analysis tested for the effects of the most consequential assumptions. Numerous improvements over earlier studies included reliance on BLS data for government workers and ten specific cancer sites rather than only one broad cancer category. The number of fatal and nonfatal injuries in 2007 was estimated to be more than 5,600 and almost 8,559,000, respectively, at a cost of $6 billion and $186 billion. The number of fatal and nonfatal illnesses was estimated at more than 53,000 and nearly 427,000, respectively, with cost estimates of $46 billion and $12 billion. For injuries and diseases combined, medical cost estimates were $67 billion (27% of the total), and indirect costs were almost $183 billion (73%). Injuries comprised 77 percent of the total, and diseases accounted for 23 percent. The total estimated costs were approximately $250 billion, compared with the inflation-adjusted cost of $217 billion for 1992. The medical and indirect costs of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Workers' compensation covers less than 25 percent of these costs, so all members of society share the burden. The contributions of job-related injuries and illnesses to the overall cost of medical care and ill health are greater than generally assumed. © 2011 Milbank Memorial Fund.

Global cost of child survival: estimates from country-level validation

PubMed Central

van Ekdom, Liselore; Scherpbier, Robert W; Niessen, Louis W

2011-01-01

Abstract Objective To cross-validate the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. Methods After the main cost categories for each country were identified, validation questionnaires were sent to 32 countries with high child mortality. Publicly available estimates for disease incidence, intervention coverage, prices and resources for individual-level and programme-level activities were validated against local data. Nine updates to the 2007 WHO model were generated using revised assumptions. Finally, estimates were extrapolated to 75 countries and combined with cost estimates for immunization and malaria programmes and for programmes for the prevention of mother-to-child transmission of the human immunodeficiency virus (HIV). Findings Twenty-six countries responded. Adjustments were largest for system- and programme-level data and smallest for patient data. Country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010–2015. Conclusion Country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritize health activities within their national resource envelope. PMID:21479091

The Burden of Pulmonary Nontuberculous Mycobacterial Disease in the United States

PubMed Central

Strollo, Sara E.; Adjemian, Jennifer; Adjemian, Michael K.

2015-01-01

Rationale: State-specific case numbers and costs are critical for quantifying the burden of pulmonary nontuberculous mycobacterial disease in the United States. Objectives: To estimate and project national and state annual cases of nontuberculous mycobacterial disease and associated direct medical costs. Methods: Available direct cost estimates of nontuberculous mycobacterial disease medical encounters were applied to nontuberculous mycobacterial disease prevalence estimates derived from Medicare beneficiary data (2003–2007). Prevalence was adjusted for International Classification of Diseases, 9th Revision, undercoding and the inclusion of persons younger than 65 years of age. U.S. Census Bureau data identified 2010 and 2014 population counts and 2012 primary insurance-type distribution. Medical costs were reported in constant 2014 dollars. Projected 2014 estimates were adjusted for population growth and assumed a previously published 8% annual growth rate of nontuberculous mycobacterial disease prevalence. Measurements and Main Results: In 2010, we estimated 86,244 national cases, totaling to $815 million, of which 87% were inpatient related ($709 million) and 13% were outpatient related ($106 million). Annual state estimates varied from 48 to 12,544 cases ($503,000–$111 million), with a median of 1,208 cases ($11.5 million). Oceanic coastline states and Gulf States comprised 70% of nontuberculous mycobacterial disease cases but 60% of the U.S. population. Medical encounters among individuals aged 65 years and older ($562 million) were twofold higher than those younger than 65 years of age ($253 million). Of all costs incurred, medications comprised 76% of nontuberculous mycobacterial disease expenditures. Projected 2014 estimates resulted in 181,037 national annual cases ($1.7 billion). Conclusions: For a relatively rare disease, the financial cost of nontuberculous mycobacterial disease is substantial, particularly among older adults. Better data on disease dynamics and more recent prevalence estimates will generate more robust estimates. PMID:26214350

Landslide risk in the San Francisco Bay region

USGS Publications Warehouse

Coe, J.A.; Crovelli, R.A.

2008-01-01

We have used historical records of damaging landslides triggered by rainstorms, and a newly developed Probabilistic Landslide Assessment Cost Estimation System (PLACES), to estimate the numbers and direct costs of future landslides in the San Francisco Bay region. The estimated annual cost of future landslides in the entire region is about US $15 million (year 2000 $). The estimated annual cost is highest for San Mateo County ($3.32 million) and lowest for Solano County ($0.18 million). Normalizing costs by dividing by the percentage of land area with slopes equal or greater than about 10° indicates that San Francisco County will have the highest cost per square km ($7,400), whereas Santa Clara County will have the lowest cost per square km ($230). These results indicate that the San Francisco Bay region has one of the highest levels of landslide risk in the United States. Compared to landslide cost estimates from the rest of the world, the risk level in the Bay region seems high, but not exceptionally high.

Unit cost analysis of training and deploying paid community health workers in three rural districts of Tanzania.

PubMed

Tani, Kassimu; Exavery, Amon; Baynes, Colin D; Pemba, Senga; Hingora, Ahmed; Manzi, Fatuma; Phillips, James F; Kanté, Almamy Malick

2016-07-08

Tanzania, like other African countries, faces significant health workforce shortages. With advisory and partnership from Columbia University, the Ifakara Health Institute and the Tanzanian Training Centre for International Health (TTCIH) developed and implemented the Connect Project as a randomized cluster experimental trial of the childhood survival impact of recruiting, training, and deploying of a new cadre of paid community health workers (CHW), named "Wawazesha wa afya ya Jamii" (WAJA). This paper presents an estimation of the cost of training and deploying WAJA in three rural districts of Tanzania. Costing data were collected by tracking project activity expenditure records and conducting in-depth interviews of TTCIH staff who have led the training and deployment of WAJA, as well as their counterparts at Public Clinical Training Centres who have responsibility for scaling up the WAJA training program. The trial is registered with the International Standard Randomized Controlled Trial Register number ( ISRCTN96819844 ). The Connect training cost was US$ 2,489.3 per WAJA, of which 40.1 % was for meals, 20.2 % for accommodation 10.2 % for tuition fees and the remaining 29.5 % for other costs including instruction and training facilities and field allowance. A comparable training program estimated unit cost for scaling-up this training via regional/district clinical training centres would be US$ 833.5 per WAJA. Of this unit cost, 50.3 % would involve the cost of meals, 27.4 % training fees, 13.7 % for field allowances, 9 % for accommodation and medical insurance. The annual running cost of WAJA in a village will cost US$ 1.16 per capita. Costs estimated by this study are likely to be sustainable on a large scale, particularly if existing regional/district institutions are utilized for this program.

Inventory of Data Sources for Estimating Health Care Costs in the United States

PubMed Central

Lund, Jennifer L.; Yabroff, K. Robin; Ibuka, Yoko; Russell, Louise B.; Barnett, Paul G.; Lipscomb, Joseph; Lawrence, William F.; Brown, Martin L.

2011-01-01

Objective To develop an inventory of data sources for estimating health care costs in the United States and provide information to aid researchers in identifying appropriate data sources for their specific research questions. Methods We identified data sources for estimating health care costs using 3 approaches: (1) a review of the 18 articles included in this supplement, (2) an evaluation of websites of federal government agencies, non profit foundations, and related societies that support health care research or provide health care services, and (3) a systematic review of the recently published literature. Descriptive information was abstracted from each data source, including sponsor, website, lowest level of data aggregation, type of data source, population included, cross-sectional or longitudinal data capture, source of diagnosis information, and cost of obtaining the data source. Details about the cost elements available in each data source were also abstracted. Results We identified 88 data sources that can be used to estimate health care costs in the United States. Most data sources were sponsored by government agencies, national or nationally representative, and cross-sectional. About 40% were surveys, followed by administrative or linked administrative data, fee or cost schedules, discharges, and other types of data. Diagnosis information was available in most data sources through procedure or diagnosis codes, self-report, registry, or chart review. Cost elements included inpatient hospitalizations (42.0%), physician and other outpatient services (45.5%), outpatient pharmacy or laboratory (28.4%), out-of-pocket (22.7%), patient time and other direct nonmedical costs (35.2%), and wages (13.6%). About half were freely available for downloading or available for a nominal fee, and the cost of obtaining the remaining data sources varied by the scope of the project. Conclusions Available data sources vary in population included, type of data source, scope, and accessibility, and have different strengths and weaknesses for specific research questions. PMID:19536009

Cost analysis of Navy acquisition alternatives for the NAVSTAR Global Positioning System

NASA Astrophysics Data System (ADS)

Darcy, T. F.; Smith, G. P.

1982-12-01

This research analyzes the life cycle cost (LCC) of the Navy's current and two hypothetical procurement alternatives for NAVSTAR Global Positioning System (GPS) user equipment. Costs are derived by the ARINC Research Corporation ACBEN cost estimating system. Data presentation is in a comparative format describing individual alternative LCC and differential costs between alternatives. Sensitivity analysis explores the impact receiver-processor unit (RPU) first unit production cost has on individual alternative LCC, as well as cost differentials between each alternative. Several benefits are discussed that might provide sufficient cost savings and/or system effectiveness improvements to warrant a procurement strategy other than the existing proposal.

Estimating the capital recovery costs of alternative patch retention treatments in eastern hardwoods

Treesearch

Chris B. LeDoux; Andrew Whitman

2006-01-01

We used a simulation model to estimate the economic opportunity costs and the density of large stems retained for patch retention in two temperate oak stands representative of the oak/hickory forest type in the eastern United States. Opportunity/retention costs ranged from $321.0 to $760.7/ha [$129.9 to $307.8/acre] depending on the species mix in the stand, the...

Estimating age-based antiretroviral therapy costs for HIV-infected children in resource-limited settings based on World Health Organization weight-based dosing recommendations.

PubMed

Doherty, Kathleen; Essajee, Shaffiq; Penazzato, Martina; Holmes, Charles; Resch, Stephen; Ciaranello, Andrea

2014-05-02

Pediatric antiretroviral therapy (ART) has been shown to substantially reduce morbidity and mortality in HIV-infected infants and children. To accurately project program costs, analysts need accurate estimations of antiretroviral drug (ARV) costs for children. However, the costing of pediatric antiretroviral therapy is complicated by weight-based dosing recommendations which change as children grow. We developed a step-by-step methodology for estimating the cost of pediatric ARV regimens for children ages 0-13 years old. The costing approach incorporates weight-based dosing recommendations to provide estimated ARV doses throughout childhood development. Published unit drug costs are then used to calculate average monthly drug costs. We compared our derived monthly ARV costs to published estimates to assess the accuracy of our methodology. The estimates of monthly ARV costs are provided for six commonly used first-line pediatric ARV regimens, considering three possible care scenarios. The costs derived in our analysis for children were fairly comparable to or slightly higher than available published ARV drug or regimen estimates. The methodology described here can be used to provide an accurate estimation of pediatric ARV regimen costs for cost-effectiveness analysts to project the optimum packages of care for HIV-infected children, as well as for program administrators and budget analysts who wish to assess the feasibility of increasing pediatric ART availability in constrained budget environments.

Vital Signs: Health Burden and Medical Costs of Nonfatal Injuries to Motor Vehicle Occupants — United States, 2012

PubMed Central

Bergen, Gwen; Peterson, Cora; Ederer, David; Florence, Curtis; Haileyesus, Tadesse; Kresnow, Marcie-jo; Xu, Likang

2014-01-01

Background Motor vehicle crashes are a leading cause of death and injury in the United States. The purpose of this study was to describe the current health burden and medical and work loss costs of nonfatal crash injuries among vehicle occupants in the United States. Methods CDC analyzed data on emergency department (ED) visits resulting from nonfatal crash injuries among vehicle occupants in 2012 using the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) and the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). The number and rate of all ED visits for the treatment of crash injuries that resulted in the patient being released and the number and rate of hospitalizations for the treatment of crash injuries were estimated, as were the associated number of hospital days and lifetime medical and work loss costs. Results In 2012, an estimated 2,519,471 ED visits resulted from nonfatal crash injuries, with an estimated lifetime medical cost of $18.4 billion (2012 U.S. dollars). Approximately 7.5% of these visits resulted in hospitalizations that required an estimated 1,057,465 hospital days in 2012. Conclusions Nonfatal crash injuries occur frequently and result in substantial costs to individuals, employers, and society. For each motor vehicle crash death in 2012, eight persons were hospitalized, and 100 were treated and released from the ED. Implications for Public Health Public health practices and laws, such as primary seat belt laws, child passenger restraint laws, ignition interlocks to prevent alcohol impaired driving, sobriety checkpoints, and graduated driver licensing systems have demonstrated effectiveness for reducing motor vehicle crashes and injuries. They might also substantially reduce associated ED visits, hospitalizations, and medical costs. PMID:25299606

COMPARISON OF METHODS FOR ESTIMATING CONTEMPORARY COSTS: AN APPLICATION TO LIVER TRANSPLANTATION IN THE UNITED KINGDOM.

PubMed

Singh, Jeshika; Longworth, Louise

2017-01-01

Our study addresses the important issue of estimating treatment costs from historical data. It is a problem frequently faced by health technology assessment analysts. We compared four approaches used to estimate current costs when good quality contemporary data are not available using liver transplantation as an example. First, the total cost estimates extracted for patients from a cohort study, conducted in the 1990s, were inflated using a published inflation multiplier. Second, resource use estimates from the cohort study were extracted for hepatitis C patients and updated using current unit costs. Third, expert elicitation was carried out to identify changes in clinical practice over time and quantify current resource use. Fourth, routine data on resource use were obtained from National Health Service Blood and Transplant (NHSBT). The first two methods did not account for changes in clinical practice. Also the first was not specific to hepatitis patients. The use of experts confirmed significant changes in clinical practice. However, the quantification of resource use using experts is challenging as clinical specialists may not have a complete overview of clinical pathway. The NHSBT data are the most accurate reflection of transplantation and posttransplantation phase; however, data were not available for the whole pathway of care. The best estimate of total cost, combining NHSBT data and expert elicitation, is £121,211. Observational data from routine care are potentially the most reliable reflection of current resource use. Efforts should be made to make such data readily available and accessible to researchers. Expert elicitation provided reasonable estimates.

Vital signs: melanoma incidence and mortality trends and projections - United States, 1982-2030.

PubMed

Guy, Gery P; Thomas, Cheryll C; Thompson, Trevor; Watson, Meg; Massetti, Greta M; Richardson, Lisa C

2015-06-05

Melanoma incidence rates have continued to increase in the United States, and risk behaviors remain high. Melanoma is responsible for the most skin cancer deaths, with about 9,000 persons dying from it each year. CDC analyzed current (2011) melanoma incidence and mortality data, and projected melanoma incidence, mortality, and the cost of treating newly diagnosed melanomas through 2030. Finally, CDC estimated the potential melanoma cases and costs averted through 2030 if a comprehensive skin cancer prevention program was implemented in the United States. In 2011, the melanoma incidence rate was 19.7 per 100,000, and the death rate was 2.7 per 100,000. Incidence rates are projected to increase for white males and females through 2019. Death rates are projected to remain stable. The annual cost of treating newly diagnosed melanomas was estimated to increase from $457 million in 2011 to $1.6 billion in 2030. Implementation of a comprehensive skin cancer prevention program was estimated to avert 230,000 melanoma cases and $2.7 billion in initial year treatment costs from 2020 through 2030. If additional prevention efforts are not undertaken, the number of melanoma cases is projected to increase over the next 15 years, with accompanying increases in health care costs. Much of this morbidity, mortality, and health care cost can be prevented. Substantial reductions in melanoma incidence, mortality, and cost can be achieved if evidence-based comprehensive interventions that reduce ultraviolet (UV) radiation exposure and increase sun protection are fully implemented and sustained.

Sustainable Mining Land Use for Lignite Based Energy Projects

NASA Astrophysics Data System (ADS)

Dudek, Michal; Krysa, Zbigniew

2017-12-01

This research aims to discuss complex lignite based energy projects economic viability and its impact on sustainable land use with respect to project risk and uncertainty, economics, optimisation (e.g. Lerchs and Grossmann) and importance of lignite as fuel that may be expressed in situ as deposit of energy. Sensitivity analysis and simulation consist of estimated variable land acquisition costs, geostatistics, 3D deposit block modelling, electricity price considered as project product price, power station efficiency and power station lignite processing unit cost, CO2 allowance costs, mining unit cost and also lignite availability treated as lignite reserves kriging estimation error. Investigated parameters have nonlinear influence on results so that economically viable amount of lignite in optimal pit varies having also nonlinear impact on land area required for mining operation.

Cost analysis of carbon dioxide concentrators

NASA Technical Reports Server (NTRS)

Yakut, M. M.

1973-01-01

Methodology and cost estimating relationships, for flight-type and prototype CO2 concentrators, have been developed and presented. A validity check was made by comparing the molecular sieves system considered here and that developed for Skylab. The system evaluated here is twice the size of the Skylab system and is also more complex as it desorbs CO2 thermally and stores it in an accumulator. The cost estimates developed were found to be approximately 50 to 70% higher than the actual cost of the Skylab unit.

The economic case for digital interventions for eating disorders among United States college students.

PubMed

Kass, Andrea E; Balantekin, Katherine N; Fitzsimmons-Craft, Ellen E; Jacobi, Corinna; Wilfley, Denise E; Taylor, C Barr

2017-03-01

Eating disorders (EDs) are serious health problems affecting college students. This article aimed to estimate the costs, in United States (US) dollars, of a stepped care model for online prevention and treatment among US college students to inform meaningful decisions regarding resource allocation and adoption of efficient care delivery models for EDs on college campuses. Using a payer perspective, we estimated the costs of (1) delivering an online guided self-help (GSH) intervention to individuals with EDs, including the costs of "stepping up" the proportion expected to "fail"; (2) delivering an online preventive intervention compared to a "wait and treat" approach to individuals at ED risk; and (3) applying the stepped care model across a population of 1,000 students, compared to standard care. Combining results for online GSH and preventive interventions, we estimated a stepped care model would cost less and result in fewer individuals needing in-person psychotherapy (after receiving less-intensive intervention) compared to standard care, assuming everyone in need received intervention. A stepped care model was estimated to achieve modest cost savings compared to standard care, but these estimates need to be tested with sensitivity analyses. Model assumptions highlight the complexities of cost calculations to inform resource allocation, and considerations for a disseminable delivery model are presented. Efforts are needed to systematically measure the costs and benefits of a stepped care model for EDs on college campuses, improve the precision and efficacy of ED interventions, and apply these calculations to non-US care systems with different cost structures. © 2017 Wiley Periodicals, Inc.

Projections of the Cost of Cancer Care in the United States: 2010–2020

PubMed Central

Robin Yabroff, K.; Shao, Yongwu; Feuer, Eric J.; Brown, Martin L.

2011-01-01

Background Current estimates of the costs of cancer care in the United States are based on data from 2003 and earlier. However, incidence, survival, and practice patterns have been changing for the majority of cancers. Methods Cancer prevalence was estimated and projected by phase of care (initial year following diagnosis, continuing, and last year of life) and tumor site for 13 cancers in men and 16 cancers in women through 2020. Cancer prevalence was calculated from cancer incidence and survival models estimated from Surveillance, Epidemiology, and End Results (SEER) Program data. Annualized net costs were estimated from recent SEER–Medicare linkage data, which included claims through 2006 among beneficiaries aged 65 years and older with a cancer diagnosis. Control subjects without cancer were identified from a 5% random sample of all Medicare beneficiaries residing in the SEER areas to adjust for expenditures not related to cancer. All cost estimates were adjusted to 2010 dollars. Different scenarios for assumptions about future trends in incidence, survival, and cost were assessed with sensitivity analysis. Results Assuming constant incidence, survival, and cost, we projected 13.8 and 18.1 million cancer survivors in 2010 and 2020, respectively, with associated costs of cancer care of 124.57 and 157.77 billion 2010 US dollars. This 27% increase in medical costs reflects US population changes only. The largest increases were in the continuing phase of care for prostate cancer (42%) and female breast cancer (32%). Projections of current trends in incidence (declining) and survival (increasing) had small effects on 2020 estimates. However, if costs of care increase annually by 2% in the initial and last year of life phases of care, the total cost in 2020 is projected to be $173 billion, which represents a 39% increase from 2010. Conclusions The national cost of cancer care is substantial and expected to increase because of population changes alone. Our findings have implications for policy makers in planning and allocation of resources. PMID:21228314

Incidence and lifetime costs of injuries in the United States

PubMed Central

Corso, P; Finkelstein, E; Miller, T; Fiebelkorn, I; Zaloshnja, E

2006-01-01

Background Standardized methodologies for assessing economic burden of injury at the national or international level do not exist. Objective To measure national incidence, medical costs, and productivity losses of medically treated injuries using the most recent data available in the United States, as a case study for similarly developed countries undertaking economic burden analyses. Method The authors combined several data sets to estimate the incidence of fatal and non‐fatal injuries in 2000. They computed unit medical and productivity costs and multiplied these costs by corresponding incidence estimates to yield total lifetime costs of injuries occurring in 2000. Main outcome measures Incidence, medical costs, productivity losses, and total costs for injuries stratified by age group, sex, and mechanism. Results More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of $406 billion; $80 billion for medical treatment and $326 billion for lost productivity. Males had a 20% higher rate of injury than females. Injuries resulting from falls or being struck by/against an object accounted for more than 44% of injuries. The rate of medically treated injuries declined by 15% from 1985 to 2000 in the US. For those aged 0–44, the incidence rate of injuries declined by more than 20%; while persons aged 75 and older experienced a 20% increase. Conclusions These national burden estimates provide unequivocal evidence of the large health and financial burden of injuries. This study can serve as a template for other countries or be used in intercountry comparisons. PMID:16887941

An ecoregional approach to the economic valuation of land- and water-based recreation in the United States

Treesearch

Gajana Bhat; John Bergsrom; R. Jeff Teasley

1998-01-01

This paper describes a framework for estimating the economic value of outdoor recreation across different ecoregions. Ten ecoregions in the continental United States were defined based on similarly functioning ecosystem characters. The individual travel cost method was employed to estimate recreation demand functions for activities such...

Economic Analysis of Delivering Primary Health Care Services through Community Health Workers in 3 North Indian States

PubMed Central

Prinja, Shankar; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

2014-01-01

Background We assessed overall annual and unit cost of delivering package of services and specific services at sub-centre level by CHWs and cost effectiveness of Government of India’s policy of introducing a second auxiliary nurse midwife (ANM) at the sub-centre compared to scenario of single ANM sub-centre. Methods We undertook an economic costing of health services delivered by CHWs, from a health system perspective. Bottom-up costing method was used to collect data on resources spent in 50 randomly selected sub-centres selected from 4 districts. Mean unit cost along with its 95% confidence intervals were estimated using bootstrap method. Multiple linear regression model was used to standardize cost and assess its determinants. Results Annually it costs INR 1.03 million (USD 19,381), or INR 187 (USD 3.5) per capita per year, to provide a package of preventive, curative and promotive services through community health workers. Unit costs for antenatal care, postnatal care, DOTS treatment and immunization were INR 525 (USD 10) per full ANC care, INR 767 (USD 14) per PNC case registered, INR 974 (USD 18) per DOTS treatment completed and INR 97 (USD 1.8) per child immunized in routine immunization respectively. A 10% increase in human resource costs results in 6% rise in per capita cost. Similarly, 10% increment in the ANC case registered per provider through-put results in a decline in unit cost ranging from 2% in the event of current capacity utilization to 3% reduction in case of full capacity utilization. Incremental cost of introducing 2nd ANM at sub-centre level per unit percent increase ANC coverage was INR 23,058 (USD 432). Conclusion Our estimates would be useful in undertaking full economic evaluations or equity analysis of CHW programs. Government of India’s policy of hiring 2nd ANM at sub-centre level is very cost effective from Indian health system perspective. PMID:24626285

Cost-effectiveness of social marketing of insecticide-treated nets for malaria control in the United Republic of Tanzania.

PubMed Central

Hanson, Kara; Kikumbih, Nassor; Armstrong Schellenberg, Joanna; Mponda, Haji; Nathan, Rose; Lake, Sally; Mills, Anne; Tanner, Marcel; Lengeler, Christian

2003-01-01

OBJECTIVE: To assess the costs and consequences of a social marketing approach to malaria control in children by means of insecticide-treated nets in two rural districts of the United Republic of Tanzania, compared with no net use. METHODS: Project cost data were collected prospectively from accounting records. Community effectiveness was estimated on the basis of a nested case-control study and a cross-sectional cluster sample survey. FINDINGS: The social marketing approach to the distribution of insecticide-treated nets was estimated to cost 1560 US dollars per death averted and 57 US dollars per disability-adjusted life year averted. These figures fell to 1018 US dollars and 37 US dollars, respectively, when the costs and consequences of untreated nets were taken into account. CONCLUSION: The social marketing of insecticide-treated nets is an attractive intervention for preventing childhood deaths from malaria. PMID:12764493

Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya.

PubMed

Shretta, Rima; Johnson, Brittany; Smith, Lisa; Doumbia, Seydou; de Savigny, Don; Anupindi, Ravi; Yadav, Prashant

2015-02-05

Studies have shown that supply chain costs are a significant proportion of total programme costs. Nevertheless, the costs of delivering specific products are poorly understood and ballpark estimates are often used to inadequately plan for the budgetary implications of supply chain expenses. The purpose of this research was to estimate the country level costs of the public sector supply chain for artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) from the central to the peripheral levels in Benin and Kenya. A micro-costing approach was used and primary data on the various cost components of the supply chain was collected at the central, intermediate, and facility levels between September and November 2013. Information sources included central warehouse databases, health facility records, transport schedules, and expenditure reports. Data from document reviews and semi-structured interviews were used to identify cost inputs and estimate actual costs. Sampling was purposive to isolate key variables of interest. Survey guides were developed and administered electronically. Data were extracted into Microsoft Excel, and the supply chain cost per unit of ACT and RDT distributed by function and level of system was calculated. In Benin, supply chain costs added USD 0.2011 to the initial acquisition cost of ACT and USD 0.3375 to RDTs (normalized to USD 1). In Kenya, they added USD 0.2443 to the acquisition cost of ACT and USD 0.1895 to RDTs (normalized to USD 1). Total supply chain costs accounted for more than 30% of the initial acquisition cost of the products in some cases and these costs were highly sensitive to product volumes. The major cost drivers were found to be labour, transport, and utilities with health facilities carrying the majority of the cost per unit of product. Accurate cost estimates are needed to ensure adequate resources are available for supply chain activities. Product volumes should be considered when costing supply chain functions rather than dollar value. Further work is needed to develop extrapolative costing models that can be applied at country level without extensive micro-costing exercises. This will allow other countries to generate more accurate estimates in the future.

Assessment of transparency of cost estimates in economic evaluations of patient safety programmes.

PubMed

Fukuda, Haruhisa; Imanaka, Yuichi

2009-06-01

Transparency of costing is essential for decision-makers who require information on the efficiency of a health care programme, because effective decisions depend largely on applicability to their settings. The main objectives of this study were to assess published studies for transparency of cost estimates. We first developed criteria with two axes by reviewing publications dealing with economic evaluations and cost accounting studies: clarification of the scope of costing and accuracy of method evaluating costs. We then performed systematic searches of the literature for studies which estimated prevention costs and assessed the transparency and accuracy of costing based on our criteria. Forty studies met the inclusion criteria. Half of the studies reported data for both the quantity and unit price of programmes in regard to prevention costs. Although 30 studies estimated costs of adverse events, 19 of these described the scope of costing only, and just five studies used a micro-costing method. Among 30 studies that estimated 'gross cost savings' and 'net cost savings', there was a huge discrepancy in labels. Even if a cost study was conducted in accordance with existing techniques of economic evaluation which mostly paid attention to internal validity of cost estimates, without adequate explanation of the process of costing, reproducibility cannot be assured and the study may lose its value as scientific information. This study found that there is tremendous room for improvement.

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

Murphy, L.T.; Hickey, M.

This paper summarizes the progress to date by CH2M HILL and the UKAEA in development of a parametric modelling capability for estimating the costs of large nuclear decommissioning projects in the United Kingdom (UK) and Europe. The ability to successfully apply parametric cost estimating techniques will be a key factor to commercial success in the UK and European multi-billion dollar waste management, decommissioning and environmental restoration markets. The most useful parametric models will be those that incorporate individual components representing major elements of work: reactor decommissioning, fuel cycle facility decommissioning, waste management facility decommissioning and environmental restoration. Models must bemore » sufficiently robust to estimate indirect costs and overheads, permit pricing analysis and adjustment, and accommodate the intricacies of international monetary exchange, currency fluctuations and contingency. The development of a parametric cost estimating capability is also a key component in building a forward estimating strategy. The forward estimating strategy will enable the preparation of accurate and cost-effective out-year estimates, even when work scope is poorly defined or as yet indeterminate. Preparation of cost estimates for work outside the organizations current sites, for which detailed measurement is not possible and historical cost data does not exist, will also be facilitated. (authors)« less

Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States.

PubMed

Peterson, Cora; Grosse, Scott D; Li, Rui; Sharma, Andrea J; Razzaghi, Hilda; Herman, William H; Gilboa, Suzanne M

2015-01-01

Preconception care for women with diabetes can reduce the occurrence of adverse birth outcomes. We aimed to estimate the preconception care (PCC)-preventable health and cost burden of adverse birth outcomes associated with diagnosed and undiagnosed pregestational diabetes mellitus (PGDM) in the United States. Among women of reproductive age (15-44 years), we estimated age- and race/ethnicity-specific prevalence of diagnosed and undiagnosed diabetes. We applied age and race/ethnicity-specific pregnancy rates, estimates of the risk reduction from PCC for 3 adverse birth outcomes (preterm birth, major birth defects, and perinatal mortality), and lifetime medical and lost productivity costs for children with those outcomes. Using a probabilistic model, we estimated the reduction in adverse birth outcomes and costs associated with universal PCC compared with no PCC among women with PGDM. We did not assess maternal outcomes and associated costs. We estimated 2.2% of US births are to women with PGDM. Among women with diagnosed diabetes, universal PCC might avert 8397 (90% prediction interval [PI], 5252-11,449) preterm deliveries, 3725 (90% PI, 3259-4126) birth defects, and 1872 (90% PI, 1239-2415) perinatal deaths annually. Associated discounted lifetime costs averted for the affected cohort of children could be as high as $4.3 billion (90% PI, 3.4-5.1 billion) (2012 US dollars). PCC among women with undiagnosed diabetes could yield an additional $1.2 billion (90% PI, 951 million-1.4 billion) in averted cost. Results suggest a substantial health and cost burden associated with PGDM that could be prevented by universal PCC, which might offset the cost of providing such care. Published by Elsevier Inc.

The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis.

PubMed

Mills, Edward J; Kanters, Steve; Hagopian, Amy; Bansback, Nick; Nachega, Jean; Alberton, Mark; Au-Yeung, Christopher G; Mtambo, Andy; Bourgeault, Ivy L; Luboga, Samuel; Hogg, Robert S; Ford, Nathan

2011-11-23

To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Human capital cost analysis using publicly accessible data. Sub-Saharan African countries. Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. In the nine source countries the estimated government subsidised cost of a doctor's education ranged from $21,000 (£13,000; €15,000) in Uganda to $58,700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their health systems.

A Regression Study of Demand, Cost and Pricing Public Library Circulation Services.

ERIC Educational Resources Information Center

Stratton, Peter J.

This paper examines three aspects of the public library's circulation service: (1) a demand function for the service is estimated; (2) a long-run unit circulation cost curve is developed; and (3) using the economist's notion of "efficiency," a general model for the pricing of the circulation service is presented. The estimated demand…

Systems design study of the Pioneer Venus spacecraft. Appendices to volume 1, sections 8-11 (part 3 of 3). [power subsystem/cost tradeoffs for Venus probe

NASA Technical Reports Server (NTRS)

1973-01-01

Power subsystem cost/weight tradeoffs are discussed for the Venus probe spacecraft. The cost estimations of power subsystem units were based upon DSCS-2, DSP, and Pioneer 10 and 11 hardware design and development and manufacturing experience. Parts count and degree of modification of existing hardware were factored into the estimate of manufacturing and design and development costs. Cost data includes sufficient quantities of units to equip probe bus and orbiter versions. It was based on the orbiter complement of equipment, but the savings in fewer slices for the probe bus balance the cost of the different probe bus battery. The preferred systems for the Thor/Delta and for the Atlas/Centaur are discussed. The weights of the candidate designs were based upon slice or tray weights for functionally equivalent circuitry measured on existing hardware such as Pioneers 10 and 11, Intelsat 3, DSCS-2, or DSP programs. Battery weights were based on measured cell weight data adjusted for case weight or off-the-shelf battery weights. The solar array weight estimate was based upon recent hardware experience on DSCS-2 and DSP arrays.

Cost-effectiveness of human papillomavirus vaccination in the United States.

PubMed

Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Markowitz, Lauri E

2008-02-01

We describe a simplified model, based on the current economic and health effects of human papillomavirus (HPV), to estimate the cost-effectiveness of HPV vaccination of 12-year-old girls in the United States. Under base-case parameter values, the estimated cost per quality-adjusted life year gained by vaccination in the context of current cervical cancer screening practices in the United States ranged from $3,906 to $14,723 (2005 US dollars), depending on factors such as whether herd immunity effects were assumed; the types of HPV targeted by the vaccine; and whether the benefits of preventing anal, vaginal, vulvar, and oropharyngeal cancers were included. The results of our simplified model were consistent with published studies based on more complex models when key assumptions were similar. This consistency is reassuring because models of varying complexity will be essential tools for policy makers in the development of optimal HPV vaccination strategies.

Cost-effective retrofit technology for reducing peak power demand in small and medium commercial buildings

DOE PAGES

Nutaro, James J.; Fugate, David L.; Kuruganti, Teja; ...

2015-05-27

We describe a cost-effective retrofit technology that uses collective control of multiple rooftop air conditioning units to reduce the peak power consumption of small and medium commercial buildings. The proposed control uses a model of the building and air conditioning units to select an operating schedule for the air conditioning units that maintains a temperature set point subject to a constraint on the number of units that may operate simultaneously. A prototype of this new control system was built and deployed in a large gymnasium to coordinate four rooftop air conditioning units. Based on data collected while operating this prototype,more » we estimate that the cost savings achieved by reducing peak power consumption is sufficient to repay the cost of the prototype within a year.« less

Costs of fire suppression forces based on cost-aggregation approach

Treesearch

Gonz& aacute; lez-Cab& aacute; Armando n; Charles W. McKetta; Thomas J. Mills

1984-01-01

A cost-aggregation approach has been developed for determining the cost of Fire Management Inputs (FMls)-the direct fireline production units (personnel and equipment) used in initial attack and large-fire suppression activities. All components contributing to an FMI are identified, computed, and summed to estimate hourly costs. This approach can be applied to any FMI...

Economic Burden of Occupational Injury and Illness in the United States

PubMed Central

Leigh, J Paul

2011-01-01

Context The allocation of scarce health care resources requires a knowledge of disease costs. Whereas many studies of a variety of diseases are available, few focus on job-related injuries and illnesses. This article provides estimates of the national costs of occupational injury and illness among civilians in the United States for 2007. Methods This study provides estimates of both the incidence of fatal and nonfatal injuries and nonfatal illnesses and the prevalence of fatal diseases as well as both medical and indirect (productivity) costs. To generate the estimates, I combined primary and secondary data sources with parameters from the literature and model assumptions. My primary sources were injury, disease, employment, and inflation data from the U.S. Bureau of Labor Statistics (BLS) and the Centers for Disease Control and Prevention (CDC) as well as costs data from the National Council on Compensation Insurance and the Healthcare Cost and Utilization Project. My secondary sources were the National Academy of Social Insurance, literature estimates of Attributable Fractions (AF) of diseases with occupational components, and national estimates for all health care costs. Critical model assumptions were applied to the underreporting of injuries, wage-replacement rates, and AFs. Total costs were calculated by multiplying the number of cases by the average cost per case. A sensitivity analysis tested for the effects of the most consequential assumptions. Numerous improvements over earlier studies included reliance on BLS data for government workers and ten specific cancer sites rather than only one broad cancer category. Findings The number of fatal and nonfatal injuries in 2007 was estimated to be more than 5,600 and almost 8,559,000, respectively, at a cost of $6 billion and $186 billion. The number of fatal and nonfatal illnesses was estimated at more than 53,000 and nearly 427,000, respectively, with cost estimates of $46 billion and $12 billion. For injuries and diseases combined, medical cost estimates were $67 billion (27% of the total), and indirect costs were almost $183 billion (73%). Injuries comprised 77 percent of the total, and diseases accounted for 23 percent. The total estimated costs were approximately $250 billion, compared with the inflation-adjusted cost of $217 billion for 1992. Conclusions The medical and indirect costs of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Workers’ compensation covers less than 25 percent of these costs, so all members of society share the burden. The contributions of job-related injuries and illnesses to the overall cost of medical care and ill health are greater than generally assumed. PMID:22188353

Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

PubMed

Than, Thet Mon; Saw, Yu Mon; Khaing, Moe; Win, Ei Mon; Cho, Su Myat; Kariya, Tetsuyoshi; Yamamoto, Eiko; Hamajima, Nobuyuki

2017-09-19

Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the available resources.

Estimating age-based antiretroviral therapy costs for HIV-infected children in resource-limited settings based on World Health Organization weight-based dosing recommendations

PubMed Central

2014-01-01

Background Pediatric antiretroviral therapy (ART) has been shown to substantially reduce morbidity and mortality in HIV-infected infants and children. To accurately project program costs, analysts need accurate estimations of antiretroviral drug (ARV) costs for children. However, the costing of pediatric antiretroviral therapy is complicated by weight-based dosing recommendations which change as children grow. Methods We developed a step-by-step methodology for estimating the cost of pediatric ARV regimens for children ages 0–13 years old. The costing approach incorporates weight-based dosing recommendations to provide estimated ARV doses throughout childhood development. Published unit drug costs are then used to calculate average monthly drug costs. We compared our derived monthly ARV costs to published estimates to assess the accuracy of our methodology. Results The estimates of monthly ARV costs are provided for six commonly used first-line pediatric ARV regimens, considering three possible care scenarios. The costs derived in our analysis for children were fairly comparable to or slightly higher than available published ARV drug or regimen estimates. Conclusions The methodology described here can be used to provide an accurate estimation of pediatric ARV regimen costs for cost-effectiveness analysts to project the optimum packages of care for HIV-infected children, as well as for program administrators and budget analysts who wish to assess the feasibility of increasing pediatric ART availability in constrained budget environments. PMID:24885453

An economic study of an advanced technology supersonic cruise vehicle

NASA Technical Reports Server (NTRS)

Smith, C. L.; Williams, L. J.

1975-01-01

A description is given of the methods used and the results of an economic study of an advanced technology supersonic cruise vehicle. This vehicle was designed for a maximum range of 4000 n.mi. at a cruise speed of Mach 2.7 and carrying 292 passengers. The economic study includes the estimation of aircraft unit cost, operating cost, and idealized cash flow and discounted cash flow return on investment. In addition, it includes a sensitivity study on the effects of unit cost, manufacturing cost, production quantity, average trip length, fuel cost, load factor, and fare on the aircraft's economic feasibility.

United States Marine Corps (USMC) Single Channel Ground and Airborne Radio System (SINCGARS) rechargeable battery trade-off study. Technical report, June-September 1992

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

Allard, S.M.; Albert, N.F.

1992-09-18

Cost estimates for USMC SINCGARS usage of BB-5590/U Lithium Sulfur Dioxide (LiSO[sub 2]) Batteries, BA-590/U Sealed Lead-Acid Batteries, and BB-490/U Nickel-Cadmium (Ni-Cad) Batteries. Estimates encompass battery costs, charger costs as applicable, and disposal costs. Annual battery-related costs were estimated for USMC usage of mix of LiSO[sub 2] and Ni-Cad batteries ranging from 100% use of LiSO[sub 2] batteries to 100% use of Ni-Cad batteries; and for mix of LiSO[sub 2] and Lead-Acid batteries over the same range. Estimated hourly battery-related costs are $2.66 per hour for LiSO[sub 2] batteries $0.34 for Ni-Cad batteries, and $0.30 for Lead-Acid batteries. Disposal relatedmore » regulations and related documents are discussed and included in Appendices.« less

Economic costs of the foot and mouth disease outbreak in the United Kingdom in 2001.

PubMed

Thompson, D; Muriel, P; Russell, D; Osborne, P; Bromley, A; Rowland, M; Creigh-Tyte, S; Brown, C

2002-12-01

The authors present estimates of the economic costs to agriculture and industries affected by tourism of the outbreak of foot and mouth disease (FMD) in the United Kingdom (UK) in 2001. The losses to agriculture and the food chain amount to about Pound Sterling3.1 billion. The majority of the costs to agriculture have been met by the Government through compensation for slaughter and disposal as well as clean-up costs. Nonetheless, agricultural producers will have suffered losses, estimated at Pound Sterling355 million, which represents about 20% of the estimated total income from farming in 2001. Based on data from surveys of tourism, businesses directly affected by tourist expenditure are estimated to have lost a similar total amount (between Pound Sterling2.7 and Pound Sterling3.2 billion) as a result of reduced numbers of people visiting the countryside. The industries which supply agriculture, the food industries and tourist-related businesses will also have suffered losses. However, the overall costs to the UK economy are substantially less than the sum of these components, as much of the expenditure by tourists was not lost, but merely displaced to other sectors of the economy. Overall, the net effect of FMD is estimated to have reduced the gross domestic product in the UK by less than 0.2% in 2001.

Methods for Identifying Part Quality Issues and Estimating Their Cost with an Application Using the UH-60

DTIC Science & Technology

2014-01-01

WPU report. TOP 5 Items with PQDRs by Value ($M) RCN # (*Oldest PQDR) Nomenclature I/E SOS NIIN CAT Qty Def Unit Cost Total # PQDR s End Item Value...401667 4 AH-64D 1.581 145 TOP 5 PQDRs by Age (Days) RCN # Nomenclature I/E SOS NIIN CAT Qty Def Unit Cost End Item Value ($M) Age (Days) W45N7V-09-0274

[Estimating the microcosts of blood transfusion for hemato-oncological patients].

PubMed

Brilhante, Dialina; Macedo, Ana; Santos, Ana

2008-01-01

There are several ways of treating and preventing chemotherapy-associated anaemia, namely with erythropoiesis stimulating agents and blood transfusion, that remains an option. Since erythropoiesis stimulating agents have a high unitary cost, it is crucial to evaluate their cost-effectiveness, namely versus transfusion. The objective of this study is to calculate the cost of a blood transfusion, carried out at the Immunohemotherapy Outward of Instituto Português de Oncologia, Francisco Gentil, in Lisbon as treatment for neoplasia-associated anaemia. Cross sectional, observational study from the perspective of the Hospital and the National Health Service, which evaluates the resources and direct costs, associated with a blood transfusion of two erythrocyte concentrate (EC) units in hemato-oncology patients. Data regarding consumables, human resources, laboratory analysis and occupation of facilities was collected for a period of seven consecutive days, regarding both blood donation and transfusion procedures in the Immunohemotherapy Outward of Instituto Português de Oncologia, Francisco Gentil, in Lisbon. The total cost of a two EC unit transfusion was estimated at euro 676.2, with the greatest part of this cost being attributed to blood preparation, analysis and storage. Determining reliable costs in relation to medical actions and procedures is essential in analysing the cost-effectiveness of new drugs. This study evaluated the cost for the transfusion of two EC units and the results presented are similar to those obtained in other European countries by several authors.

Cost projections for implementation of safety interventions to prevent transfusion-transmitted Zika virus infection in the United States

PubMed Central

Ellingson, Katherine D.; Sapiano, Mathew R.P.; Haass, Kathryn A.; Savinkina, Alexandra A.; Baker, Misha L.; Henry, Richard A.; Berger, James J.; Kuehnert, Matthew J.; Basavaraju, Sridhar V.

2017-01-01

BACKGROUND In August 2016, the Food and Drug Administration advised US blood centers to screen all whole blood and apheresis donations for Zika virus (ZIKV) with an individual-donor nucleic acid test (ID-NAT) or to use approved pathogen reduction technology (PRT). The cost of implementing this guidance nationally has not been assessed. STUDY DESIGN AND METHODS Scenarios were constructed to characterize approaches to ZIKV screening, including universal ID-NAT, risk-based seasonal allowance of minipool (MP) NAT by state, and universal MP-NAT. Data from the 2015 National Blood Collection and Utilization Survey (NBCUS) were used to characterize the number of donations nationally and by state. For each scenario, the estimated cost per donor ($3–$9 for MP-NAT, $7–$13 for ID-NAT) was multiplied by the estimated number of relevant donations from the NBCUS. Cost of PRT was calculated by multiplying the cost per unit ($50–$125) by the number of units approved for PRT. Prediction intervals for costs were generated using Monte Carlo simulation methods. RESULTS Screening all donations in the 50 states and DC for ZIKV by ID-NAT would cost $137 million (95% confidence interval [CI], $109–$167) annually. Allowing seasonal MP-NAT in states with lower ZIKV risk could reduce NAT screening costs by 18% to 25%. Application of PRT to all platelet (PLT) and plasma units would cost $213 million (95% CI, $156–$304). CONCLUSION Universal ID-NAT screening for ZIKV will cost US blood centers more than $100 million annually. The high cost of PRT for apheresis PLTs and plasma could be mitigated if, once validated, testing for transfusion transmissible pathogens could be eliminated. PMID:28591470

Price competition and hospital cost growth in the United States (1989-1994).

PubMed

Bamezai, A; Zwanziger, J; Melnick, G A; Mann, J M

1999-05-01

In recent years, most health care markets in the United States (US) have experienced rapid penetration by health maintenance organizations (HMOs) and preferred provider organizations (PPOs). During this same period, the US has also experienced slowing health care costs. Using a national database, we demonstrate that HMOs and PPOs have significantly restrained cost growth among hospitals located in competitive hospital markets, but not so in the case of hospitals located in relatively concentrated markets. In relative terms, we estimate that HMOs have contained cost growth more effectively than PPOs.

Economic benefits of the Mediterranean-style diet consumption in Canada and the United States

PubMed Central

Abdullah, Mohammad M.H.; Jones, Jason P.H.; Jones, Peter J.H.

2015-01-01

Background The Mediterranean-style diet (MedDiet) is an established healthy-eating behavior that has consistently been shown to favorably impact cardiovascular health, thus likely improving quality of life and reducing costs associated with cardiovascular disease (CVD). Data on the economic benefits of MedDiet intakes are, however, scarce. Objective The objective of this study was to estimate the annual healthcare and societal cost savings that would accrue to the Canadian and American public, independently, as a result of a reduction in the incidence of CVD following adherence to a MedDiet. Design A variation in cost-of-illness analysis entailing three stages of estimations was developed to 1) identify the proportion of individuals who are likely to adopt a MedDiet in North America, 2) assess the impact of the MedDiet intake on CVD incidence reduction, and 3) impute the potential savings in costs associated with healthcare and productivity following the estimated CVD reduction. To account for the uncertainty factor, a sensitivity analysis of four scenarios, including ideal, optimistic, pessimistic, and very-pessimistic assumptions, was implemented within each of these stages. Results Significant improvements in CVD-related costs were evident with varying MedDiet adoption and CVD reduction rates. Specifically, CAD $41.9 million to 2.5 billion in Canada and US $1.0–62.8 billion in the United States were estimated to accrue as total annual savings in economic costs, given the ‘very-pessimistic’ through ‘ideal’ scenarios. Conclusions Closer adherence to dietary behaviors that are consistent with the principles of the MedDiet is expected to contribute to a reduction in the monetary burdens of CVD in Canada, the United States, and possibly other parts of the world. PMID:26111965

Estimating Renewable Energy Economic Potential in the United States. Methodology and Initial Results

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

Brown, Austin; Beiter, Philipp; Heimiller, Donna

This report describes a geospatial analysis method to estimate the economic potential of several renewable resources available for electricity generation in the United States. Economic potential, one measure of renewable generation potential, may be defined in several ways. For example, one definition might be expected revenues (based on local market prices) minus generation costs, considered over the expected lifetime of the generation asset. Another definition might be generation costs relative to a benchmark (e.g., a natural gas combined cycle plant) using assumptions of fuel prices, capital cost, and plant efficiency. Economic potential in this report is defined as the subsetmore » of the available resource technical potential where the cost required to generate the electricity (which determines the minimum revenue requirements for development of the resource) is below the revenue available in terms of displaced energy and displaced capacity. The assessment is conducted at a high geospatial resolution (more than 150,000 technology-specific sites in the continental United States) to capture the significant variation in local resource, costs, and revenue potential. This metric can be a useful screening factor for understanding the economic viability of renewable generation technologies at a specific location. In contrast to many common estimates of renewable energy potential, economic potential does not consider market dynamics, customer demand, or most policy drivers that may incent renewable energy generation.« less

Comparative Cost Analysis of Surgical and PrePex Device Male Circumcision in Zimbabwe and Mozambique.

PubMed

Schutte, Carl; Tshimanga, M; Mugurungi, Owen; Come, Iotamo; Necochea, Edgar; Mahomed, Mehebub; Xaba, Sinokuthemba; Bossemeyer, Debora; Ferreira, Thais; Macaringue, Lucinda; Chatikobo, Pessanai; Gundididza, Patricia; Hatzold, Karin

2016-06-01

The PrePex device has proven to be safe for voluntary medical male circumcision (VMMC) in adults in several African countries. Costing studies were conducted as part of a PrePex/Surgery comparison study in Zimbabwe and a pilot implementation study in Mozambique. The studies calculated per male circumcision unit costs using a cost-analysis approach. Both direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training) and selected indirect costs (capital and support personnel costs) were calculated. The cost comparison in Zimbabwe showed a unit cost per VMMC of $45.50 for PrePex and $53.08 for surgery. The unit cost difference was based on higher personnel and consumable supplies costs for the surgical procedure, which used disposable instrument kits. In Mozambique, the costing analysis estimated a higher unit cost for PrePex circumcision ($40.66) than for surgery ($20.85) because of higher consumable costs, particularly the PrePex device and lower consumable supplies costs for the surgical procedure using reusable instruments. Supplies and direct staff costs contributed 87.2% for PrePex and 65.8% for surgical unit costs in Mozambique. PrePex device male circumcision could potentially be cheaper than surgery in Zimbabwe, especially in settings that lack the infrastructure and personnel required for surgical VMMC, and this might result in programmatic cost savings. In Mozambique, the surgical procedure seems to be less costly compared with PrePex mainly because of higher consumable supplies costs. With reduced device unit costs, PrePex VMMC could become more cost-efficient and considered as complementary for Mozambique's VMMC scale-up program.

Economic Impacts of Non-Native Forest Insects in the Continental United States

PubMed Central

Aukema, Juliann E.; Leung, Brian; Kovacs, Kent; Chivers, Corey; Britton, Kerry O.; Englin, Jeffrey; Frankel, Susan J.; Haight, Robert G.; Holmes, Thomas P.; Liebhold, Andrew M.; McCullough, Deborah G.; Von Holle, Betsy

2011-01-01

Reliable estimates of the impacts and costs of biological invasions are critical to developing credible management, trade and regulatory policies. Worldwide, forests and urban trees provide important ecosystem services as well as economic and social benefits, but are threatened by non-native insects. More than 450 non-native forest insects are established in the United States but estimates of broad-scale economic impacts associated with these species are largely unavailable. We developed a novel modeling approach that maximizes the use of available data, accounts for multiple sources of uncertainty, and provides cost estimates for three major feeding guilds of non-native forest insects. For each guild, we calculated the economic damages for five cost categories and we estimated the probability of future introductions of damaging pests. We found that costs are largely borne by homeowners and municipal governments. Wood- and phloem-boring insects are anticipated to cause the largest economic impacts by annually inducing nearly $1.7 billion in local government expenditures and approximately $830 million in lost residential property values. Given observations of new species, there is a 32% chance that another highly destructive borer species will invade the U.S. in the next 10 years. Our damage estimates provide a crucial but previously missing component of cost-benefit analyses to evaluate policies and management options intended to reduce species introductions. The modeling approach we developed is highly flexible and could be similarly employed to estimate damages in other countries or natural resource sectors. PMID:21931766

Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results From a Randomized Noninferiority Trial of AccuCirc Device Versus Mogen Clamp.

PubMed

Mangenah, Collin; Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K; Madidi, Ngonidzashe; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M; Thirumurthy, Harsha

2015-08-15

Safe and cost-effective programs for implementing early infant male circumcision (EIMC) in Africa need to be piloted. We present results on a relative cost analysis within a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe. Between January and June 2013, male infants who met inclusion criteria were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. We evaluated the overall unit cost plus the key cost drivers of EIMC using both AccuCirc and Mogen clamp. Direct costs included consumable and nonconsumable supplies, device, personnel, associated staff training, and environmental costs. Indirect costs comprised capital and support personnel costs. In 1-way sensitivity analyses, we assessed potential changes in unit costs due to variations in main parameters, one at a time, holding all other values constant. The unit costs of EIMC using AccuCirc and Mogen clamp were $49.53 and $55.93, respectively. Key cost drivers were consumable supplies, capacity utilization, personnel costs, and device price. Unit prices are likely to be lowest at full capacity utilization and increase as capacity utilization decreases. Unit prices also fall with lower personnel salaries and increase with higher device prices. EIMC has a lower unit cost when using AccuCirc compared with Mogen clamp. To minimize unit costs, countries planning to scale-up EIMC using AccuCirc need to control costs of consumables and personnel. There is also need to negotiate a reasonable device price and maximize capacity utilization.

State-Level Estimates of Cancer-Related Absenteeism Costs

PubMed Central

Tangka, Florence K.; Trogdon, Justin G.; Nwaise, Isaac; Ekwueme, Donatus U.; Guy, Gery P.; Orenstein, Diane

2016-01-01

Background Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. Methods In analyses of data from the 2004–2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. Results We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. Conclusions The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population. PMID:23969498

State-level estimates of cancer-related absenteeism costs.

PubMed

Tangka, Florence K; Trogdon, Justin G; Nwaise, Isaac; Ekwueme, Donatus U; Guy, Gery P; Orenstein, Diane

2013-09-01

Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. In analyses of data from the 2004-2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population.

A simplified economic filter for open-pit gold-silver mining in the United States

USGS Publications Warehouse

Singer, Donald A.; Menzie, W. David; Long, Keith R.

1998-01-01

In resource assessments of undiscovered mineral deposits and in the early stages of exploration, including planning, a need for prefeasibility cost models exists. In exploration, these models to filter economic from uneconomic deposits help to focus on targets that can really benefit the exploration enterprise. In resource assessment, these models can be used to eliminate deposits that would probably be uneconomic even if discovered. The U. S. Bureau of Mines (USBM) previously developed simplified cost models for such problems (Camm, 1991). These cost models estimate operating and capital expenditures for a mineral deposit given its tonnage, grade, and depth. These cost models were also incorporated in USBM prefeasibility software (Smith, 1991). Because the cost data used to estimate operating and capital costs in these models are now over ten years old, we decided that it was necessary to test these equations with more current data. We limited this study to open-pit gold-silver mines located in the United States.

Estimating the economic opportunity cost of water use with river basin simulators in a computationally efficient way

NASA Astrophysics Data System (ADS)

Rougé, Charles; Harou, Julien J.; Pulido-Velazquez, Manuel; Matrosov, Evgenii S.

2017-04-01

The marginal opportunity cost of water refers to benefits forgone by not allocating an additional unit of water to its most economically productive use at a specific location in a river basin at a specific moment in time. Estimating the opportunity cost of water is an important contribution to water management as it can be used for better water allocation or better system operation, and can suggest where future water infrastructure could be most beneficial. Opportunity costs can be estimated using 'shadow values' provided by hydro-economic optimization models. Yet, such models' use of optimization means the models had difficulty accurately representing the impact of operating rules and regulatory and institutional mechanisms on actual water allocation. In this work we use more widely available river basin simulation models to estimate opportunity costs. This has been done before by adding in the model a small quantity of water at the place and time where the opportunity cost should be computed, then running a simulation and comparing the difference in system benefits. The added system benefits per unit of water added to the system then provide an approximation of the opportunity cost. This approximation can then be used to design efficient pricing policies that provide incentives for users to reduce their water consumption. Yet, this method requires one simulation run per node and per time step, which is demanding computationally for large-scale systems and short time steps (e.g., a day or a week). Besides, opportunity cost estimates are supposed to reflect the most productive use of an additional unit of water, yet the simulation rules do not necessarily use water that way. In this work, we propose an alternative approach, which computes the opportunity cost through a double backward induction, first recursively from outlet to headwaters within the river network at each time step, then recursively backwards in time. Both backward inductions only require linear operations, and the resulting algorithm tracks the maximal benefit that can be obtained by having an additional unit of water at any node in the network and at any date in time. Results 1) can be obtained from the results of a rule-based simulation using a single post-processing run, and 2) are exactly the (gross) benefit forgone by not allocating an additional unit of water to its most productive use. The proposed method is applied to London's water resource system to track the value of storage in the city's water supply reservoirs on the Thames River throughout a weekly 85-year simulation. Results, obtained in 0.4 seconds on a single processor, reflect the environmental cost of water shortage. This fast computation allows visualizing the seasonal variations of the opportunity cost depending on reservoir levels, demonstrating the potential of this approach for exploring water values and its variations using simulation models with multiple runs (e.g. of stochastically generated plausible future river inflows).

19 CFR 10.21 - Updating cost data and other information.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Updating cost data and other information. 10.21... Articles Assembled Abroad with United States Components § 10.21 Updating cost data and other information. When a claim for the exemption is predicated on estimated cost data furnished either in advance of or...

19 CFR 10.21 - Updating cost data and other information.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Updating cost data and other information. 10.21... Articles Assembled Abroad with United States Components § 10.21 Updating cost data and other information. When a claim for the exemption is predicated on estimated cost data furnished either in advance of or...

19 CFR 10.21 - Updating cost data and other information.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Updating cost data and other information. 10.21... Articles Assembled Abroad with United States Components § 10.21 Updating cost data and other information. When a claim for the exemption is predicated on estimated cost data furnished either in advance of or...

19 CFR 10.21 - Updating cost data and other information.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Updating cost data and other information. 10.21... Articles Assembled Abroad with United States Components § 10.21 Updating cost data and other information. When a claim for the exemption is predicated on estimated cost data furnished either in advance of or...

Regional cost information for private timberland conversion and management.

Treesearch

Lucas S Bair; Ralph J. Alig

2006-01-01

Cost of private timber management practices in the United States are identified, and their relationship to timber production in general is highlighted. Costs across timber-producing regions and forest types are identified by forest type and timber management practices historically applied in each region. This includes cost estimates for activities such as forest...

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

PubMed

Eaton Turner, Emily; Jenks, Michelle

2018-06-01

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

Theory and Techniques for Assessing the Demand and Supply of Outdoor Recreation in the United States

Treesearch

H. Ken Cordell; John C. Bergstrom

1989-01-01

As the central analysis for the 1989 Renewable Resources planning Act Assessment, a household market model covering 37 recreational activities was computed for the United States. Equilibrium consumption and costs were estimated, as were likely future changes in consumption and costs in response to expected demand growth and alternative development and access policies...

Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme

PubMed Central

Anopa, Yulia; McMahon, Alex D.; Conway, David I.; Ball, Graham E.; McIntosh, Emma; Macpherson, Lorna M. D.

2015-01-01

Dental caries is one of the most common diseases of childhood. The aim of this study was to compare the cost of providing the Scotland-wide nursery toothbrushing programme with associated National Health Service (NHS) cost savings from improvements in the dental health of five-year-old children: through avoided dental extractions, fillings and potential treatments for decay. Methods Estimated costs of the nursery toothbrushing programme in 2011/12 were requested from all Scottish Health Boards. Unit costs of a filled, extracted and decayed primary tooth were calculated using verifiable sources of information. Total costs associated with dental treatments were estimated for the period from 1999/00 to 2009/10. These costs were based on the unit costs above and using the data of the National Dental Inspection Programme and then extrapolated to the population level. Expected cost savings were calculated for each of the subsequent years in comparison with the 2001/02 dental treatment costs. Population standardised analysis of hypothetical cohorts of 1000 children per deprivation category was performed. Results The estimated cost of the nursery toothbrushing programme in Scotland was £1,762,621 per year. The estimated cost of dental treatments in the baseline year 2001/02 was £8,766,297, while in 2009/10 it was £4,035,200. In 2002/03 the costs of dental treatments increased by £213,380 (2.4%). In the following years the costs decreased dramatically with the estimated annual savings ranging from £1,217,255 in 2003/04 (13.9% of costs in 2001/02) to £4,731,097 in 2009/10 (54.0%). Population standardised analysis by deprivation groups showed that the largest decrease in modelled costs was for the most deprived cohort of children. Conclusions The NHS costs associated with the dental treatments for five-year-old children decreased over time. In the eighth year of the toothbrushing programme the expected savings were more than two and a half times the costs of the programme implementation. PMID:26305577

Conductor requirements for high-temperature superconducting utility power transformers

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

Pleva, E. F.; Mehrotra, V.; Schwenterly, S W

High-temperature superconducting (HTS) coated conductors in utility power transformers must satisfy a set of operating requirements that are driven by two major considerations-HTS transformers must be economically competitive with conventional units, and the conductor must be robust enough to be used in a commercial manufacturing environment. The transformer design and manufacturing process will be described in order to highlight the various requirements that it imposes on the HTS conductor. Spreadsheet estimates of HTS transformer costs allow estimates of the conductor cost required for an HTS transformer to be competitive with a similarly performing conventional unit.

Probabilistic estimation of numbers and costs of future landslides in the San Francisco Bay region

USGS Publications Warehouse

Crovelli, R.A.; Coe, J.A.

2009-01-01

We used historical records of damaging landslides triggered by rainstorms and a newly developed Probabilistic Landslide Assessment Cost Estimation System (PLACES) to estimate the numbers and direct costs of future landslides in the 10-county San Francisco Bay region. Historical records of damaging landslides in the region are incomplete. Therefore, our estimates of numbers and costs of future landslides are minimal estimates. The estimated mean annual number of future damaging landslides for the entire 10-county region is about 65. Santa Cruz County has the highest estimated mean annual number of damaging future landslides (about 18), whereas Napa, San Francisco, and Solano Counties have the lowest estimated mean numbers of damaging landslides (about 1 each). The estimated mean annual cost of future landslides in the entire region is about US $14.80 million (year 2000 $). The estimated mean annual cost is highest for San Mateo County ($3.24 million) and lowest for Solano County ($0.18 million). The annual per capita cost for the entire region will be about $2.10. Santa Cruz County will have the highest annual per capita cost at $8.45, whereas San Francisco County will have the lowest per capita cost at $0.31. Normalising costs by dividing by the percentage of land area with slopes equal to or greater than 17% indicates that San Francisco County will have the highest cost per square km ($7,101), whereas Santa Clara County will have the lowest cost per square km ($229). These results indicate that the San Francisco Bay region has one of the highest levels of landslide risk in the United States. Compared with landslide cost estimates from the rest of the world, the risk level in the Bay region seems high, but not exceptionally high.

The cost and cost-effectiveness of childhood cancer treatment in El Salvador, Central America: A report from the Childhood Cancer 2030 Network.

PubMed

Fuentes-Alabi, Soad; Bhakta, Nickhill; Vasquez, Roberto Franklin; Gupta, Sumit; Horton, Susan E

2018-01-15

Although previous studies have examined the cost of treating individual childhood cancers in low-income and middle-income countries, to the authors' knowledge none has examined the overall cost and cost-effectiveness of operating a childhood cancer treatment center. Herein, the authors examined the cost and sources of financing of a pediatric cancer unit in Hospital Nacional de Ninos Benjamin Bloom in El Salvador, and make estimates of cost-effectiveness. Administrative data regarding costs and volumes of inputs were obtained for 2016 for the pediatric cancer unit. Similar cost and volume data were obtained for shared medical services provided centrally (eg, blood bank). Costs of central nonmedical support services (eg, utilities) were obtained from hospital data and attributed by inpatient share. Administrative data also were used for sources of financing. Cost-effectiveness was estimated based on the number of new patients diagnosed annually and survival rates. The pediatric cancer unit cost $5.2 million to operate in 2016 (treating 90 outpatients per day and experiencing 1385 inpatient stays per year). Approximately three-quarters of the cost (74.7%) was attributed to 4 items: personnel (21.6%), pathological diagnosis (11.5%), pharmacy (chemotherapy, supportive care medications, and nutrition; 31.8%), and blood products (9.8%). Funding sources included government (52.5%), charitable foundations (44.2%), and a social security contribution scheme (3.4%). Based on 181 new patients per year and a 5-year survival rate of 48.5%, the cost per disability-adjusted life-year averted was $1624, which is under the threshold considered to be very cost effective. Treating childhood cancer in a specialized unit in low-income and middle-income countries can be done cost-effectively. Strong support from charitable foundations aids with affordability. Cancer 2018;124:391-7. © 2017 American Cancer Society. © 2017 American Cancer Society.

Velocity-Aided Attitude Estimation for Helicopter Aircraft Using Microelectromechanical System Inertial-Measurement Units.

PubMed

Lee, Sang Cheol; Hong, Sung Kyung

2016-12-11

This paper presents an algorithm for velocity-aided attitude estimation for helicopter aircraft using a microelectromechanical system inertial-measurement unit. In general, high- performance gyroscopes are used for estimating the attitude of a helicopter, but this type of sensor is very expensive. When designing a cost-effective attitude system, attitude can be estimated by fusing a low cost accelerometer and a gyro, but the disadvantage of this method is its relatively low accuracy. The accelerometer output includes a component that occurs primarily as the aircraft turns, as well as the gravitational acceleration. When estimating attitude, the accelerometer measurement terms other than gravitational ones can be considered as disturbances. Therefore, errors increase in accordance with the flight dynamics. The proposed algorithm is designed for using velocity as an aid for high accuracy at low cost. It effectively eliminates the disturbances of accelerometer measurements using the airspeed. The algorithm was verified using helicopter experimental data. The algorithm performance was confirmed through a comparison with an attitude estimate obtained from an attitude heading reference system based on a high accuracy optic gyro, which was employed as core attitude equipment in the helicopter.

Velocity-Aided Attitude Estimation for Helicopter Aircraft Using Microelectromechanical System Inertial-Measurement Units

PubMed Central

Lee, Sang Cheol; Hong, Sung Kyung

2016-01-01

This paper presents an algorithm for velocity-aided attitude estimation for helicopter aircraft using a microelectromechanical system inertial-measurement unit. In general, high- performance gyroscopes are used for estimating the attitude of a helicopter, but this type of sensor is very expensive. When designing a cost-effective attitude system, attitude can be estimated by fusing a low cost accelerometer and a gyro, but the disadvantage of this method is its relatively low accuracy. The accelerometer output includes a component that occurs primarily as the aircraft turns, as well as the gravitational acceleration. When estimating attitude, the accelerometer measurement terms other than gravitational ones can be considered as disturbances. Therefore, errors increase in accordance with the flight dynamics. The proposed algorithm is designed for using velocity as an aid for high accuracy at low cost. It effectively eliminates the disturbances of accelerometer measurements using the airspeed. The algorithm was verified using helicopter experimental data. The algorithm performance was confirmed through a comparison with an attitude estimate obtained from an attitude heading reference system based on a high accuracy optic gyro, which was employed as core attitude equipment in the helicopter. PMID:27973429

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings.

PubMed

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider's perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements.

Carvedilol reduces the costs of medical care in severe heart failure: an economic analysis of the COPERNICUS study applied to the United Kingdom.

PubMed

Stewart, Simon; McMurray, John J V; Hebborn, Ansgar; Coats, Andrew J S; Packer, Milton

2005-04-08

The aim of this study was to determine the effects of carvedilol on the costs related to the treatment of severe chronic heart failure (CHF). Costs for the treatment for heart failure within the National Health Service (NHS) in the United Kingdom (UK) were applied to resource utilisation data prospectively collected in all patients randomized into the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study. Unit-specific, per diem (hospital bed day) costs were used to calculate expenditures due to hospitalizations. We also included costs of carvedilol treatment, general practitioner surgery/office visits, hospital out-patient clinic visits and nursing home care based on estimates derived from validated patterns of clinical practice in the UK. The estimated cost of carvedilol therapy and related ambulatory care for the 1156 patients assigned to active treatment was pound530,771 ( pound44.89 per patient/month of follow-up). However, patients assigned to carvedilol were hospitalised less often and accumulated fewer and less expensive days of admission. Consequently, the total estimated cost of hospital care was pound3.49 million in the carvedilol group compared with pound4.24 million for the 1133 patients in the placebo arm. The cost of post-discharge care was also less in the carvedilol than in the placebo group ( pound479,200 vs. pound548,300). Overall, the cost per patient treated in the carvedilol group was pound3948 compared to pound4279 in the placebo group. This equated to a cost of pound385.98 vs. pound434.18, respectively, per patient/month of follow-up: an 11.1% reduction in health care costs in favour of carvedilol. These findings suggest that not only can carvedilol treatment increase survival and reduce hospital admissions in patients with severe CHF but that it can also cut costs in the process.

Economic aspects of severe sepsis: a review of intensive care unit costs, cost of illness and cost effectiveness of therapy.

PubMed

Burchardi, Hilmar; Schneider, Heinz

2004-01-01

Severe sepsis remains both an important clinical challenge and an economic burden in intensive care. An estimated 750,000 cases occur each year in the US alone (300 cases per 100,000 population). Lower numbers are estimated for most European countries (e.g. Germany and Austria: 54-116 cases per year per 100,000). Sepsis patients are generally treated in intensive care units (ICUs) where close supervision and intensive care treatment by a competent team with adequate equipment can be provided. Staffing costs represent from 40% to >60% of the total ICU budget. Because of the high proportion of fixed costs in ICU treatment, the total cost of ICU care is mainly dependent on the length of ICU stay (ICU-LOS). The average total cost per ICU day is estimated at approximately 1200 Euro for countries with a highly developed healthcare system (based on various studies conducted between 1989 and 2001 and converted at 2003 currency rates). Patients with infections and severe sepsis require a prolonged ICU-LOS, resulting in higher costs of treatment compared with other ICU patients. US cost-of-illness studies focusing on direct costs per sepsis patient have yielded estimates of 34,000 Euro, whereas European studies have given lower cost estimates, ranging from 23,000 Euro to 29,000 Euro. Direct costs, however, make up only about 20-30% of the cost of illness of severe sepsis. Indirect costs associated with severe sepsis account for 70-80% of costs and arise mainly from productivity losses due to mortality. Because of increasing healthcare cost pressures worldwide, economic issues have become important for the introduction of new innovations. This is evident when introducing new biotechnology products, such as drotrecogin-alpha (activated protein C), into specific therapy for severe sepsis. Data so far suggest that when drotrecogin-alpha treatment is targeted to those patients most likely to achieve the greatest benefit, the drug is cost effective by the standards of other well accepted life-saving interventions.

Felling and skidding cost estimates for thinnings to reduce gypsy moth impacts

Treesearch

Michael D. Erickson; Curt C. Hassler; Chris B. LeDoux

1991-01-01

The gypsy moth is a serious threat to the hardwood forests of the eastern United States. Although chemical treatments currently exist which can be used to help control the impacts of the moth, silvicultural control measures are just now being proposed and tested. Felling and skidding cost estimates for harvesting merchantable timber under two such proposed...

An expert system for estimating production rates and costs for hardwood group-selection harvests

Treesearch

Chris B. LeDoux; B. Gopalakrishnan; R. S. Pabba

2003-01-01

As forest managers shift their focus from stands to entire ecosystems alternative harvesting methods such as group selection are being used increasingly. Results of several field time and motion studies and simulation runs were incorporated into an expert system for estimating production rates and costs associated with harvests of group-selection units of various size...

The worldwide costs of dementia 2015 and comparisons with 2010.

PubMed

Wimo, Anders; Guerchet, Maëlenn; Ali, Gemma-Claire; Wu, Yu-Tzu; Prina, A Matthew; Winblad, Bengt; Jönsson, Linus; Liu, Zhaorui; Prince, Martin

2017-01-01

In 2010, Alzheimer's Disease International presented estimates of the global cost of illness (COI) of dementia. Since then, new studies have been conducted, and the number of people with dementia has increased. Here, we present an update of the global cost estimates. This is a societal, prevalence-based global COI study. The worldwide costs of dementia were estimated at United States (US) $818 billion in 2015, an increase of 35% since 2010; 86% of the costs occur in high-income countries. Costs of informal care and the direct costs of social care still contribute similar proportions of total costs, whereas the costs in the medical sector are much lower. The threshold of US $1 trillion will be crossed by 2018. Worldwide costs of dementia are enormous and still inequitably distributed. The increase in costs arises from increases in numbers of people with dementia and in increases in per person costs. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Progress report on a multi-service family planning mobile unit September, 1981.

PubMed

1981-12-01

In 1979, the National Family Planning Program's (NFPP) multiservice mobile unit pilot project was implemented to deliver a full complement of clinical and nonclinical family planning services to remote Thai villages by transporting nurses, physicians, and supplies by van. 15 provinces with the lowest family planning achievement in 1978 were selected to participate in the project for 1 year; one refused. Funding was allocated for mobile unit trips and promotional billboards. Implementation at the time of data analysis averaged 9.8 province-months, sufficient to reveal trends in project achievement. 9579 new acceptors were reported after 805 mobile trips in the 14 provinces, an average of 12 new acceptors/trip. New acceptor recruitment costs were estimated at $6.20/client. Based on Thai data for continuation rates, an estimated 18,238 couples years of protection (CYP) were achieved by the mobile unit. In comparison to other family planning services' mobile units, the multiservice unit had the lowest operating costs, but the most expensive cost/CYP. The effectiveness of the promotional billboards was assessed by comparing acceptor rates in provinces with and without billboards. Overall, the provinces with billboards showed less of an increase in new acceptors. When months of project implementation are controlled, a positive effect of the billboards is suggested. While demonstrating that all modern contraception can be delivered via mobile units to remote villages, there is inadequate acceptance of the highly effective family planning methods to justify the cost of transporting staff and equipment.

A cost analysis comparing xeroradiography to film technics for intraoral radiography.

PubMed

Gratt, B M; Sickles, E A

1986-01-01

In the United States during 1978 $730 million was spent on dental radiographic services. Currently there are three alternatives for the processing of intraoral radiographs: manual wet-tanks, automatic film units, or xeroradiography. It was the intent of this study to determine which processing system is the most economical. Cost estimates were based on a usage rate of 750 patient images per month and included a calculation of the average cost per radiograph over a five-year period. Capital costs included initial processing equipment and site preparation. Operational costs included labor, supplies, utilities, darkroom rental, and breakdown costs. Clinical time trials were employed to measure examination times. Maintenance logs were employed to assess labor costs. Indirect costs of training were estimated. Results indicated that xeroradiography was the most cost effective ($0.81 per image) compared to either automatic film processing ($1.14 per image) or manual processing ($1.35 per image). Variations in projected costs indicated that if a dental practice performs primarily complete-mouth surveys, exposes less than 120 radiographs per month, and pays less than +6.50 per hour in wages, then manual (wet-tank) processing is the most economical method for producing intraoral radiographs.

Does scale matter? The costs of HIV-prevention interventions for commercial sex workers in India.

PubMed Central

Guinness, Lorna; Kumaranayake, Lilani; Rajaraman, Bhuvaneswari; Sankaranarayanan, Girija; Vannela, Gangadhar; Raghupathi, P.; George, Alex

2005-01-01

OBJECTIVE: To explore how the scale of a project affects both the total costs and average costs of HIV prevention in India. METHODS: Economic cost data and measures of scale (coverage and service volume indicators for number of cases of sexually transmitted infections (STIs) referred, number of STIs treated, condoms distributed and contacts made with target groups) were collected from 17 interventions run by nongovernmental organizations aimed at commercial sex workers in southern India. Nonparametric methods and regression analyses were used to look at the relationship between total costs, unit costs and scale. FINDINGS: Coverage varied from 250 to 2008 sex workers. Annual costs ranged from US$ 11 274 to US$ 52 793. The median cost per sex worker reached was US$ 19.21 (range = US$ 10.00-51.00). The scale variables explain more than 50% of the variation in unit costs for all of the unit cost measures except cost per contact. Total costs and unit costs have non-linear relationships to scale. CONCLUSION: Average costs vary with the scale of the project. Estimates of resource requirements based on a constant average cost could underestimate or overestimate total costs. The results highlight the importance of improving scale-specific cost information for planning. PMID:16283051

The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa

PubMed Central

Heap, Marion; Sinanovic, Edina

2017-01-01

Background The World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs) improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care. Methods The ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects’ registry from 2008–2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs. Results Average Sign Language Interpreter services’ utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008–2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013. Conclusions In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population. However, this service requires significant capital investment by government to enable access to healthcare for the Deaf. PMID:29272272

The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa.

PubMed

Zulu, Tryphine; Heap, Marion; Sinanovic, Edina

2017-01-01

The World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs) improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care. The ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects' registry from 2008-2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs. Average Sign Language Interpreter services' utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008-2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013. In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population. However, this service requires significant capital investment by government to enable access to healthcare for the Deaf.

Comparison of feed energy costs of maintenance, lean deposition, and fat deposition in three lines of mice selected for heat loss.

PubMed

Eggert, D L; Nielsen, M K

2006-02-01

Three replications of mouse selection populations for high heat loss (MH), low heat loss (ML), and a nonselected control (MC) were used to estimate the feed energy costs of maintenance and gain and to test whether selection had changed these costs. At 21 and 49 d of age, mice were weighed and subjected to dual x-ray densitometry measurement for prediction of body composition. At 21 d, mice were randomly assigned to an ad libitum, an 80% of ad libitum, or a 60% of ad libitum feeding group for 28-d collection of individual feed intake. Data were analyzed using 3 approaches. The first approach was an attempt to partition energy intake between costs for maintenance, fat deposition, and lean deposition for each replicate, sex, and line by multiple regression of feed intake on the sum of daily metabolic weight (kg(0.75)), fat gain, and lean gain. Approach II was a less restrictive attempt to partition energy intake between costs for maintenance and total gain for each replicate, sex, and line by multiple regression of feed intake on the sum of daily metabolic weight and total gain. Approach III used multiple regression on the entire data set with pooled regressions on fat and lean gains, and subclass regressions for maintenance. Contrasts were conducted to test the effect of selection (MH - ML) and asymmetry of selection [(MH + ML)/2 - MC] for the various energy costs. In approach I, there were no differences between lines for costs of maintenance, fat deposition, or protein deposition, but we question our ability to estimate these accurately. In approach II, selection changed both cost of maintenance (P = 0.03) and gain (P = 0.05); MH mice had greater per unit costs than ML mice for both. Asymmetry of the selection response was found in approach II for the cost of maintenance (P = 0.06). In approach III, the effect of selection (P < 0.01) contributed to differences in the maintenance cost, but asymmetry of selection (P > 0.17) was not evident. Sex effects were found for the cost of fat deposition (P = 0.02) in approach I and the cost of gain (P = 0.001) in approach II; females had a greater cost per unit than males. When costs per unit of fat and per unit of lean gain were assumed to be the same for both sexes (approach III), females had a somewhat greater estimate for maintenance cost (P = 0.10). We conclude that selection for heat loss has changed the costs for maintenance per unit size but probably not the costs for gain.

Pathology economic model tool: a novel approach to workflow and budget cost analysis in an anatomic pathology laboratory.

PubMed

Muirhead, David; Aoun, Patricia; Powell, Michael; Juncker, Flemming; Mollerup, Jens

2010-08-01

The need for higher efficiency, maximum quality, and faster turnaround time is a continuous focus for anatomic pathology laboratories and drives changes in work scheduling, instrumentation, and management control systems. To determine the costs of generating routine, special, and immunohistochemical microscopic slides in a large, academic anatomic pathology laboratory using a top-down approach. The Pathology Economic Model Tool was used to analyze workflow processes at The Nebraska Medical Center's anatomic pathology laboratory. Data from the analysis were used to generate complete cost estimates, which included not only materials, consumables, and instrumentation but also specific labor and overhead components for each of the laboratory's subareas. The cost data generated by the Pathology Economic Model Tool were compared with the cost estimates generated using relative value units. Despite the use of automated systems for different processes, the workflow in the laboratory was found to be relatively labor intensive. The effect of labor and overhead on per-slide costs was significantly underestimated by traditional relative-value unit calculations when compared with the Pathology Economic Model Tool. Specific workflow defects with significant contributions to the cost per slide were identified. The cost of providing routine, special, and immunohistochemical slides may be significantly underestimated by traditional methods that rely on relative value units. Furthermore, a comprehensive analysis may identify specific workflow processes requiring improvement.

Economic costs of obesity in Thailand: a retrospective cost-of-illness study

PubMed Central

2014-01-01

Background Over the last decade, the prevalence of obesity (BMI ≥ 25 kg/m2) in Thailand has been rising rapidly and consistently. Estimating the cost of obesity to society is an essential step in setting priorities for research and resource use and helping improve public awareness of the negative economic impacts of obesity. This prevalence-based, cost-of-illness study aims to estimate the economic costs of obesity in Thailand. Methods The estimated costs in this study included health care cost, cost of productivity loss due to premature mortality, and cost of productivity loss due to hospital-related absenteeism. The Obesity-Attributable Fraction (OAF) was used to estimate the extent to which the co-morbidities were attributable to obesity. The health care cost of obesity was further estimated by multiplying the number of patients in each disease category attributable to obesity by the unit cost of treatment. The cost of productivity loss was calculated using the human capital approach. Results The health care cost attributable to obesity was estimated at 5,584 million baht or 1.5% of national health expenditure. The cost of productivity loss attributable to obesity was estimated at 6,558 million baht - accounting for 54% of the total cost of obesity. The cost of hospital-related absenteeism was estimated at 694 million baht, while the cost of premature mortality was estimated at 5,864 million baht. The total cost of obesity was then estimated at 12,142 million baht (725.3 million US$PPP, 16.74 baht =1 US$PPP accounting for 0.13% of Thailand’s Gross Domestic Product (GDP). Conclusions Obesity imposes a substantial economic burden on Thai society especially in term of health care costs. Large-scale comprehensive interventions focused on improving public awareness of the cost of and problems associated with obesity and promoting a healthy lifestyle should be regarded as a public health priority. PMID:24690106

Economic costs of obesity in Thailand: a retrospective cost-of-illness study.

PubMed

Pitayatienanan, Paiboon; Butchon, Rukmanee; Yothasamut, Jomkwan; Aekplakorn, Wichai; Teerawattananon, Yot; Suksomboon, Naeti; Thavorncharoensap, Montarat

2014-04-02

Over the last decade, the prevalence of obesity (BMI ≥ 25 kg/m2) in Thailand has been rising rapidly and consistently. Estimating the cost of obesity to society is an essential step in setting priorities for research and resource use and helping improve public awareness of the negative economic impacts of obesity. This prevalence-based, cost-of-illness study aims to estimate the economic costs of obesity in Thailand. The estimated costs in this study included health care cost, cost of productivity loss due to premature mortality, and cost of productivity loss due to hospital-related absenteeism. The Obesity-Attributable Fraction (OAF) was used to estimate the extent to which the co-morbidities were attributable to obesity. The health care cost of obesity was further estimated by multiplying the number of patients in each disease category attributable to obesity by the unit cost of treatment. The cost of productivity loss was calculated using the human capital approach. The health care cost attributable to obesity was estimated at 5,584 million baht or 1.5% of national health expenditure. The cost of productivity loss attributable to obesity was estimated at 6,558 million baht - accounting for 54% of the total cost of obesity. The cost of hospital-related absenteeism was estimated at 694 million baht, while the cost of premature mortality was estimated at 5,864 million baht. The total cost of obesity was then estimated at 12,142 million baht (725.3 million US$PPP, 16.74 baht =1 US$PPP accounting for 0.13% of Thailand's Gross Domestic Product (GDP). Obesity imposes a substantial economic burden on Thai society especially in term of health care costs. Large-scale comprehensive interventions focused on improving public awareness of the cost of and problems associated with obesity and promoting a healthy lifestyle should be regarded as a public health priority.

Economic Studies in Colorectal Cancer: Challenges in Measuring and Comparing Costs

PubMed Central

2013-01-01

Estimates of the costs associated with cancer care are essential both for assessing burden of disease at the population level and for conducting economic evaluations of interventions to prevent, detect, or treat cancer. Comparisons of cancer costs between health systems and across countries can improve understanding of the economic consequences of different health-care policies and programs. We conducted a structured review of the published literature on colorectal cancer (CRC) costs, including direct medical, direct nonmedical (ie, patient and caregiver time, travel), and productivity losses. We used MEDLINE to identify English language articles published between 2000 and 2010 and found 55 studies. The majority were conducted in the United States (52.7%), followed by France (12.7%), Canada (10.9%), the United Kingdom (9.1%), and other countries (9.1%). Almost 90% of studies estimated direct medical costs, but few studies estimated patient or caregiver time costs or productivity losses associated with CRC. Within a country, we found significant heterogeneity across the studies in populations examined, health-care delivery settings, methods for identifying incident and prevalent patients, types of medical services included, and analyses. Consequently, findings from studies with seemingly the same objective (eg, costs of chemotherapy in year following CRC diagnosis) are difficult to compare. Across countries, aggregate and patient-level estimates vary in so many respects that they are almost impossible to compare. Our findings suggest that valid cost comparisons should be based on studies with explicit standardization of populations, services, measures of costs, and methods with the goal of comparability within or between health systems or countries. Expected increases in CRC prevalence and costs in the future highlight the importance of such studies for informing health-care policy and program planning. PMID:23962510

A Comprehensive Study of Costs Associated With Recurrent Clostridium difficile Infection.

PubMed

Rodrigues, Rodrigo; Barber, Grant E; Ananthakrishnan, Ashwin N

2017-02-01

BACKGROUND Clostridium difficile infection (CDI) is the most common healthcare-associated infection and is associated with considerable morbidity. Recurrent CDI is a key contributing factor to this morbidity. Despite an estimated 83,000 recurrences annually in the United States, there are few accurate estimates of costs associated with recurrent CDI. OBJECTIVE We performed this study (1) to identify the health consequences of recurrent CDI including need for repeat hospitalization, intensive care unit (ICU) stay, and surgery; (2) to determine costs associated with recurrent CDI and identify determinants of such costs; and (3) to compare the outcomes and costs of recurrent CDI to those who develop reinfection. METHODS We identified all patients with confirmed recurrent CDI between January to December 2013 at a single referral center. Healthcare burden associated with recurrence including diagnostic testing, pharmacologic treatment, and inpatient and outpatient healthcare visits were identified in the 12 months following the first recurrence. Total healthcare costs were calculated, and the predictors of high healthcare utilization were identified. RESULTS Our study population included 98 patients with recurrent CDI. The median interval between the initial infection and recurrence was 37 days. The mean age of the cohort was 67 years, two-thirds were women (62%), and the mean Charlson index was 8.6. During the year following the first recurrence of CDI, each patient underwent a mean of 4.4 stool C. difficile toxin tests and received a mean of 2.5 prescriptions for oral vancomycin (range, 0-6). Most patients (84%) with recurrence had a CDI-related hospitalization, and 6% underwent colectomy. The mean total CDI-associated cost was $34,104 per patient, with hospitalization costs accounting for 68%, surgery 20%, and drug treatment 8% of this cost, respectively. Extrapolating to the United States overall, we estimate an annual cost of $2.8 billion related to recurrent CDI. CONCLUSION Recurrent CDI is associated with considerable morbidity and cost. Infect Control Hosp Epidemiol 2017;38:196-202.

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

PubMed

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

2010-04-01

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

A Reliability Improvement Program Planning Report for the SNAP 10A Space Nuclear Power Unit

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

Coombs, M. G.; Smith, C. K.; Wilson, L. A.

1961-03-14

The estimated achieved reliability of SNAP 10A space nuclear power units will be relatively low at the timeof the first SNAPSHOT flight test in April 1963 and the existing R&D program does not provide a significant reliabiity growth thereafter. The total costs of an 8-satellite network using SNAP 10A units over a 5-year period has been approximated for the case where the total cost of a single satellite launched is 8 million dollars.

Mammographic screening: measurement of the cost in a population based programme in Victoria, Australia.

PubMed

Hurley, S F; Livingston, P M; Thane, N; Quang, L

1994-08-01

To estimate the cost per woman participating in a mammographic screening programme, and to describe methods for measuring costs. Expenditure, resource usage, and throughput were monitored over a 12 month period. Unit costs for each phase of the screening process were estimated and linked with the probabilities of each screening outcome to obtain the cost per woman screened and the cost per breast cancer detected. A pilot, population based Australian programme offering free two-view mammographic screening. A total of 5986 women aged 50-69 years who lived in the target area, were listed on the electoral roll, had no previous breast cancer, and attended the programme. Unit costs for recruitment, screening, and recall mammography were $17.54, $60.04, and $175.54, respectively. The costs of clinical assessment for women with subsequent clear, benign, malignant (palpable), and malignant (impalpable) diagnoses were $173.71, $527.29, $436.62, and $567.22, respectively. The cost per woman screened was $117.70, and the cost per breast cancer detected was $11,550. The cost per woman screened is a key variable in assessment of the cost effectiveness of mammographic screening, and is likely to vary between health care settings. Its measurement is justified if decisions about health care services are to be based on cost effectiveness criteria.

GAO's Estimate of the Costs of the "Parental and Medical Leave Act of 1987" (S. 249). Testimony before the Subcommittee on Children, Families, Drugs, and Alcoholism, Committee on Labor and Human Resources, United States Senate.

ERIC Educational Resources Information Center

Gainer, William J.

The General Accounting Office (GAO) estimates that the cost of S.249, the Parental and Medical Leave Act of 1987, will be, at most, 500 million dollars annually, a figure which reflects the cost of continuing health insurance coverage for employees on unpaid leave. S.249 is legislation which aims to provide to workers at firms with 15 or more…

14 CFR 151.61 - Grant payments: Partial.

Code of Federal Regulations, 2012 CFR

2012-01-01

... payments: Partial. (a) Subject to the final determination of allowable project costs as provided in § 151.63 partial grant payments for project costs may be made to a sponsor upon application. Unless... partial payments to the estimated United States share of the project costs of the airport development...

14 CFR 151.61 - Grant payments: Partial.

Code of Federal Regulations, 2010 CFR

2010-01-01

... payments: Partial. (a) Subject to the final determination of allowable project costs as provided in § 151.63 partial grant payments for project costs may be made to a sponsor upon application. Unless... partial payments to the estimated United States share of the project costs of the airport development...

14 CFR 151.61 - Grant payments: Partial.

Code of Federal Regulations, 2011 CFR

2011-01-01

... payments: Partial. (a) Subject to the final determination of allowable project costs as provided in § 151.63 partial grant payments for project costs may be made to a sponsor upon application. Unless... partial payments to the estimated United States share of the project costs of the airport development...

A review of the literature on the social cost of motor vehicle use in the United States

DOT National Transportation Integrated Search

1998-01-01

Over the past five years, analysts and policymakers have become increasingly interested in the "full social cost" of motor vehicle use. Not surprisingly, there is little agreement about how to estimate the social cost or why, with the result that est...

External damage cost of noise emitted from motor vehicles

DOT National Transportation Integrated Search

1998-10-01

With a detailed model of the cost of motor vehicle noise in the United States in 1990, it is estimated that the external damage cost of this noise could range from as little as $100 million per year to as much as $40 billion per year, although it is ...

Joint Intelligence Analysis Complex: DOD Needs to Fully Incorporate Best Practices into Future Cost Estimates

DTIC Science & Technology

2016-11-01

Report to Congressional Requesters November 2016 GAO-17-29 United States Government Accountability Office United States Government... Accountability Office Highlights of GAO-17-29, a report to congressional requesters November 2016 JOINT INTELLIGENCE ANALYSIS COMPLEX DOD...of scope, according to DOD and Air Force officials. However, without fully accounting for life- cycle costs, management may have difficulty

Evaluation of the reference unit method for herbaceous biomass estimation in native grasslands of southwestern South Dakota

Treesearch

Eric D. Boyda

2013-01-01

The high costs associated with physically harvesting plant biomass may prevent sufficient data collection, which is necessary to account for the natural variability of vegetation at a landscape scale. A biomass estimation technique was previously developed using representative samples or "reference units", which eliminated the need to harvest biomass from all...

Louisiana Airport System Plan : financial assessment.

DOT National Transportation Integrated Search

1992-07-01

This report is intended to identify costs and estimates for the improvements identified for Louisiana airports participating in the five-year planning horizon. A database was developed from airport master plans and standard unit costs from recent Lou...

Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.

PubMed

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.

Introduction of the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Costing Tool: a user-friendly spreadsheet program to estimate costs of providing patient-centered interventions.

PubMed

Reed, Shelby D; Li, Yanhong; Kamble, Shital; Polsky, Daniel; Graham, Felicia L; Bowers, Margaret T; Samsa, Gregory P; Paul, Sara; Schulman, Kevin A; Whellan, David J; Riegel, Barbara J

2012-01-01

Patient-centered health care interventions, such as heart failure disease management programs, are under increasing pressure to demonstrate good value. Variability in costing methods and assumptions in economic evaluations of such interventions limit the comparability of cost estimates across studies. Valid cost estimation is critical to conducting economic evaluations and for program budgeting and reimbursement negotiations. Using sound economic principles, we developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Costing Tool, a spreadsheet program that can be used by researchers and health care managers to systematically generate cost estimates for economic evaluations and to inform budgetary decisions. The tool guides users on data collection and cost assignment for associated personnel, facilities, equipment, supplies, patient incentives, miscellaneous items, and start-up activities. The tool generates estimates of total program costs, cost per patient, and cost per week and presents results using both standardized and customized unit costs for side-by-side comparisons. Results from pilot testing indicated that the tool was well-formatted, easy to use, and followed a logical order. Cost estimates of a 12-week exercise training program in patients with heart failure were generated with the costing tool and were found to be consistent with estimates published in a recent study. The TEAM-HF Costing Tool could prove to be a valuable resource for researchers and health care managers to generate comprehensive cost estimates of patient-centered interventions in heart failure or other conditions for conducting high-quality economic evaluations and making well-informed health care management decisions.

Introduction of the TEAM-HF Costing Tool: A User-Friendly Spreadsheet Program to Estimate Costs of Providing Patient-Centered Interventions

PubMed Central

Reed, Shelby D.; Li, Yanhong; Kamble, Shital; Polsky, Daniel; Graham, Felicia L.; Bowers, Margaret T.; Samsa, Gregory P.; Paul, Sara; Schulman, Kevin A.; Whellan, David J.; Riegel, Barbara J.

2011-01-01

Background Patient-centered health care interventions, such as heart failure disease management programs, are under increasing pressure to demonstrate good value. Variability in costing methods and assumptions in economic evaluations of such interventions limit the comparability of cost estimates across studies. Valid cost estimation is critical to conducting economic evaluations and for program budgeting and reimbursement negotiations. Methods and Results Using sound economic principles, we developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Costing Tool, a spreadsheet program that can be used by researchers or health care managers to systematically generate cost estimates for economic evaluations and to inform budgetary decisions. The tool guides users on data collection and cost assignment for associated personnel, facilities, equipment, supplies, patient incentives, miscellaneous items, and start-up activities. The tool generates estimates of total program costs, cost per patient, and cost per week and presents results using both standardized and customized unit costs for side-by-side comparisons. Results from pilot testing indicated that the tool was well-formatted, easy to use, and followed a logical order. Cost estimates of a 12-week exercise training program in patients with heart failure were generated with the costing tool and were found to be consistent with estimates published in a recent study. Conclusions The TEAM-HF Costing Tool could prove to be a valuable resource for researchers and health care managers to generate comprehensive cost estimates of patient-centered interventions in heart failure or other conditions for conducting high-quality economic evaluations and making well-informed health care management decisions. PMID:22147884

Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results From a Randomized Noninferiority Trial of AccuCirc Device Versus Mogen Clamp

PubMed Central

Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K.; Madidi, Ngonidzashe; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M.; Thirumurthy, Harsha

2015-01-01

Background: Safe and cost-effective programs for implementing early infant male circumcision (EIMC) in Africa need to be piloted. We present results on a relative cost analysis within a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe. Methods: Between January and June 2013, male infants who met inclusion criteria were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. We evaluated the overall unit cost plus the key cost drivers of EIMC using both AccuCirc and Mogen clamp. Direct costs included consumable and nonconsumable supplies, device, personnel, associated staff training, and environmental costs. Indirect costs comprised capital and support personnel costs. In 1-way sensitivity analyses, we assessed potential changes in unit costs due to variations in main parameters, one at a time, holding all other values constant. Results: The unit costs of EIMC using AccuCirc and Mogen clamp were $49.53 and $55.93, respectively. Key cost drivers were consumable supplies, capacity utilization, personnel costs, and device price. Unit prices are likely to be lowest at full capacity utilization and increase as capacity utilization decreases. Unit prices also fall with lower personnel salaries and increase with higher device prices. Conclusions: EIMC has a lower unit cost when using AccuCirc compared with Mogen clamp. To minimize unit costs, countries planning to scale-up EIMC using AccuCirc need to control costs of consumables and personnel. There is also need to negotiate a reasonable device price and maximize capacity utilization. PMID:26017658

Cost of high prevalence mental disorders: Findings from the 2007 Australian National Survey of Mental Health and Wellbeing.

PubMed

Lee, Yu-Chen; Chatterton, Mary Lou; Magnus, Anne; Mohebbi, Mohammadreza; Le, Long Khanh-Dao; Mihalopoulos, Cathrine

2017-12-01

The aim of this project was to detail the costs associated with the high prevalence mental disorders (depression, anxiety-related and substance use) in Australia, using community-based, nationally representative survey data. Respondents diagnosed, within the preceding 12 months, with high prevalence mental disorders using the Confidentialised Unit Record Files of the 2007 National Survey of Mental Health and Wellbeing were analysed. The use of healthcare resources (hospitalisations, consultations and medications), productivity loss, income tax loss and welfare benefits were estimated. Unit costs of healthcare services were obtained from the Independent Hospital Pricing Authority, Medicare and Pharmaceutical Benefits Scheme. Labour participation rates and unemployment rates were determined from the National Survey of Mental Health and Wellbeing. Daily wage rates adjusted by age and sex were obtained from Australian Bureau of Statistics and used to estimate productivity losses. Income tax loss was estimated based on the Australian Taxation Office rates. The average cost of commonly received Government welfare benefits adjusted by age was used to estimate welfare payments. All estimates were expressed in 2013-2014 AUD and presented from multiple perspectives including public sector, individuals, private insurers, health sector and societal. The average annual treatment cost for people seeking treatment was AUD660 (public), AUD195 (individual), AUD1058 (private) and AUD845 from the health sector's perspective. The total annual healthcare cost was estimated at AUD974m, consisting of AUD700m to the public sector, AUD168m to individuals, and AUD107m to the private sector. The total annual productivity loss attributed to the population with high prevalence mental disorders was estimated at AUD11.8b, coupled with the yearly income tax loss at AUD1.23b and welfare payments at AUD12.9b. The population with high prevalence mental disorders not only incurs substantial cost to the Australian healthcare system but also large economic losses to society.

Cost of services provided by the National Breast and Cervical Cancer Early Detection Program.

PubMed

Ekwueme, Donatus U; Subramanian, Sujha; Trogdon, Justin G; Miller, Jacqueline W; Royalty, Janet E; Li, Chunyu; Guy, Gery P; Crouse, Wesley; Thompson, Hope; Gardner, James G

2014-08-15

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is the largest cancer screening program for low-income women in the United States. This study updates previous estimates of the costs of delivering preventive cancer screening services in the NBCCEDP. We developed a standardized web-based cost-assessment tool to collect annual activity-based cost data on screening for breast and cervical cancer in the NBCCEDP. Data were collected from 63 of the 66 programs that received funding from the Centers for Disease Control and Prevention during the 2006/2007 fiscal year. We used these data to calculate costs of delivering preventive public health services in the program. We estimated the total cost of all NBCCEDP services to be $296 (standard deviation [SD], $123) per woman served (including the estimated value of in-kind donations, which constituted approximately 15% of this total estimated cost). The estimated cost of screening and diagnostic services was $145 (SD, $38) per women served, which represented 57.7% of the total cost excluding the value of in-kind donations. Including the value of in-kind donations, the weighted mean cost of screening a woman for breast cancer was $110 with an office visit and $88 without, the weighted mean cost of a diagnostic procedure was $401, and the weighted mean cost per breast cancer detected was $35,480. For cervical cancer, the corresponding cost estimates were $61, $21, $415, and $18,995, respectively. These NBCCEDP cost estimates may help policy makers in planning and implementing future costs for various potential changes to the program. © 2014 American Cancer Society.

Is computer aided detection (CAD) cost effective in screening mammography? A model based on the CADET II study

PubMed Central

2011-01-01

Background Single reading with computer aided detection (CAD) is an alternative to double reading for detecting cancer in screening mammograms. The aim of this study is to investigate whether the use of a single reader with CAD is more cost-effective than double reading. Methods Based on data from the CADET II study, the cost-effectiveness of single reading with CAD versus double reading was measured in terms of cost per cancer detected. Cost (Pound (£), year 2007/08) of single reading with CAD versus double reading was estimated assuming a health and social service perspective and a 7 year time horizon. As the equipment cost varies according to the unit size a separate analysis was conducted for high, average and low volume screening units. One-way sensitivity analyses were performed by varying the reading time, equipment and assessment cost, recall rate and reader qualification. Results CAD is cost increasing for all sizes of screening unit. The introduction of CAD is cost-increasing compared to double reading because the cost of CAD equipment, staff training and the higher assessment cost associated with CAD are greater than the saving in reading costs. The introduction of single reading with CAD, in place of double reading, would produce an additional cost of £227 and £253 per 1,000 women screened in high and average volume units respectively. In low volume screening units, the high cost of purchasing the equipment will results in an additional cost of £590 per 1,000 women screened. One-way sensitivity analysis showed that the factors having the greatest effect on the cost-effectiveness of CAD with single reading compared with double reading were the reading time and the reader's professional qualification (radiologist versus advanced practitioner). Conclusions Without improvements in CAD effectiveness (e.g. a decrease in the recall rate) CAD is unlikely to be a cost effective alternative to double reading for mammography screening in UK. This study provides updated estimates of CAD costs in a full-field digital system and assessment cost for women who are re-called after initial screening. However, the model is highly sensitive to various parameters e.g. reading time, reader qualification, and equipment cost. PMID:21241473

State-level estimates of obesity-attributable costs of absenteeism.

PubMed

Andreyeva, Tatiana; Luedicke, Joerg; Wang, Y Claire

2014-11-01

To provide state-level estimates of obesity-attributable costs of absenteeism among working adults in the United States. Nationally representative data from the National Health and Nutrition Examination Survey for 1998 to 2008 and from the Behavioral Risk Factor Surveillance System for 2012 are examined. The outcome is obesity-attributable workdays missed in the previous year because of health and their costs to states. Obesity, but not overweight, is associated with a significant increase in workdays absent, from 1.1 to 1.7 extra days missed annually compared with normal-weight employees. Obesity-attributable absenteeism among American workers costs the nation an estimated $8.65 billion per year. Obesity imposes a considerable financial burden on states, accounting for 6.5% to 12.6% of total absenteeism costs in the workplace. State legislatures and employers should seek effective ways to reduce these costs.

Estimation of lifespan and economy parameters of steam-turbine power units in thermal power plants using varying regimes

NASA Astrophysics Data System (ADS)

Aminov, R. Z.; Shkret, A. F.; Garievskii, M. V.

2016-08-01

The use of potent power units in thermal and nuclear power plants in order to regulate the loads results in intense wear of power generating equipment and reduction in cost efficiency of their operation. We review the methodology of a quantitative assessment of the lifespan and wear of steam-turbine power units and estimate the effect of various operation regimes upon their efficiency. To assess the power units' equipment wear, we suggest using the concept of a turbine's equivalent lifespan. We give calculation formulae and an example of calculation of the lifespan of a steam-turbine power unit for supercritical parameters of steam for different options of its loading. The equivalent lifespan exceeds the turbine's assigned lifespan only provided daily shutdown of the power unit during the night off-peak time. We obtained the engineering and economical indices of the power unit operation for different loading regulation options in daily and weekly diagrams. We proved the change in the prime cost of electric power depending on the operation regimes and annual daily number of unloading (non-use) of the power unit's installed capacity. According to the calculation results, the prime cost of electric power for the assumed initial data varies from 11.3 cents/(kW h) in the basic regime of power unit operation (with an equivalent operation time of 166700 hours) to 15.5 cents/(kW h) in the regime with night and holiday shutdowns. The reduction of using the installed capacity of power unit at varying regimes from 3.5 to 11.9 hours per day can increase the prime cost of energy from 4.2 to 37.4%. Furthermore, repair and maintenance costs grow by 4.5% and by 3 times, respectively, in comparison with the basic regime. These results indicate the need to create special maneuverable equipment for working in the varying section of the electric load diagram.

How much does care in palliative care wards cost in Poland?

PubMed Central

Pokropska, Wieslawa; Łuczak, Jacek; Kaptacz, Anna; Stachowiak, Andrzej; Hurich, Krystyna; Koszela, Monika

2016-01-01

Introduction The main task of palliative care units is to provide a dignified life for people with advanced progressive chronic disease through appropriate symptom management, communication between medical specialists and the patient and his family, as well as the coordination of care. Many palliative care units struggle with low incomes from the National Health Fund (NHF), which causes serious economic problems. The aim of the study was to estimate of direct and administrative costs of care and the actual cost per patient per day in selected palliative care units and comparison of the results to the valuation of the NHF. Material and methods The study of the costs of hospitalization of 175 patients was conducted prospectively in five palliative care units (PCUs). The costs directly associated with care were recorded on the specially prepared forms in each unit and also personnel and administrative costs provided by the accounting departments. Results The total costs of analyzed units amounted to 209 002 EUR (898 712 PLN), while the payment for palliative care services from the NHF amounted to 126 010 EUR (541 844 PLN), which accounted for only 60% of the costs incurred by the units. The average cost per person per day of hospitalization, calculated according to the actual duration of hospitalization in the unit, was 83 EUR (357 PLN), and the average payment from the NHF was 52.8 EUR (227 PLN). Underpayment per person per day was approximately 29.2 EUR (125 PLN). Conclusions The study showed a significant difference between the actual cost of palliative care units and the level of refund from the NHF. Based on the analysis of costs, the application has been submitted to the NHF to change the reimbursement amount of palliative care services in 2013. PMID:27186194

Cost Effectiveness of Contraceptives in the United States

PubMed Central

Trussell, James; Lalla, Anjana M.; Doan, Quan V.; Reyes, Eileen; Pinto, Lionel; Gricar, Joseph

2013-01-01

Background The study was conducted to estimate the relative cost effectiveness of contraceptives in the United States from a payer’s perspective. Methods A Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period. Failure rates, adverse event rates, and resource utilization were derived from the literature. Sensitivity analyses were performed on costs and failure rates. Results Any contraceptive method is superior to “no method”. The three least expensive methods were the copper-T IUD ($647), vasectomy ($713) and LNG-20 IUS ($930). Results were sensitive to the cost of contraceptive methods, the cost of an unintended pregnancy, and plan disenrollment rates. Conclusion The copper-T IUD, vasectomy, and the LNG-20 IUS are the most cost-effective contraceptive methods available in the United States. Differences in method costs, the cost of an unintended pregnancy, and time horizon are influential factors that determine the overall value of a contraceptive method. PMID:19041435

The economic burden of child sexual abuse in the United States.

PubMed

Letourneau, Elizabeth J; Brown, Derek S; Fang, Xiangming; Hassan, Ahmed; Mercy, James A

2018-05-01

The present study provides an estimate of the U.S. economic impact of child sexual abuse (CSA). Costs of CSA were measured from the societal perspective and include health care costs, productivity losses, child welfare costs, violence/crime costs, special education costs, and suicide death costs. We separately estimated quality-adjusted life year (QALY) losses. For each category, we used the best available secondary data to develop cost per case estimates. All costs were estimated in U.S. dollars and adjusted to the reference year 2015. Estimating 20 new cases of fatal and 40,387 new substantiated cases of nonfatal CSA that occurred in 2015, the lifetime economic burden of CSA is approximately $9.3 billion, the lifetime cost for victims of fatal CSA per female and male victim is on average $1,128,334 and $1,482,933, respectively, and the average lifetime cost for victims of nonfatal CSA is of $282,734 per female victim. For male victims of nonfatal CSA, there was insufficient information on productivity losses, contributing to a lower average estimated lifetime cost of $74,691 per male victim. If we included QALYs, these costs would increase by approximately $40,000 per victim. With the exception of male productivity losses, all estimates were based on robust, replicable incidence-based costing methods. The availability of accurate, up-to-date estimates should contribute to policy analysis, facilitate comparisons with other public health problems, and support future economic evaluations of CSA-specific policy and practice. In particular, we hope the availability of credible and contemporary estimates will support increased attention to primary prevention of CSA. Copyright © 2018. Published by Elsevier Ltd.

Cost-outcome analysis in injury prevention and control: eighty-four recent estimates for the United States.

PubMed

Miller, T R; Levy, D T

2000-06-01

The objectives of this study were to review cost-outcome analyses in injury prevention and control and estimate associated benefit-cost ratios and cost per quality-adjusted life-year. Medline and Internet search, bibliographic review, and federal agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupational, air, rail, and water transport safety programs were excluded. Selected results were recomputed to increase discount rate, benefit category, and benefit estimate comparability and to update injury incidence rates. More than half of the 84 injury prevention measures reviewed yielded net societal cost savings. Twelve measures had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, whereas 8 had costs that exceeded benefits. Interventions with the highest benefit-cost ratios included juvenile delinquent therapy programs, fire-safe cigarettes, federal road and traffic safety program funding, lane markers painted on roads, post-mounted reflectors on hazardous curves, safety belts in front seats, safety belt laws with primary enforcement, child safety seats, child bicycle helmets, enforcement of laws against serving alcohol to the intoxicated, substance abuse treatment, brief medical interventions with heavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several injury types. Injury prevention often can reduce medical costs and save lives. Wider implementation of proven measures is warranted.

Estimating the cost to U.S. health departments to conduct HIV surveillance.

PubMed

Shrestha, Ram K; Sansom, Stephanie L; Laffoon, Benjamin T; Farnham, Paul G; Shouse, R Luke; MacMaster, Karen; Hall, H Irene

2014-01-01

HIV case surveillance is a primary source of information for monitoring HIV burden in the United States and guiding the allocation of prevention and treatment funds. While the number of people living with HIV and the need for surveillance data have increased, little is known about the cost of surveillance. We estimated the economic cost to health departments of conducting high-quality HIV case surveillance. We collected primary data on the unit cost and quantity of resources used to operate the HIV case surveillance program in Michigan, where HIV burden (i.e., the number of HIV cases) is moderate to high (n=14,864 cases). Based on Michigan's data, we projected the expected annual HIV surveillance cost for U.S., state, local, and territorial health departments. We based our cost projection on the variation in the number of new and established cases, area-specific wages, and potential economies of scale. We estimated the annual total HIV surveillance cost to the Michigan health department to be $1,286,524 ($87/case), the annual total cost of new cases to be $108,657 ($133/case), and the annual total cost of established cases to be $1,177,867 ($84/case). Our projected median annual HIV surveillance cost per health department ranged from $210,600 in low-HIV burden sites to $1,835,000 in high-HIV burden sites. Our analysis shows that a systematic approach to costing HIV surveillance at the health department level is feasible. For HIV surveillance, a substantial portion of total surveillance costs is attributable to maintaining established cases.

Costs of hospitalization for stroke patients aged 18-64 years in the United States.

PubMed

Wang, Guijing; Zhang, Zefeng; Ayala, Carma; Dunet, Diane O; Fang, Jing; George, Mary G

2014-01-01

Estimates for the average cost of stroke have varied 20-fold in the United States. To provide a robust cost estimate, we conducted a comprehensive analysis of the hospitalization costs for stroke patients by diagnosis status and event type. Using the 2006-2008 MarketScan inpatient database, we identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke. We analyzed the costs after stratifying the hospitalizations by stroke type (hemorrhagic, ischemic, and other strokes) and diagnosis status (primary and secondary). We employed regressions to estimate the impact of event type and diagnosis status on costs while controlling for major potential confounders. Among the 97,374 hospitalizations (average cost: $20,396 ± $23,256), the number with ischemic, hemorrhagic, or other strokes was 62,637, 16,331, and 48,208, respectively, with these types having average costs, in turn, of $18,963 ± $21,454, $32,035 ± $32,046, and $19,248 ± $21,703. A majority (62%) of the hospitalizations had stroke listed as a secondary diagnosis only. Regression analysis found that, overall, hemorrhagic stroke cost $14,499 more than ischemic stroke (P < .001). For hospitalizations with a primary diagnosis of ischemic stroke, those with a secondary diagnosis of ischemic heart disease (IHD) had costs that were $9836 higher (P < .001) than those without IHD. The costs of hospitalizations involving stroke are high and vary greatly by type of stroke, diagnosis status, and comorbidities. These findings should be incorporated into cost-effective strategies to reduce the impact of stroke. Published by Elsevier Inc.

Strategies to Prevent MRSA Transmission in Community-Based Nursing Homes: A Cost Analysis.

PubMed

Roghmann, Mary-Claire; Lydecker, Alison; Mody, Lona; Mullins, C Daniel; Onukwugha, Eberechukwu

2016-08-01

OBJECTIVE To estimate the costs of 3 MRSA transmission prevention scenarios compared with standard precautions in community-based nursing homes. DESIGN Cost analysis of data collected from a prospective, observational study. SETTING AND PARTICIPANTS Care activity data from 401 residents from 13 nursing homes in 2 states. METHODS Cost components included the quantities of gowns and gloves, time to don and doff gown and gloves, and unit costs. Unit costs were combined with information regarding the type and frequency of care provided over a 28-day observation period. For each scenario, the estimated costs associated with each type of care were summed across all residents to calculate an average cost and standard deviation for the full sample and for subgroups. RESULTS The average cost for standard precautions was $100 (standard deviation [SD], $77) per resident over a 28-day period. If gown and glove use for high-risk care was restricted to those with MRSA colonization or chronic skin breakdown, average costs increased to $137 (SD, $120) and $125 (SD, $109), respectively. If gowns and gloves were used for high-risk care for all residents in addition to standard precautions, the average cost per resident increased substantially to $223 (SD, $127). CONCLUSIONS The use of gowns and gloves for high-risk activities with all residents increased the estimated cost by 123% compared with standard precautions. This increase was ameliorated if specific subsets (eg, those with MRSA colonization or chronic skin breakdown) were targeted for gown and glove use for high-risk activities. Infect Control Hosp Epidemiol 2016;37:962-966.

Development of a Carbon Management Geographic Information System (GIS) for the United States

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

Howard Herzog; Holly Javedan

In this project a Carbon Management Geographical Information System (GIS) for the US was developed. The GIS stored, integrated, and manipulated information relating to the components of carbon management systems. Additionally, the GIS was used to interpret and analyze the effect of developing these systems. This report documents the key deliverables from the project: (1) Carbon Management Geographical Information System (GIS) Documentation; (2) Stationary CO{sub 2} Source Database; (3) Regulatory Data for CCS in United States; (4) CO{sub 2} Capture Cost Estimation; (5) CO{sub 2} Storage Capacity Tools; (6) CO{sub 2} Injection Cost Modeling; (7) CO{sub 2} Pipeline Transport Costmore » Estimation; (8) CO{sub 2} Source-Sink Matching Algorithm; and (9) CO{sub 2} Pipeline Transport and Cost Model.« less

A risk adjustment approach to estimating the burden of skin disease in the United States.

PubMed

Lim, Henry W; Collins, Scott A B; Resneck, Jack S; Bolognia, Jean; Hodge, Julie A; Rohrer, Thomas A; Van Beek, Marta J; Margolis, David J; Sober, Arthur J; Weinstock, Martin A; Nerenz, David R; Begolka, Wendy Smith; Moyano, Jose V

2018-01-01

Direct insurance claims tabulation and risk adjustment statistical methods can be used to estimate health care costs associated with various diseases. In this third manuscript derived from the new national Burden of Skin Disease Report from the American Academy of Dermatology, a risk adjustment method that was based on modeling the average annual costs of individuals with or without specific diseases, and specifically tailored for 24 skin disease categories, was used to estimate the economic burden of skin disease. The results were compared with the claims tabulation method used in the first 2 parts of this project. The risk adjustment method estimated the direct health care costs of skin diseases to be $46 billion in 2013, approximately $15 billion less than estimates using claims tabulation. For individual skin diseases, the risk adjustment cost estimates ranged from 11% to 297% of those obtained using claims tabulation for the 10 most costly skin disease categories. Although either method may be used for purposes of estimating the costs of skin disease, the choice of method will affect the end result. These findings serve as an important reference for future discussions about the method chosen in health care payment models to estimate both the cost of skin disease and the potential cost impact of care changes. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Can real time location system technology (RTLS) provide useful estimates of time use by nursing personnel?

PubMed

Jones, Terry L; Schlegel, Cara

2014-02-01

Accurate, precise, unbiased, reliable, and cost-effective estimates of nursing time use are needed to insure safe staffing levels. Direct observation of nurses is costly, and conventional surrogate measures have limitations. To test the potential of electronic capture of time and motion through real time location systems (RTLS), a pilot study was conducted to assess efficacy (method agreement) of RTLS time use; inter-rater reliability of RTLS time-use estimates; and associated costs. Method agreement was high (mean absolute difference = 28 seconds); inter-rater reliability was high (ICC = 0.81-0.95; mean absolute difference = 2 seconds); and costs for obtaining RTLS time-use estimates on a single nursing unit exceeded $25,000. Continued experimentation with RTLS to obtain time-use estimates for nursing staff is warranted. © 2013 Wiley Periodicals, Inc.

Cost-benefit analysis of biopsy methods for suspicious mammographic lesions; discussion 994-5.

PubMed

Fahy, B N; Bold, R J; Schneider, P D; Khatri, V; Goodnight, J E

2001-09-01

Stereotactic core biopsy (SCB) is more cost-effective than needle-localized biopsy (NLB) for evaluation and treatment of mammographic lesions. A computer-generated mathematical model was developed based on clinical outcome modeling to estimate costs accrued during evaluation and treatment of suspicious mammographic lesions. Total costs were determined for evaluation and subsequent treatment of cancer when either SCB or NLB was used as the initial biopsy method. Cost was estimated by the cumulative work relative value units accrued. The risk of malignancy based on the Breast Imaging Reporting Data System (BIRADS) score and mammographic suspicion of ductal carcinoma in situ were varied to simulate common clinical scenarios. Total cost accumulated during evaluation and subsequent surgical therapy (if required). Evaluation of BIRADS 5 lesions (highly suggestive, risk of malignancy = 90%) resulted in equivalent relative value units for both techniques (SCB, 15.54; NLB, 15.47). Evaluation of lesions highly suspicious for ductal carcinoma in situ yielded similar total treatment relative value units (SCB, 11.49; NLB, 10.17). Only for evaluation of BIRADS 4 lesions (suspicious abnormality, risk of malignancy = 34%) was SCB more cost-effective than NLB (SCB, 7.65 vs. NLB, 15.66). No difference in cost-benefit was found when lesions highly suggestive of malignancy (BIRADS 5) or those suspicious for ductal carcinoma in situ were evaluated initially with SCB vs. NLB, thereby disproving the hypothesis. Only for intermediate-risk lesions (BIRADS 4) did initial evaluation with SCB yield a greater cost savings than with NLB.

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

PubMed

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

2014-09-01

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

Field activity cost estimates for the first 3 years of the World Bank Loan Project for schistosomiasis control in China.

PubMed

Guo, J; Booth, M; Jenkins, J; Wang, H; Tanner, M

1998-12-01

The World Bank Loan Project for schistosomiasis in China commenced field activities in 1992. In this paper, we describe disease control strategies for levels of different endemicity, and estimate unit costs and total expenditure of screening, treatment (cattle and humans) and snail control for 8 provinces where Schistosoma japonicum infection is endemic. Overall, we estimate that more than 21 million US dollars were spent on field activities during the first three years of the project. Mollusciciding (43% of the total expenditure) and screening (28% of the total) are estimated to have the most expensive field activities. However, despite the expense of screening, a simple model predicts that selective chemotherapy could have been cheaper than mass chemotherapy in areas where infection prevalence was higher than 15%, which was the threshold for mass chemotherapy intervention. It is concluded that considerable cost savings could be made in the future by narrowing the scope of snail control activities, redefining the threshold infection prevalence for mass chemotherapy, defining smaller administrative units, and developing rapid assessment tools.

Generalisability and Cost-Impact of Antibiotic-Impregnated Central Venous Catheters for Reducing Risk of Bloodstream Infection in Paediatric Intensive Care Units in England.

PubMed

Harron, Katie; Mok, Quen; Hughes, Dyfrig; Muller-Pebody, Berit; Parslow, Roger; Ramnarayan, Padmanabhan; Gilbert, Ruth

2016-01-01

We determined the generalisability and cost-impact of adopting antibiotic-impregnated CVCs in all paediatric intensive care units (PICUs) in England, based on results from a large randomised controlled trial (the CATCH trial; ISRCTN34884569). BSI rates using standard CVCs were estimated through linkage of national PICU audit data (PICANet) with laboratory surveillance data. We estimated the number of BSI averted if PICUs switched from standard to antibiotic-impregnated CVCs by applying the CATCH trial rate-ratio (0.40; 95% CI 0.17,0.97) to the BSI rate using standard CVCs. The value of healthcare resources made available by averting one BSI as estimated from the trial economic analysis was £10,975; 95% CI -£2,801,£24,751. The BSI rate using standard CVCs was 4.58 (95% CI 4.42,4.74) per 1000 CVC-days in 2012. Applying the rate-ratio gave 232 BSI averted using antibiotic CVCs. The additional cost of purchasing antibiotic-impregnated compared with standard CVCs was £36 for each child, corresponding to additional costs of £317,916 for an estimated 8831 CVCs required in PICUs in 2012. Based on 2012 BSI rates, management of BSI in PICUs cost £2.5 million annually (95% uncertainty interval: -£160,986, £5,603,005). The additional cost of antibiotic CVCs would be less than the value of resources associated with managing BSI in PICUs with standard BSI rates >1.2 per 1000 CVC-days. The cost of introducing antibiotic-impregnated CVCs is less than the cost associated with managing BSIs occurring with standard CVCs. The long-term benefits of preventing BSI could mean that antibiotic CVCs are cost-effective even in PICUs with extremely low BSI rates.

Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units

PubMed Central

Bernatchez, Stéphanie F.; Ruckly, Stéphane; Timsit, Jean-François

2015-01-01

Objective To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients. Design This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. Patients 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours. Intervention Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings. Results The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88. Conclusions According to the base case scenario, the chlorhexidine gluconate dressing is more cost-effective than the reference dressing. Trial Registration This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682). PMID:26086783

Cost estimating Brayton and Stirling engines

NASA Technical Reports Server (NTRS)

Fortgang, H. R.

1980-01-01

Brayton and Stirling engines were analyzed for cost and selling price for production quantities ranging from 1000 to 400,000 units per year. Parts and components were subjected to indepth scrutiny to determine optimum manufacturing processes coupled with make or buy decisions on materials and small parts. Tooling and capital equipment costs were estimated for each detail and/or assembly. For low annual production volumes, the Brayton engine appears to have a lower cost and selling price than the Stirling Engine. As annual production quantities increase, the Stirling becomes a lower cost engine than the Brayton. Both engines could benefit cost wise if changes were made in materials, design and manufacturing process as annual production quantities increase.

How much does it cost to achieve coverage targets for primary healthcare services? A costing model from Aceh, Indonesia.

PubMed

Abdullah, Asnawi; Hort, Krishna; Abidin, Azwar Zaenal; Amin, Fadilah M

2012-01-01

Despite significant investment in improving service infrastructure and training of staff, public primary healthcare services in low-income and middle-income countries tend to perform poorly in reaching coverage targets. One of the factors identified in Aceh, Indonesia was the lack of operational funds for service provision. The objective of this study was to develop a simple and transparent costing tool that enables health planners to calculate the unit costs of providing basic health services to estimate additional budgets required to deliver services in accordance with national targets. The tool was developed using a standard economic approach that linked the input activities to achieving six national priority programs at primary healthcare level: health promotion, sanitation and environment health, maternal and child health and family planning, nutrition, immunization and communicable diseases control, and treatment of common illness. Costing was focused on costs of delivery of the programs that need to be funded by local government budgets. The costing tool consisting of 16 linked Microsoft Excel worksheets was developed and tested in several districts enabled the calculation of the unit costs of delivering of the six national priority programs per coverage target of each program (such as unit costs of delivering of maternal and child health program per pregnant mother). This costing tool can be used by health planners to estimate additional money required to achieve a certain level of coverage of programs, and it can be adjusted for different costs and program delivery parameters in different settings. Copyright © 2012 John Wiley & Sons, Ltd.

Aggregation and the Measurement of Health Care Costs

PubMed Central

Getzen, Thomas E

2006-01-01

Objective This study evaluated the extent to which the causes of variation in health care costs differ by the level at which observations are made. Methods More than 40 U.S. and international studies providing empirical estimates of the sources of variation in health care costs were reviewed and arrayed by size of observational units. A simplified graphical analysis demonstrating how estimated correlation coefficients change with the level and type of aggregation is presented. Results As the unit of observation becomes larger, association between health care costs and health status/morbidity becomes weaker and smaller in magnitude, while correlation with income (per capita GDP) becomes stronger and larger. Individual expenditure variation within a particular health care system is largely due to differences in health status, but across systems, morbidity has almost no effect on costs. For nations, differences in per capita income explain over 90 percent of the variation in both time series and cross section. Conclusions Units of observation used for analysis of health care costs must be matched to the units at which decision making occurs. The observed pattern of empirical results is consistent with a multilevel allocative model incorporating aggregate capacity constraints. To the extent that macro constraints determine total budgets at the national level, policy interventions at the micro level (substitution of generic pharmaceuticals, use of CEA for allocation of treatments, controls on construction and technology, etc.) can act to improve efficiency, equity and average health status, but will not usually reduce aggregate average per capita costs of medical care. PMID:16987309

Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale

PubMed Central

Quentin, Wilm; Adu-Sarkodie, Yaw; Terris-Prestholt, Fern; Legood, Rosa; Opoku, Baafuor K; Mayaud, Philippe

2011-01-01

Objectives To estimate the incremental costs of visual inspection with acetic acid (VIA) and cryotherapy at cervical cancer screening facilities in Ghana; to explore determinants of costs through modelling; and to estimate national scale-up and annual programme costs. Methods Resource-use data were collected at four out of six active VIA screening centres, and unit costs were ascertained to estimate the costs per woman of VIA and cryotherapy. Modelling and sensitivity analysis were used to explore the influence of observed differences between screening facilities on estimated costs and to calculate national costs. Results Incremental economic costs per woman screened with VIA ranged from 4.93 US$ to 14.75 US$, and costs of cryotherapy were between 47.26 US$ and 84.48 US$ at surveyed facilities. Under base case assumptions, our model estimated the costs of VIA to be 6.12 US$ per woman and those of cryotherapy to be 27.96 US$. Sensitivity analysis showed that the number of women screened per provider and treated per facility was the most important determinants of costs. National annual programme costs were estimated to be between 0.6 and 4.0 million US$ depending on assumed coverage and adopted screening strategy. Conclusion When choosing between different cervical cancer prevention strategies, the feasibility of increasing uptake to achieve economies of scale should be a major concern. PMID:21214692

Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale.

PubMed

Quentin, Wilm; Adu-Sarkodie, Yaw; Terris-Prestholt, Fern; Legood, Rosa; Opoku, Baafuor K; Mayaud, Philippe

2011-03-01

To estimate the incremental costs of visual inspection with acetic acid (VIA) and cryotherapy at cervical cancer screening facilities in Ghana; to explore determinants of costs through modelling; and to estimate national scale-up and annual programme costs. Resource-use data were collected at four out of six active VIA screening centres, and unit costs were ascertained to estimate the costs per woman of VIA and cryotherapy. Modelling and sensitivity analysis were used to explore the influence of observed differences between screening facilities on estimated costs and to calculate national costs. Incremental economic costs per woman screened with VIA ranged from 4.93 US$ to 14.75 US$, and costs of cryotherapy were between 47.26 US$ and 84.48 US$ at surveyed facilities. Under base case assumptions, our model estimated the costs of VIA to be 6.12 US$ per woman and those of cryotherapy to be 27.96 US$. Sensitivity analysis showed that the number of women screened per provider and treated per facility was the most important determinants of costs. National annual programme costs were estimated to be between 0.6 and 4.0 million US$ depending on assumed coverage and adopted screening strategy.   When choosing between different cervical cancer prevention strategies, the feasibility of increasing uptake to achieve economies of scale should be a major concern. © 2011 Blackwell Publishing Ltd.

Toward inventory-based estimates of soil organic carbon in forests of the United States

Treesearch

G.M. Domke; C.H. Perry; B.F. Walters; L.E. Nave; C.W. Woodall; C.W. Swanston

2017-01-01

Soil organic carbon (SOC) is the largest terrestrial carbon (C) sink on Earth; this pool plays a critical role in ecosystem processes and climate change. Given the cost and time required to measure SOC, and particularly changes in SOC, many signatory nations to the United Nations Framework Convention on Climate Change report estimates of SOC stocks and stock changes...

The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis

PubMed Central

Kanters, Steve; Hagopian, Amy; Bansback, Nick; Nachega, Jean; Alberton, Mark; Au-Yeung, Christopher G; Mtambo, Andy; Bourgeault, Ivy L; Luboga, Samuel; Hogg, Robert S; Ford, Nathan

2011-01-01

Objective To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Design Human capital cost analysis using publicly accessible data. Settings Sub-Saharan African countries. Participants Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. Main outcome measures The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. Results In the nine source countries the estimated government subsidised cost of a doctor’s education ranged from $21 000 (£13 000; €15 000) in Uganda to $58 700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Conclusions Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their health systems. PMID:22117056

A patient-centred approach to estimate total annual healthcare cost by body mass index in the UK Counterweight programme.

PubMed

Tigbe, W W; Briggs, A H; Lean, M E J

2013-08-01

Previous studies, based on relative risks for certain secondary diseases, have shown greater healthcare costs in higher body mass index (BMI) categories. The present study quantifies the relationship between BMI and total healthcare expenditure, with the patient as the unit of analysis. Analyses of cross-sectional data, collected over 18-months in 2002-2003, from 3324 randomly selected patients, in 65 general practices across UK. Healthcare costs estimated from primary care, outpatient, accident/emergency and hospitalisation attendances, weighted by unit costs taken from standard sources. In univariate analyses, significant associations (P<0.05) were found between total healthcare expenditure and all dependent variables (women>men, drinkernon-smokers, and increasing with greater physical activity, age and BMI. In multivariate analysis, age, sex, BMI, smoking and alcohol consumption remained significantly associated with healthcare cost, and together explained just 9% of the variance in healthcare expenditure. Adjusted total annual healthcare cost was £16 (95% CI £11-£21) higher per unit BMI. All cost categories were significantly (P<0.003) higher for those with BMI >40 compared with BMI <20 kg m(-2): prescription drugs (men: £390 versus £16; women: £211 versus £73), hospitalisation (men: £72 versus £0; women: £243 versus £107), primary care (men: £191 versus £69; women: £268 versus £153) and outpatient care (£234 versus £107 women only). Annual healthcare expenditure rose a mean of £16 per unit greater BMI, doubling between BMI 20-40 kg m(-2). This gradient may be an underestimate if the lower-BMI patients with heights and weights recorded had other costly diseases.

Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation

PubMed Central

Jit, Mark; Stagg, Helen R; Aldridge, Robert W; White, Peter J

2011-01-01

Objective To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis. Design Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis. Setting London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London’s enhanced tuberculosis surveillance system. Main outcome measures Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service. Results The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10 000/QALY gained (about €7300-€11 000 or $10 000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18 000-£26 000/QALY gained; case management support team, £4100-£6800/QALY gained). Conclusions Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance. PMID:22067473

Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation.

PubMed

Jit, Mark; Stagg, Helen R; Aldridge, Robert W; White, Peter J; Abubakar, Ibrahim

2011-09-14

To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis. Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis. London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London's enhanced tuberculosis surveillance system. Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service. The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10,000/QALY gained (about €7300-€11,000 or $10,000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18,000-£26,000/QALY gained; case management support team, £4100-£6800/QALY gained). Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance.

Cost of delivering secondary-level health care services through public sector district hospitals in India.

PubMed

Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

2017-09-01

Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was ' 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was ' 844 (USD 15.5), ' 3481 (USD 64) and ' 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was ' 139 (USD 2.5). The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.

Commercial Vessel Safety. Economic Costs. Preliminary.

DTIC Science & Technology

1979-12-01

or "rippled" through the economy when a regulation is implemented. The survey associated with determination of costs focused upon two basic areas...in their application of standard financial principles and in their utilization of basic ship cost components (e.g., investment and operating costs...on the estimation of costs per ton of capacity provided. The basic unit for analyzing ships’ costs used is a single voyage (round trip) on a particular

Assessment of costs and benefits of flexible and alternative fuel use in the US transportation sector

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

None

1993-01-01

The primary objective of this report is to provide estimates of volumes and development costs of known nonassociated gas reserves in selected, potentially important supplier nations, using a standard set of costing algorithms and conventions. Estimates of undeveloped nonassociated gas reserves and the cost of drilling development wells, production equipment, gas processing facilities, and pipeline construction are made at the individual field level. A discounted cash-flow model of production, investment, and expenses is used to estimate the present value cost of developing each field on a per-thousand-cubic-foot (Mcf) basis. These gas resource cost estimates for individual accumulations (that is, fieldsmore » or groups of fields) then were aggregated into country-specific price-quantity curves. These curves represent the cost of developing and transporting natural gas to an export point suitable for tanker shipments or to a junction with a transmission line. The additional costs of LNG or methanol conversion are not included. A brief summary of the cost of conversion to methanol and transportation to the United States is contained in Appendix D: Implications of Gas Development Costs for Methanol Conversion.« less

44 CFR 62.20 - Claims appeals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (includes contractors' estimates), detailing unit cost and quantities for the items needing repair or replacement; replacement cost proofs of loss; Preliminary Report; Final Report; detailed damaged personal... wind policies and any claim information submitted to the other companies; Waiver, Letter of Map...

44 CFR 62.20 - Claims appeals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (includes contractors' estimates), detailing unit cost and quantities for the items needing repair or replacement; replacement cost proofs of loss; Preliminary Report; Final Report; detailed damaged personal... wind policies and any claim information submitted to the other companies; Waiver, Letter of Map...

The Economic Costs of Poverty in the United States: Subsequent Effects of Children Growing Up Poor. Discussion Paper No. 1327-07

ERIC Educational Resources Information Center

Holzer, Harry J.; Schanzenbach, Diane Whitmore; Duncan, Greg J.; Ludwig, Jens

2007-01-01

In this paper, we review a range of rigorous research studies that estimate the average statistical relationships between children growing up in poverty and their earnings, propensity to commit crime, and quality of health later in life. We also review estimates of the costs that crime and poor health per person impose on the economy. Then we…

A Study of Ship Acquisition Cost Estimating in the Naval Sea Systems Command. Appendices

DTIC Science & Technology

1977-10-01

Shipbuilding Is A Heovy Fabrication Industry Pro- ducing Small Numbers Of Expensive, Complex Units Of Output PAGE A-2 (1) Due to its heavy ...estimate future ship construction costs. - A-l 1. SHIPBUILDING IS A HEAVY FABRICATION INDUSTRY PRODUCING SMALL NUMBERS OF EXPENSIVE, COMPLEX...extensively in production line industries such as automotive products and the airframe industry. (1) Due To Its Heavy Construction Orientation

Global cost analysis on adaptation to sea level rise based on RCP/SSP scenarios

NASA Astrophysics Data System (ADS)

Kumano, N.; Tamura, M.; Yotsukuri, M.; Kuwahara, Y.; Yokoki, H.

2017-12-01

Low-lying areas are the most vulnerable to sea level rise (SLR) due to climate change in the future. In order to adapt to SLR, it is necessary to decide whether to retreat from vulnerable areas or to install dykes to protect them from inundation. Therefore, cost- analysis of adaptation using coastal dykes is one of the most essential issues in the context of climate change and its countermeasures. However, few studies have globally evaluated the future costs of adaptation in coastal areas. This study tries to globally analyze the cost of adaptation in coastal areas. First, global distributions of projected inundation impacts induced by SLR including astronomical high tide were assessed. Economic damage was estimated on the basis of the econometric relationship between past hydrological disasters, affected population, and per capita GDP using CRED's EM-DAT database. Second, the cost of adaptation was also determined using the cost database and future scenarios. The authors have built a cost database for installed coastal dykes worldwide and applied it to estimating the future cost of adaptation. The unit costs of dyke construction will increase with socio-economic scenario (SSP) such as per capita GDP. Length of vulnerable coastline is calculated by identifying inundation areas using ETOPO1. Future cost was obtained by multiplying the length of vulnerable coastline and the unit cost of dyke construction. Third, the effectiveness of dyke construction was estimated by comparing cases with and without adaptation.As a result, it was found that incremental adaptation cost is lower than economic damage in the cases of SSP1 and SSP3 under RCP scenario, while the cost of adaptation depends on the durability of the coastal dykes.

Cost of Services Provided by the National Breast and Cervical Cancer Early Detection Program

PubMed Central

Ekwueme, Donatus U.; Subramanian, Sujha; Trogdon, Justin G.; Miller, Jacqueline W.; Royalty, Janet E.; Li, Chunyu; Guy, Gery P.; Crouse, Wesley; Thompson, Hope; Gardner, James G.

2015-01-01

BACKGROUND The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is the largest cancer screening program for low-income women in the United States. This study updates previous estimates of the costs of delivering preventive cancer screening services in the NBCCEDP. METHODS We developed a standardized web-based cost-assessment tool to collect annual activity-based cost data on screening for breast and cervical cancer in the NBCCEDP. Data were collected from 63 of the 66 programs that received funding from the Centers for Disease Control and Prevention during the 2006/2007 fiscal year. We used these data to calculate costs of delivering preventive public health services in the program. RESULTS We estimated the total cost of all NBCCEDP services to be $296 (standard deviation [SD], $123) per woman served (including the estimated value of in-kind donations, which constituted approximately 15% of this total estimated cost). The estimated cost of screening and diagnostic services was $145 (SD, $38) per women served, which represented 57.7% of the total cost excluding the value of in-kind donations. Including the value of in-kind donations, the weighted mean cost of screening a woman for breast cancer was $110 with an office visit and $88 without, the weighted mean cost of a diagnostic procedure was $401, and the weighted mean cost per breast cancer detected was $35,480. For cervical cancer, the corresponding cost estimates were $61, $21, $415, and $18,995, respectively. CONCLUSIONS These NBCCEDP cost estimates may help policy makers in planning and implementing future costs for various potential changes to the program. PMID:25099904

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 Economic Impact of Adult Hearing Loss: A Systematic Review.

PubMed

Huddle, Matthew G; Goman, Adele M; Kernizan, Faradia C; Foley, Danielle M; Price, Carrie; Frick, Kevin D; Lin, Frank R

2017-10-01

Hearing impairment (HI) is highly prevalent in older adults and has been associated with adverse health outcomes. However, the overall economic impact of HI is not well described. The goal of this review was to summarize available data on all relevant costs associated with HI among adults. A literature search of PubMed, Embase, the Cochrane Library, CINAHL, and Scopus was conducted in August 2015. For this systematic review, data extraction and quality assessment were performed by 2 independent reviewers. Eligibility criteria for included studies were presence of quantitative estimation of economic impact or loss of productivity of patients with HI, full-text English-language access, and publication in an academic, peer-reviewed journal or government report prior to August 2015. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A meta-analysis was not performed owing to the studies' heterogeneity in outcomes measures, methodology, and study country. The initial literature search yielded 4595 total references. After 2043 duplicates were removed, 2552 publications underwent title and abstract review, yielding 59 articles for full-text review. After full-text review, 25 articles were included. Of the included articles, 8 incorporated measures of disability; 5 included direct estimates of medical expenditures; 8 included other cost estimates; and 7 were related to noise-induced or work-related HI. Estimates of the economic cost of lost productivity varied widely, from $1.8 to $194 billion in the United States. Excess medical costs resulting from HI ranged from $3.3 to $12.8 billion in the United States. Hearing loss is associated with billions of dollars of excess costs in the United States, but significant variance is seen between studies. A rigorous, comprehensive estimate of the economic impact of hearing loss is needed to help guide policy decisions around the management of hearing loss in adults.

The cost of health professionals' brain drain in Kenya.

PubMed

Kirigia, Joses Muthuri; Gbary, Akpa Raphael; Muthuri, Lenity Kainyu; Nyoni, Jennifer; Seddoh, Anthony

2006-07-17

Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. The costs of primary, secondary, medical and nursing schools were estimated in 2005. The cost information used in this study was obtained from one non-profit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidized cost. The loss incurred by Kenya through emigration was obtained by compounding the cost of educating a medical doctor and a nurse over the period between the average age of emigration (30 years) and the age of retirement (62 years) in recipient countries. The total cost of educating a single medical doctor from primary school to university is 65,997 US dollars; and for every doctor who emigrates, a country loses about 517,931 US dollars worth of returns from investment. The total cost of educating one nurse from primary school to college of health sciences is 43,180 US dollars; and for every nurse that emigrates, a country loses about 338,868 US dollars worth of returns from investment. Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals) from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Kenya and to keeping a majority of her people in the vicious circle of ill-health and poverty. Therefore, both developed and developing countries need to urgently develop and implement strategies for addressing the health human resource crisis.

The cost of health professionals' brain drain in Kenya

PubMed Central

Kirigia, Joses Muthuri; Gbary, Akpa Raphael; Muthuri, Lenity Kainyu; Nyoni, Jennifer; Seddoh, Anthony

2006-01-01

Background Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. Methods The costs of primary, secondary, medical and nursing schools were estimated in 2005. The cost information used in this study was obtained from one non-profit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidized cost. The loss incurred by Kenya through emigration was obtained by compounding the cost of educating a medical doctor and a nurse over the period between the average age of emigration (30 years) and the age of retirement (62 years) in recipient countries. Results The total cost of educating a single medical doctor from primary school to university is US$ 65,997; and for every doctor who emigrates, a country loses about US$ 517,931 worth of returns from investment. The total cost of educating one nurse from primary school to college of health sciences is US$ 43,180; and for every nurse that emigrates, a country loses about US$ 338,868 worth of returns from investment. Conclusion Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals) from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Kenya and to keeping a majority of her people in the vicious circle of ill-health and poverty. Therefore, both developed and developing countries need to urgently develop and implement strategies for addressing the health human resource crisis. PMID:16846492

Pushing the boundaries of viability: the economic impact of extreme preterm birth.

PubMed

Petrou, Stavros; Henderson, Jane; Bracewell, Melanie; Hockley, Christine; Wolke, Dieter; Marlow, Neil

2006-02-01

Previous assessments of the economic impact of preterm birth focussed on short term health service costs across the broad spectrum of prematurity. To estimate the societal costs of extreme preterm birth during the sixth year after birth. Unit costs were applied to estimates of health, social and broader resource use made by 241 children born at 20 through 25 completed weeks of gestation in the United Kingdom and Republic of Ireland and a comparison group of 160 children born at full term. Societal costs per child during the sixth year after birth were estimated and subjected to a rigorous sensitivity analysis. The effects of gestational age at birth on annual societal costs were analysed, first in a simple linear regression and then in a multiple linear regression. Mean societal costs over the 12 month period were 9541 pounds sterling (standard deviation 11,678 pounds sterling) for the extreme preterm group and 3883 pounds sterling (1098 pounds sterling) for the term group, generating a mean cost difference of 5658 pounds sterling (bootstrap 95% confidence interval: 4203 pounds sterling, 7256 pounds sterling) that was statistically significant (P<0.001). After adjustment for clinical and sociodemographic covariates, sex-specific extreme preterm birth was a strong predictor of high societal costs. The results of this study should facilitate the effective planning of services and may be used to inform the development of future economic evaluations of interventions aimed at preventing extreme preterm birth or alleviating its effects.

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings

PubMed Central

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E.; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

Objective To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. Design A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Methods Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. Results The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. Conclusion For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements. PMID:25933414

Effects of enhanced pacing modalities on health care resource utilization and costs in bradycardia patients: An analysis of the randomized MINERVA trial.

PubMed

Boriani, Giuseppe; Manolis, Antonis S; Tukkie, Raymond; Mont, Lluis; Pürerfellner, Helmut; Santini, Massimo; Inama, Giuseppe; Serra, Paolo; Gulizia, Michele; Samoilenko, Igor Vasilyevich; Wolff, Claudia; Holbrook, Reece; Gavazza, Federica; Padeletti, Luigi

2015-06-01

Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR). The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union. Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits. The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P < .001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States. New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Short-term Resource Utilization and Cost-Effectiveness of Comprehensive Geriatric Assessment in Acute Hospital Care for Severely Frail Elderly Patients.

PubMed

Ekerstad, Niklas; Karlson, Björn W; Andersson, David; Husberg, Magnus; Carlsson, Per; Heintz, Emelie; Alwin, Jenny

2018-05-18

The objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective. Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups. Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit. A large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female. The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up. We undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was -3226 US dollars (95% CI: -6167 to -285). The results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

An Analysis of the Factors Generating the Variance Between the Budgeted and Actual Operating Results of the Naval Aviation Depot at North Island, California

DTIC Science & Technology

2008-06-01

management structure employs free- market system principles and encourages business-like processes that are mission driven. Since no operating funds are...variable (Potvin, 2007). 2. Unit Cost Goal NWCFs use the unit cost goal ( UCG ) for planning purposes. The UCG is an estimate of what a unit of product...mission 6. Will not interfere with depot performance This section opens the depot to the private market . 53 Chapter 159 – Real Property

Cost of care of patients with cystic fibrosis in The Netherlands in 1990-1.

PubMed Central

Wildhagen, M. F.; Verheij, J. B.; Verzijl, J. G.; Hilderink, H. B.; Kooij, L.; Tijmstra, T.; ten Kate, L. P.; Gerritsen, J.; Bakker, W.; Habbema, J. D.; Habbema, F.

1996-01-01

BACKGROUND: Research on the cost of care of patients with cystic fibrosis is scarce. The aim of this study was to estimate the costs using age-specific medical consumption from real patient data. METHODS: The age-specific medical consumption of patients with cystic fibrosis in The Netherlands in 1991 was estimated from a survey of medical records and a patient questionnaire. A distinction was made between costs of hospital care, hospital and non-hospital medication, and home care. Costs per year were obtained by multiplying the yearly amount of care and the costs per unit. RESULTS: On average the annual cost of a patient with cystic fibrosis in 1991 was 10,908 pounds (hospital care 42%, medication 37%, home care 20%). The cost of care of cystic fibrosis in The Netherlands, with approximately 1000 patients, is estimated at 10.9 million pounds per year, which is 0.07% of the total health care budget. The cost of care of a patient up to the age of 35 is estimated at 614,587 pounds. When year-to-year survival is taken into account and future costs are discounted to the year of birth with a yearly discount rate of 5%, the cost of care of a patient with cystic fibrosis is estimated at 164,365 pounds for 1991. This estimate will be used in a prospective evaluation of screening for cystic fibrosis carriers. CONCLUSIONS: The cost of care of patients with cystic fibrosis estimated by age-specific medical consumption of real patients is higher than that estimated by non-age-specific medical consumption and/or expert opinions. PMID:8779135

[Economic evaluation and rationale for human health risk management decisions].

PubMed

Fokin, S G; Bobkova, T E

2011-01-01

The priority task of human health maintenance and improvement is risk management using the new economic concepts based on the assessment of potential and real human risks from exposure to poor environmental factors and on the estimation of cost-benefit and cost-effectiveness ratios. The application of economic tools to manage a human risk makes it possible to assess various measures both as a whole and their individual priority areas, to rank different scenarios in terms of their effectiveness, to estimate costs per unit of risk reduction and benefit increase (damage decrease).

Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing theBrain Trauma Foundation guidelines for the treatment of severe traumatic brain injury.

PubMed

Faul, Mark; Wald, Marlena M; Rutland-Brown, Wesley; Sullivent, Ernest E; Sattin, Richard W

2007-12-01

A decade after promulgation of treatment guidelines by the Brain Trauma Foundation (BTF), few studies exist that examine the application of these guidelines for severe traumatic brain injury (TBI) patients. These studies have reported both cost savings and reduced mortality. We projected the results of previous studies of BTF guideline adoption to estimate the impact of widespread adoption across the United States. We used surveillance systems and national surveys to estimate the number of severely injured TBI patients and compared the lifetime costs of BTF adoption to the current state of treatment. After examining the health outcomes and costs, we estimated that a substantial savings in annual medical costs ($262 million), annual rehabilitation costs ($43 million) and lifetime societal costs ($3.84 billion) would be achieved if treatment guidelines were used more routinely. Implementation costs were estimated to be $61 million. The net savings were primarily because of better health outcomes and a decreased burden on lifetime social support systems. We also estimate that mortality would be reduced by 3,607 lives if the guidelines were followed. Widespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.

Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Study

PubMed Central

2010-01-01

Introduction Severe acute kidney injury (AKI) can be treated with either continuous renal replacement therapy (CRRT) or intermittent renal replacement therapy (IRRT). Limited evidence from existing studies does not support an outcome advantage of one modality versus the other, and most centers around the word use both modalities according to patient needs. However, cost estimates involve multiple factors that may not be generalizable to other sites, and, to date, only single-center cost studies have been performed. The aim of this study was to estimate the cost difference between CRRT and IRRT in the intensive care unit (ICU). Methods We performed a post hoc analysis of a prospective observational study among 53 centers from 23 countries, from September 2000 to December 2001. We estimated costs based on staffing, as well as dialysate and replacement fluid, anticoagulation and extracorporeal circuit. Results We found that the theoretic range of costs were from $3,629.80/day more with CRRT to $378.60/day more with IRRT. The median difference in cost between CRRT and IRRT was $289.60 (IQR 830.8-116.8) per day (greater with CRRT). Costs also varied greatly by region. Reducing replacement fluid volumes in CRRT to ≤ 25 ml/min (approximately 25 ml/kg/hr) would result in $67.20/day (23.2%) mean savings. Conclusions Cost considerations with RRT are important and vary substantially among centers. We identified the relative impact of four cost domains (nurse staffing, fluid, anticoagulation, and extracorporeal circuit) on overall cost differences, and hospitals can look to these areas to reduce costs associated with RRT. PMID:20346163

Cost profiles and budget impact of rechargeable versus non-rechargeable sacral neuromodulation devices in the treatment of overactive bladder syndrome.

PubMed

Noblett, Karen L; Dmochowski, Roger R; Vasavada, Sandip P; Garner, Abigail M; Liu, Shan; Pietzsch, Jan B

2017-03-01

Sacral neuromodulation (SNM) is a guideline-recommended third-line treatment option for managing overactive bladder. Current SNM devices are not rechargeable, and require neurostimulator replacement every 3-6 years. Our study objective was to assess potential cost effects to payers of adopting a rechargeable SNM neurostimulator device. We constructed a cost-consequence model to estimate the costs of long-term SNM-treatment with a rechargeable versus non-rechargeable device. Costs were considered from the payer perspective at 2015 reimbursement levels. Adverse events, therapy discontinuation, and programming rates were based on the latest published data. Neurostimulator longevity was assumed to be 4.4 and 10.0 years for non-rechargeable and rechargeable devices, respectively. A 15-year horizon was modeled, with costs discounted at 3% per year. Total budget impact to the United States healthcare system was estimated based on the computed per-patient cost findings. Over the 15-year horizon, per-patient cost of treatment with a non-rechargeable device was $64,111 versus $36,990 with a rechargeable device, resulting in estimated payer cost savings of $27,121. These cost savings were found to be robust across a wide range of scenarios. Longer analysis horizon, younger patient age, and longer rechargeable neurostimulator lifetime were associated with increased cost savings. Over a 15-year horizon, adoption of a rechargeable device strategy was projected to save the United States healthcare system up to $12 billion. At current reimbursement rates, our analysis suggests that rechargeable neurostimulator SNM technology for managing overactive bladder syndrome may deliver significant cost savings to payers over the course of treatment. Neurourol. Urodynam. 36:727-733, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

[Costs of maternal-infant care in an institutionalized health care system].

PubMed

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.

Stump-to-mill timber production cost equations for cable logging eastern hardwoods

Treesearch

Chris B. LeDoux; Chris B. LeDoux

1985-01-01

Logging cost simulators and data from logging cost studies have been assembled and converted into a series of equations that can be used to estimate the stump-to-mill cost of cable logging in mountainous terrain in the Eastern United States. These equations include the use of two small and four mediumsize cable yarders and are appropriate for harvested trees ranging in...

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

Crawford, Aladsair J.; Viswanathan, Vilayanur V.; Stephenson, David E.

A robust performance-based cost model is developed for all-vanadium, iron-vanadium and iron chromium redox flow batteries. Systems aspects such as shunt current losses, pumping losses and thermal management are accounted for. The objective function, set to minimize system cost, allows determination of stack design and operating parameters such as current density, flow rate and depth of discharge (DOD). Component costs obtained from vendors are used to calculate system costs for various time frames. A 2 kW stack data was used to estimate unit energy costs and compared with model estimates for the same size electrodes. The tool has been sharedmore » with the redox flow battery community to both validate their stack data and guide future direction.« less

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom12

PubMed Central

Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

2015-01-01

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). Objective: The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. Design: In this cross-sectional study of adults aged 39–79 y from the European Prospective Investigation into Cancer and Nutrition–Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom–based supermarket comparison website. Results: Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Conclusions: Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed. PMID:25926505

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom.

PubMed

Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

2015-07-01

The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. In this cross-sectional study of adults aged 39-79 y from the European Prospective Investigation into Cancer and Nutrition-Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom-based supermarket comparison website. Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed.

Effect of present technology on airship capabilities

NASA Technical Reports Server (NTRS)

Madden, R. T.

1975-01-01

The effect is presented of updating past airship designs using current materials and propulsion systems to determine new airship performance and productivity capabilities. New materials and power plants permit reductions in the empty weights and increases in the useful load capabilities of past airship designs. The increased useful load capability results in increased productivity for a given range, i.e., either increased payload at the same operating speed or increased operating speed for the same payload weight or combinations of both. Estimated investment costs and operating costs are presented to indicate the significant cost parameters in estimating transportation costs of payloads in cents per ton mile. Investment costs are presented considering production lots of 1, 10 and 100 units. Operating costs are presented considering flight speeds and ranges.

Costs of IQ Loss from Leaded Aviation Gasoline Emissions

PubMed Central

Wolfe, Philip J.; Giang, Amanda; Ashok, Akshay; Selin, Noelle E.; Barrett, Steven R. H.

2017-01-01

In the United States, general aviation piston-driven aircraft are now the largest source of lead emitted to the atmosphere. Elevated lead concentrations impair children’s IQ and can lead to lower earnings potentials. This study is the first assessment of the nationwide annual costs of IQ losses from aircraft lead emissions. We develop a general aviation emissions inventory for the continental United States and model its impact on atmospheric concentrations using the Community Multi-Scale Air Quality Model (CMAQ). We use these concentrations to quantify the impacts of annual aviation lead emissions on the U.S. population using two methods: through static estimates of cohort-wide IQ deficits and through dynamic economy-wide effects using a computational general equilibrium model. We also examine the sensitivity of these damage estimates to different background lead concentrations, showing the impact of lead controls and regulations on marginal costs. We find that aircraft-attributable lead contributes to $1.06 billion 2006 USD ($0.01 – $11.6) in annual damages from lifetime earnings reductions, and that dynamic economy-wide methods result in damage estimates that are 54% larger. Because the marginal costs of lead are dependent on background concentration, the costs of piston-driven aircraft lead emissions are expected to increase over time as regulations on other emissions sources are tightened. PMID:27494542

Costs of IQ Loss from Leaded Aviation Gasoline Emissions.

PubMed

Wolfe, Philip J; Giang, Amanda; Ashok, Akshay; Selin, Noelle E; Barrett, Steven R H

2016-09-06

In the United States, general aviation piston-driven aircraft are now the largest source of lead emitted to the atmosphere. Elevated lead concentrations impair children's IQ and can lead to lower earnings potentials. This study is the first assessment of the nationwide annual costs of IQ losses from aircraft lead emissions. We develop a general aviation emissions inventory for the continental United States and model its impact on atmospheric concentrations using the community multi-scale air quality model (CMAQ). We use these concentrations to quantify the impacts of annual aviation lead emissions on the U.S. population using two methods: through static estimates of cohort-wide IQ deficits and through dynamic economy-wide effects using a computational general equilibrium model. We also examine the sensitivity of these damage estimates to different background lead concentrations, showing the impact of lead controls and regulations on marginal costs. We find that aircraft-attributable lead contributes to $1.06 billion 2006 USD ($0.01-$11.6) in annual damages from lifetime earnings reductions, and that dynamic economy-wide methods result in damage estimates that are 54% larger. Because the marginal costs of lead are dependent on background concentration, the costs of piston-driven aircraft lead emissions are expected to increase over time as regulations on other emissions sources are tightened.

Updated Value of Service Reliability Estimates for Electric Utility Customers in the United States

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

Sullivan, Michael; Schellenberg, Josh; Blundell, Marshall

2015-01-01

This report updates the 2009 meta-analysis that provides estimates of the value of service reliability for electricity customers in the United States (U.S.). The meta-dataset now includes 34 different datasets from surveys fielded by 10 different utility companies between 1989 and 2012. Because these studies used nearly identical interruption cost estimation or willingness-to-pay/accept methods, it was possible to integrate their results into a single meta-dataset describing the value of electric service reliability observed in all of them. Once the datasets from the various studies were combined, a two-part regression model was used to estimate customer damage functions that can bemore » generally applied to calculate customer interruption costs per event by season, time of day, day of week, and geographical regions within the U.S. for industrial, commercial, and residential customers. This report focuses on the backwards stepwise selection process that was used to develop the final revised model for all customer classes. Across customer classes, the revised customer interruption cost model has improved significantly because it incorporates more data and does not include the many extraneous variables that were in the original specification from the 2009 meta-analysis. The backwards stepwise selection process led to a more parsimonious model that only included key variables, while still achieving comparable out-of-sample predictive performance. In turn, users of interruption cost estimation tools such as the Interruption Cost Estimate (ICE) Calculator will have less customer characteristics information to provide and the associated inputs page will be far less cumbersome. The upcoming new version of the ICE Calculator is anticipated to be released in 2015.« less

Soil-transmitted helminthiasis in Latin America and the Caribbean: modelling the determinants, prevalence, population at risk and costs of control at sub-national level.

PubMed

Colston, Josh; Saboyá, Martha

2013-05-01

We present an example of a tool for quantifying the burden, the population in need of intervention and resources need to contribute for the control of soil-transmitted helminth (STH) infection at multiple administrative levels for the region of Latin America and the Caribbean (LAC). The tool relies on published STH prevalence data along with data on the distribution of several STH transmission determinants for 12,273 sub-national administrative units in 22 LAC countries taken from national censuses. Data on these determinants was aggregated into a single risk index based on a conceptual framework and the statistical significance of the association between this index and the STH prevalence indicators was tested using simple linear regression. The coefficient and constant from the output of this regression was then put into a regression formula that was applied to the risk index values for all of the administrative units in order to model the estimated prevalence of each STH species. We then combine these estimates with population data, treatment thresholds and unit cost data to calculate total control costs. The model predicts an annual cost for the procurement of preventive chemotherapy of around US$ 1.7 million and a total cost of US$ 47 million for implementing a comprehensive STH control programme targeting an estimated 78.7 million school-aged children according to the WHO guidelines throughout the entirety of the countries included in the study. Considerable savings to this cost could potentially be made by embedding STH control interventions within existing health programmes and systems. A study of this scope is prone to many limitations which restrict the interpretation of the results and the uses to which its findings may be put. We discuss several of these limitations.

Estimating the costs of intensity-modulated and 3-dimensional conformal radiotherapy in Ontario.

PubMed

Yong, J H E; McGowan, T; Redmond-Misner, R; Beca, J; Warde, P; Gutierrez, E; Hoch, J S

2016-06-01

Radiotherapy is a common treatment for many cancers, but up-to-date estimates of the costs of radiotherapy are lacking. In the present study, we estimated the unit costs of intensity-modulated radiotherapy (imrt) and 3-dimensional conformal radiotherapy (3D-crt) in Ontario. An activity-based costing model was developed to estimate the costs of imrt and 3D-crt in prostate cancer. It included the costs of equipment, staff, and supporting infrastructure. The framework was subsequently adapted to estimate the costs of radiotherapy in breast cancer and head-and-neck cancer. We also tested various scenarios by varying the program maturity and the use of volumetric modulated arc therapy (vmat) alongside imrt. From the perspective of the health care system, treating prostate cancer with imrt and 3D-crt respectively cost $12,834 and $12,453 per patient. The cost of radiotherapy ranged from $5,270 to $14,155 and was sensitive to analytic perspective, radiation technique, and disease site. Cases of head-and-neck cancer were the most costly, being driven by treatment complexity and fractions per treatment. Although imrt was more costly than 3D-crt, its cost will likely decline over time as programs mature and vmat is incorporated. Our costing model can be modified to estimate the costs of 3D-crt and imrt for various disease sites and settings. The results demonstrate the important role of capital costs in studies of radiotherapy cost from a health system perspective, which our model can accommodate. In addition, our study established the need for future analyses of imrt cost to consider how vmat affects time consumption.

Two-year post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany.

PubMed

Kaier, Klaus; von Kampen, Frederike; Baumbach, Hardy; von Zur Mühlen, Constantin; Hehn, Philip; Vach, Werner; Zehender, Manfred; Bode, Christoph; Reinöhl, Jochen

2017-07-11

This study presents data on post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement over a two year period. Based on a prospective clinical trial, post-discharge utilization of health services and status of assistance were collected for 151 elderly patients via 2250 monthly telephone interviews, valued using standardized unit costs and analysed using two-part regression models. At month 1 post-discharge, total costs of care are substantially elevated (monthly mean: €3506.7) and then remain relatively stable over the following 23 months (monthly mean: €622.3). As expected, the majority of these costs are related to in-hospital care (~98% in month 1 post-discharge and ~72% in months 2-24). Patients that died during follow-up were associated with substantially higher cost estimates of in-hospital care than those surviving the two-year study period, while patients' age and other patient characteristics were of minor relevance. Estimated costs of outpatient care are lower at month 1 than during the rest of the study period, and not affected by the event of death during follow-up. The estimated costs of nursing care are, in contrast, much higher in year 2 than in year 1 and differ substantially by gender and type of procedure as well as by patients' age. Overall, these monthly cost estimates add up to €10,352 for the first and €7467.6 for the second year post-discharge. Substantial cost increases at month 1 post-discharge and in case of death during follow-up are the main findings of the study, which should be taken into account in future economic evaluations on the topic. Application of standardized unit costs in combination with monthly patient interviews allows for a far more precise estimate of the variability in post-discharge health service utilization in this group of patients than the ones given in previous studies. German Clinical Trial Register Nr. DRKS00000797 .

Production cost analysis of Euphorbia lathyris. Final report

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

Mendel, D.A.; Schooley, F.A.; Dickenson, R.L.

1979-08-01

The purpose of SRI's study was to estimate the costs of producing Euphorbia in commercial quantities in five regions of the United States, which include both irrigated and nonirrigated areas. The study assumed that a uniform crop yield could be achieved in the five regions by varying the quantities of production inputs. Therefore, the production costs estimates, which are based on fourth quarter 1978 dollars, include both fixed and variable costs for each region. Doane's Machinery Custom Rates for 1978 were used to estimate all variable costs except materials, which were estimated separately. Custom rates are determined by members ofmore » the Doane Countywide Farm Panel, a group of farmers specifically selected to represent the various sizes and types of commercial farms found throughout the country. The rates reported are the most recent rates the panel members had either paid, charged, or known for certain a second party had paid or charged. Custom rates for any particular operation include equipment operating costs (fuel, lubrication, and repairs), equipment ownership costs (depreciation, taxes, interest), as well as a labor charge for the operator. Custom rates are regionally specific and thereby assist the accuracy of this analysis. Fixed costs include land, management, and transportation of the plant material to a conversion facility. When appropriate, fixed costs were regionally specific. Changes in total production costs over future time periods were not addressed. The total estimated production costs of Euphorbia in each region were compared with production costs for corn and alfalfa in the same regions. Finally, the effects on yield and costs of changes in the production inputs were estimated.« less

Immediate financial impact of computerized clinical decision support for long-term care residents with renal insufficiency: a case study.

PubMed

Subramanian, Sujha; Hoover, Sonja; Wagner, Joann L; Donovan, Jennifer L; Kanaan, Abir O; Rochon, Paula A; Gurwitz, Jerry H; Field, Terry S

2012-01-01

In a randomized trial of a clinical decision support system for drug prescribing for residents with renal insufficiency in a large long-term care facility, analyses were conducted to estimate the system's immediate, direct financial impact. We determined the costs that would have been incurred if drug orders that triggered the alert system had actually been completed compared to the costs of the final submitted orders and then compared intervention units to control units. The costs incurred by additional laboratory testing that resulted from alerts were also estimated. Drug orders were conservatively assigned a duration of 30 days of use for a chronic drug and 10 days for antibiotics. It was determined that there were modest reductions in drug costs, partially offset by an increase in laboratory-related costs. Overall, there was a reduction in direct costs (US$1391.43, net 7.6% reduction). However, sensitivity analyses based on alternative estimates of duration of drug use suggested a reduction as high as US$7998.33 if orders for non-antibiotic drugs were assumed to be continued for 180 days. The authors conclude that the immediate and direct financial impact of a clinical decision support system for medication ordering for residents with renal insufficiency is modest and that the primary motivation for such efforts must be to improve the quality and safety of medication ordering.

The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece.

PubMed

Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Tzanakis, Nikos; Toumbis, Michalis; Vassilakopoulos, Theodoros

2017-01-01

COPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece. A Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver's costs were recorded in order to quantify indirect COPD costs. The total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver's costs were estimated at €806 per year. The management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.

Direct and Indirect Costs of Chronic and Episodic Migraine in the United States: A Web-Based Survey.

PubMed

Messali, Andrew; Sanderson, Joanna C; Blumenfeld, Andrew M; Goadsby, Peter J; Buse, Dawn C; Varon, Sepideh F; Stokes, Michael; Lipton, Richard B

2016-02-01

The objective of this study was to compare the societal direct and indirect costs of chronic and episodic migraine in the United States. Episodic and chronic migraine are distinguished by the frequency of headache-days. Chronic migraine has a greater overall impact on quality of life than does episodic migraine. Individuals with chronic migraine also use more healthcare resources (resulting in higher direct costs) and experience greater decreases in productivity (resulting in higher indirect costs) than those with episodic migraine as shown in the American Migraine Prevalence and Prevention (AMPP) Study. The International Burden of Migraine Study utilized a web-based questionnaire to elicit data on several topics related to the burden of migraine illness, including health resource utilization and productivity losses. Potential survey participants were identified by Synovate Healthcare (Chicago, IL, USA) from a pool of registered panelists from various countries. The panelists were screened online to determine eligibility and to identify individuals with migraine (episodic or chronic), based on reported symptoms. Participants from the United States were divided into episodic and chronic migraine groups, based on reported headache-day per month frequency. Direct and indirect costs were estimated by applying estimated unit costs to reported headache-related productivity losses and resource use. Costs were compared between participants with episodic and chronic migraine. Mean [standard deviation] total annual cost of headache among people with chronic migraine ($8243 [$10,646]) was over three times that of episodic migraine ($2649 [$4634], P < .001). Participants with chronic migraine had significantly greater direct medical costs ($4943 [$6382]) and indirect (lost productivity) costs ($3300 [$6907]) than did participants with episodic migraine (direct, $1705 [$3591]; indirect, $943 [$2084]) (P < .001 for each). Unlike previous findings, direct medical costs constituted the majority of total headache-related costs for both chronic migraine (60.0%, $4943 of $8243) and episodic migraine (64.3%, $1705 of $2649) participants. A large portion of direct medical costs are attributable to pharmaceutical utilization among both chronic migraine (80%, $3925 of 4943) and episodic migraine (70%, $1196 of $1705) participants. The results of this study build on previous results of the AMPP Study, demonstrating that headache-related direct, indirect, and total costs are significantly greater among individuals with chronic migraine than with episodic migraine in the United States. © 2016 American Headache Society.

Space Station: Actions Under Way to Manage Cost, but Significant Challenges Remain

DTIC Science & Technology

2002-07-01

GAO United States General Accounting OfficeReport to Congressional CommitteesJuly 2002 SPACE STATION Actions Under Way to Manage Cost , but...because NASA does not have good cost - accounting systems or practices. 1 The estimated cost growth is having a profound effect on the utility of the...SPACE STATION: Actions Under Way to Manage Cost , but Significant Challenges Remain Contract Number Grant Number Program Element Number Author(s

Dairy farm cost efficiency.

PubMed

Tauer, L W; Mishra, A K

2006-12-01

A stochastic cost equation was estimated for US dairy farms using national data from the production year 2000 to determine how farmers might reduce their cost of production. Cost of producing a unit of milk was estimated into separate frontier (efficient) and inefficiency components, with both components estimated as a function of management and causation variables. Variables were entered as impacting the frontier component as well as the efficiency component of the stochastic curve because a priori both components could be impacted. A factor that has an impact on the cost frontier was the number of hours per day the milking facility is used. Using the milking facility for more hours per day decreased frontier costs; however, inefficiency increased with increased hours of milking facility use. Thus, farmers can decrease costs with increased utilization of the milking facility, but only if they are efficient in this strategy. Parlors compared with stanchions used for milking did not decrease frontier costs, but decreased costs because of increased efficiency, as did the use of a nutritionist. Use of rotational grazing decreased frontier costs but also increased inefficiency. Older farmers were less efficient.

Using known populations of pronghorn to evaluate sampling plans and estimators

USGS Publications Warehouse

Kraft, K.M.; Johnson, D.H.; Samuelson, J.M.; Allen, S.H.

1995-01-01

Although sampling plans and estimators of abundance have good theoretical properties, their performance in real situations is rarely assessed because true population sizes are unknown. We evaluated widely used sampling plans and estimators of population size on 3 known clustered distributions of pronghorn (Antilocapra americana). Our criteria were accuracy of the estimate, coverage of 95% confidence intervals, and cost. Sampling plans were combinations of sampling intensities (16, 33, and 50%), sample selection (simple random sampling without replacement, systematic sampling, and probability proportional to size sampling with replacement), and stratification. We paired sampling plans with suitable estimators (simple, ratio, and probability proportional to size). We used area of the sampling unit as the auxiliary variable for the ratio and probability proportional to size estimators. All estimators were nearly unbiased, but precision was generally low (overall mean coefficient of variation [CV] = 29). Coverage of 95% confidence intervals was only 89% because of the highly skewed distribution of the pronghorn counts and small sample sizes, especially with stratification. Stratification combined with accurate estimates of optimal stratum sample sizes increased precision, reducing the mean CV from 33 without stratification to 25 with stratification; costs increased 23%. Precise results (mean CV = 13) but poor confidence interval coverage (83%) were obtained with simple and ratio estimators when the allocation scheme included all sampling units in the stratum containing most pronghorn. Although areas of the sampling units varied, ratio estimators and probability proportional to size sampling did not increase precision, possibly because of the clumped distribution of pronghorn. Managers should be cautious in using sampling plans and estimators to estimate abundance of aggregated populations.

Cost-Effectiveness of Routine Screening for Critical Congenital Heart Disease in US Newborns

PubMed Central

Peterson, Cora; Grosse, Scott D.; Oster, Matthew E.; Olney, Richard S.; Cassell, Cynthia H.

2015-01-01

OBJECTIVES Clinical evidence indicates newborn critical congenital heart disease (CCHD) screening through pulse oximetry is lifesaving. In 2011, CCHD was added to the US Recommended Uniform Screening Panel for newborns. Several states have implemented or are considering screening mandates. This study aimed to estimate the cost-effectiveness of routine screening among US newborns unsuspected of having CCHD. METHODS We developed a cohort model with a time horizon of infancy to estimate the inpatient medical costs and health benefits of CCHD screening. Model inputs were derived from new estimates of hospital screening costs and inpatient care for infants with late-detected CCHD, defined as no diagnosis at the birth hospital. We estimated the number of newborns with CCHD detected at birth hospitals and life-years saved with routine screening compared with no screening. RESULTS Screening was estimated to incur an additional cost of $6.28 per newborn, with incremental costs of $20 862 per newborn with CCHD detected at birth hospitals and $40 385 per life-year gained (2011 US dollars). We estimated 1189 more newborns with CCHD would be identified at birth hospitals and 20 infant deaths averted annually with screening. Another 1975 false-positive results not associated with CCHD were estimated to occur, although these results had a minimal impact on total estimated costs. CONCLUSIONS This study provides the first US cost-effectiveness analysis of CCHD screening in the United States could be reasonably cost-effective. We anticipate data from states that have recently approved or initiated CCHD screening will become available over the next few years to refine these projections. PMID:23918890

COST OF PRIMARY HEALTH CARE IN PAKISTAN.

PubMed

Malik, Muhammad Ashar; Gul, Wahid; Iqbal, Saleem Perwaiz; Abrejo, Farina

2015-01-01

Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan. Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005-06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits to BHUs. Perspective on cost estimates was district-based health planning and management of BHUs. Average recurring cost was PKR.245 (USD 4.1) per OPV to BHU. Staff salaries constituted 90% of recurrent cost. On the average there were 16 OPV per day to the BHUs. CONCLUDION: Recurrent cost per OPV has doubled from the previous estimates of cost of OPV in Baluchistan. The estimated recurrent cost was six times higher than average consultation charges with the private general practitioner (GP) in the country (i.e., PKR 50/ GP consultation). Performance of majority of the BHUs was much lower than the performance target (50 patients per day) set in the sixth five-year plan of the government of Pakistan. The Government of Pakistan may use these analyses to revisit the performance target, staffinL and location of BHUs.

Cost effectiveness of recombinant activated factor VII for the control of bleeding in patients with severe blunt trauma injuries in the United Kingdom.

PubMed

Morris, S; Ridley, S; Munro, V; Christensen, M C

2007-01-01

The aim of this study was to assess the lifetime cost effectiveness of recombinant activated factor VII vs placebo as adjunctive therapy for control of bleeding in patients with severe blunt trauma in the UK. We developed a cost-effectiveness model based on patient level data from a 30-day international, randomised, placebo-controlled Phase II trial. The data were supplemented with secondary data from UK sources to estimate lifetime costs and benefits. The model produced a baseline estimate of the incremental cost per life year gained with recombinant activated factor VII relative to placebo of 12 613 UK pounds. The incremental cost per quality adjusted life year gained was 18 825 UK pounds. These estimates are sensitive to the choice of discount rate and health state utility values used. Preliminary results suggest that relative to placebo, recombinant activated factor VII may be a cost-effective therapy to the UK National Health Service.

The economics of treatment for infants with respiratory distress syndrome.

PubMed

Neil, N; Sullivan, S D; Lessler, D S

1998-01-01

To define clinical outcomes and prevailing patterns of care for the initial hospitalization of infants at greatest risk for respiratory distress syndrome (RDS); to estimate direct medical care costs associated with the initial hospitalization; and to introduce and demonstrate a simulation technique for the economic evaluation of health care technologies. Clinical outcomes and usual-care algorithms were determined for infants with RDS in three birthweight categories (500-1,000g; >1,000-1,500g; and >1,500g) using literature- and expert-panel-based data. The experts were practitioners from major U.S. hospitals who were directly involved in the clinical care of such infants. Using the framework derived from the usual care patterns and outcomes, the authors developed an itemized "micro-costing" economic model to simulate the costs associated with the initial hospitalization of a hypothetical RDS patient. The model is computerized and dynamic; unit costs, frequencies, number of days, probabilities and population multipliers are all variable and can be modified on the basis of new information or local conditions. Aggregated unit costs are used to estimate the expected medical costs of treatment per patient. Expected costs of initial hospitalization per uncomplicated surviving infant with RDS were estimated to be $101,867 for 500-1,000g infants; $64,524 for >1,000-1,500g infants; and $27,224 for >1,500g infants. Incremental costs of complications among survivors were estimated to be $22,155 (500-1,000g); $11,041 (>1,000-1,500g); and $2,448 (>1,500 g). Expected costs of initial hospitalization per case (including non-survivors) were $100,603; $72,353; and $28,756, respectively. An itemized model such as the one developed here serves as a benchmark for the economic assessment of treatment costs and utilization. Moreover, it offers a powerful tool for the prospective evaluation of new technologies or procedures designed to reduce the incidence of, severity of, and/or total hospital resource use ascribed to RDS.

National estimated costs of never events following radical prostatectomy.

PubMed

Deibert, Christopher M; Kates, Max; McKiernan, James M; Spencer, Benjamin A

2015-09-01

To examine the Centers for Medicare and Medicaid Services, which since 2008 has identified and not reimbursed 10 common postoperative complications deemed "never events" or hospital-acquired conditions (HACs). Prostate cancer, the most frequent cancer among U.S. men, is most often treated with radical prostatectomy (RP). Therefore, its complications in total may represent significant costs to hospitals and providers if not reimbursed. We evaluated the potential effect of these unreimbursed HACs following RP on clinical outcomes and costs. Using the Nationwide Inpatient Sample, we selected a weighed, national, estimated sample of 451,707 men with prostate cancer who underwent RP between 2002 and 2009. Baseline sociodemographic and hospital characteristics are described. We calculated estimated frequencies and costs of HACs and the predictors of in-hospital mortality, prolonged length of stay, and increased total hospital costs. Overall, HACs were infrequent at 0.08%, with pressure ulcer development (0.02%) and foreign object retained at surgery (0.02%) being the most common. HAC occurrence was not affected by hospital teaching status or surgical volume, but larger hospital size was related to more HACs. Those experiencing an HAC were much more likely to have a prolonged length of stay (odds ratio = 6.68, 95% CI: 5.34-8.36) and increased hospital costs (odds ratio = 5.03, 95% CI: 4.05-6.24). HACs after RP cost an estimated nearly $1 million annually in the United States. In a robust sample of patients who underwent RP in the United States, HACs were very uncommon and contributed approximately $1 million in additional expenditures. As the U.S. government continues to expand quality improvement programs and develop incentives to avoid complications, efforts to monitor unnecessary complications should continue as well. Copyright © 2015. Published by Elsevier Inc.

Estimating the Economic Potential of Offshore Wind in the United States

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

Beiter, P.; Musial, W.; Smith, A.

The potential for cost reduction and market deployment for offshore wind varies considerably within the United States. This analysis estimates the future economic viability of offshore wind at more than 7,000 sites under a variety of electric sector and cost reduction scenarios. Identifying the economic potential of offshore wind at a high geospatial resolution can capture the significant variation in local offshore resource quality, costs, and revenue potential. In estimating economic potential, this article applies a method initially developed in Brown et al. (2015) to offshore wind and estimates the sensitivity of results under a variety of most likely electricmore » sector scenarios. For the purposes of this analysis, a theoretical framework is developed introducing a novel offshore resource classification system that is analogous to established resource classifications from the oil and gas sector. Analyzing economic potential within this framework can help establish a refined understanding across industries of the technology and site-specific risks and opportunities associated with future offshore wind development. The results of this analysis are intended to inform the development of the U.S. Department of Energy's offshore wind strategy.« less

Using Top‐down and Bottom‐up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale

PubMed Central

Sinanovic, Edina; Ramma, Lebogang; Foster, Nicola; Berrie, Leigh; Stevens, Wendy; Molapo, Sebaka; Marokane, Puleng; McCarthy, Kerrigan; Churchyard, Gavin; Vassall, Anna

2016-01-01

Abstract Purpose Estimating the incremental costs of scaling‐up novel technologies in low‐income and middle‐income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low‐income and middle‐income countries, using the example of costing the scale‐up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. Materials and methods We estimate costs, by applying two distinct approaches of bottom‐up and top‐down costing, together with an assessment of processes and capacity. Results The unit costs measured using the different methods of bottom‐up and top‐down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. Conclusion Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource‐use data collected from a bottom‐up or top‐down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce. PMID:26763594

Using Top-down and Bottom-up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale.

PubMed

Cunnama, Lucy; Sinanovic, Edina; Ramma, Lebogang; Foster, Nicola; Berrie, Leigh; Stevens, Wendy; Molapo, Sebaka; Marokane, Puleng; McCarthy, Kerrigan; Churchyard, Gavin; Vassall, Anna

2016-02-01

Estimating the incremental costs of scaling-up novel technologies in low-income and middle-income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low-income and middle-income countries, using the example of costing the scale-up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. We estimate costs, by applying two distinct approaches of bottom-up and top-down costing, together with an assessment of processes and capacity. The unit costs measured using the different methods of bottom-up and top-down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource-use data collected from a bottom-up or top-down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

Airborne Warning and Control System Block 40/45 Upgrade (AWACS Blk 40/45 Upgrade)

DTIC Science & Technology

2013-12-01

MILCON - Military Construction N /A - Not Applicable O&S - Operating and Support Oth - Other PAUC - Program Acquisition Unit Cost PB - President’s...and Evaluation SAR - Selected Acquisition Report Sch - Schedule Spt - Support TBD - To Be Determined TY - Then Year UCR - Unit Cost Reporting AWACS Blk...Objective and Threshold, and Current Estimate for IOT&E milestone have been corrected from June 2011 to June 2012, to reflect the actual date of

Suicide and Suicidal Attempts in the United States: Costs and Policy Implications.

PubMed

Shepard, Donald S; Gurewich, Deborah; Lwin, Aung K; Reed, Gerald A; Silverman, Morton M

2016-06-01

The national cost of suicides and suicide attempts in the United States in 2013 was $58.4 billion based on reported numbers alone. Lost productivity (termed indirect costs) represents most (97.1%) of this cost. Adjustment for under-reporting increased the total cost to $93.5 billion or $298 per capita, 2.1-2.8 times that of previous studies. Previous research suggests that improved continuity of care would likely reduce the number of subsequent suicidal attempts following a previous nonfatal attempt. We estimate a highly favorable benefit-cost ratio of 6 to 1 for investments in additional medical, counseling, and linkage services for such patients. © 2015 The Authors. Suicide and LifeThreatening Behavior published by Wiley Periodicals, Inc. on behalf of American Association of Suicidology.

ABC estimation of unit costs for emergency department services.

PubMed

Holmes, R L; Schroeder, R E

1996-04-01

Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.

Cost analysis of DAWT innovative wind energy systems

NASA Astrophysics Data System (ADS)

Foreman, K. M.

The results of a diffuser augmented wind turbine (DAWT) preliminary design study of three constructional material approaches and cost analysis of DAWT electrical energy generation are presented. Costs are estimated assuming a limited production run (100 to 500 units) of factory-built subassemblies and on-site final assembly and erection within 200 miles of regional production centers. It is concluded that with the DAWT the (busbar) cost of electricity (COE) can range between 2.0 and 3.5 cents/kW-hr for farm and REA cooperative end users, for sites with annual average wind speeds of 16 and 12 mph respectively, and 150 kW rated units. No tax credit incentives are included in these figures. For commercial end users of the same units and site characteristics, the COE ranges between 4.0 and 6.5 cents/kW-hr.

Design study of wind turbines 50 kW to 3000 kW for electric utility applications. Volume 2: Analysis and design

NASA Technical Reports Server (NTRS)

1976-01-01

All possible overall system configurations, operating modes, and subsystem concepts for a wind turbine configuration for cost effective generation of electrical power were evaluated for both technical feasibility and compatibility with utility networks, as well as for economic attractiveness. A design optimization computer code was developed to determine the cost sensitivity of the various design features, and thus establish the configuration and design conditions that would minimize the generated energy costs. The preliminary designs of both a 500 kW unit and a 1500 kW unit operating in a 12 mph and 18 mph median wind speed respectively, were developed. The various design features and components evaluated are described, and the rationale employed to select the final design configuration is given. All pertinent technical performance data and component cost data is included. The costs of all major subassemblies are estimated and the resultant energy costs for both the 500 kW and 1500 kW units are calculated.

A synthesis of regional inputs and damage costs of reactive nitrogen in the United States

EPA Science Inventory

We estimated the fate of N in crops and in the environment (air, land, freshwater, groundwater, and coastal zones) with published coefficients describing nutrient uptake efficiency, gaseous emissions, and leaching losses. Benefits and damage costs of anthropogenic N inputs were ...

Economic considerations of breeding for polled dairy cows versus dehorning in the United States

USDA-ARS?s Scientific Manuscript database

Dairy producers today face labor, equipment, and medical costs associated with dehorning heifers. Further, complications requiring veterinary intervention occur with some probability. The objective of this work is to develop preliminary cost estimates of selecting for polled dairy heifers. Stochasti...

A Spatial-Economic Cost-Reduction Pathway Analysis for U.S. Offshore Wind Energy Development from 2015-2030

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

Beiter, Philipp; Stehly, Tyler

The potential for cost reduction and economic viability for offshore wind varies considerably within the United States. This analysis models the cost impact of a range of offshore wind locational cost variables across more than 7,000 potential coastal sites in the United States' offshore wind resource area. It also assesses the impact of over 50 technology innovations on potential future costs between 2015 and 2027 (Commercial Operation Date) for both fixed-bottom and floating wind systems. Comparing these costs to an initial assessment of local avoided generating costs, this analysis provides a framework for estimating the economic potential for offshore wind.more » Analyzing economic potential within this framework can help establish a refined understanding across industries of the technology and site-specific risks and opportunities associated with future offshore wind development. The findings from the original report indicate that under the modeled scenario, offshore wind can be expected to achieve significant cost reductions and may approach economic viability in some parts of the United States within the next 15 years.« less

Cost of skeletal complications from bone metastases in six European countries.

PubMed

Pereira, J; Body, J-J; Gunther, O; Sleeboom, H; Hechmati, G; Maniadakis, N; Terpos, E; Acklin, Y P; Finek, J; von Moos, R

2016-06-01

Objective Patients with bone metastases or lesions secondary to solid tumors or multiple myeloma often experience bone complications (skeletal-related events [SREs]-radiation to bone, pathologic fracture, surgery to bone, and spinal cord compression); however, recent data that can be used to assess the value of treatments to prevent SREs across European countries are limited. This study aimed to provide estimates of health resource utilization (HRU) and cost associated with all SRE types in Europe. HRU data were reported previously; cost data are reported herein. Methods Eligible patients from 49 centers across Austria (n = 57), the Czech Republic (n = 59), Finland (n = 60), Greece (n = 59), Portugal (n = 59), and Sweden (n = 62) had bone metastases or lesions secondary to breast, lung, or prostate cancer, or multiple myeloma, and ≥1 index SRE (a SRE preceded by a SRE-free period of ≥ 6.5 months). SRE-related costs were estimated from a payer perspective using health resource utilization data from patient charts (before and after the index SRE diagnosis). Country-specific unit costs were from 2010 and local currencies were converted to 2010 euros. Results The mean costs across countries were €7043, €5242, €11,101, and €11,509 per radiation to bone, pathologic fracture, surgery to bone, and spinal cord compression event, respectively. Purchasing power parity (PPP)-adjusted mean cost ratios were similar in most countries, with the exception of radiation to bone. Limitations The overall burden of SREs may have been under-estimated owing to home visits and evaluations outside the hospital setting not being reported here. Conclusions All SREs were associated with substantial costs. Variation in SRE-associated costs between countries was most likely driven by differences in treatment practices and unit costs.

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

PubMed Central

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

2000-01-01

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

Testing the convergent validity of the contingent valuation and travel cost methods in valuing the benefits of health care.

PubMed

Clarke, Philip M

2002-03-01

In this study, the convergent validity of the contingent valuation method (CVM) and travel cost method (TCM) is tested by comparing estimates of the willingness to pay (WTP) for improving access to mammographic screening in rural areas of Australia. It is based on a telephone survey of 458 women in 19 towns, in which they were asked about their recent screening behaviour and their WTP to have a mobile screening unit visit their nearest town. After eliminating missing data and other non-usable responses the contingent valuation experiment and travel cost model were based on information from 372 and 319 women, respectively. Estimates of the maximum WTP for the use of mobile screening units were derived using both methods and compared. The highest mean WTP estimated using the TCM was $83.10 (95% C.I. $99.06-$68.53), which is significantly less than the estimate of $148.09 ($131.13-$166.60) using the CVM. This could be due to the CVM estimates also reflecting non-use values such as altruism, or a range of potential biases that are known to affect both methods. Further tests of validity are required in order to gain a greater understanding of the relationship between these two methods of estimating WTP. Copyright 2001 John Wiley & Sons, Ltd.

Prioritizing food safety and research

USDA-ARS?s Scientific Manuscript database

Recent publications have revealed that approximately 48 million individuals in the the United States of America contract foodborne illnesses each year, with associated costs estimated at $77.7 billion U.S. dollars (equivalent to ca. 87.5 trillion Korean won in the year 2012). The United States Depa...

Lost productivity due to premature mortality in developed and emerging countries: an application to smoking cessation.

PubMed

Menzin, Joseph; Marton, Jeno P; Menzin, Jordan A; Willke, Richard J; Woodward, Rebecca M; Federico, Victoria

2012-06-25

Researchers and policy makers have determined that accounting for productivity costs, or "indirect costs," may be as important as including direct medical expenditures when evaluating the societal value of health interventions. These costs are also important when estimating the global burden of disease. The estimation of indirect costs is commonly done on a country-specific basis. However, there are few studies that evaluate indirect costs across countries using a consistent methodology. Using the human capital approach, we developed a model that estimates productivity costs as the present value of lifetime earnings (PVLE) lost due to premature mortality. Applying this methodology, the model estimates productivity costs for 29 selected countries, both developed and emerging. We also provide an illustration of how the inclusion of productivity costs contributes to an analysis of the societal burden of smoking. A sensitivity analysis is undertaken to assess productivity costs on the basis of the friction cost approach. PVLE estimates were higher for certain subpopulations, such as men, younger people, and people in developed countries. In the case study, productivity cost estimates from our model showed that productivity loss was a substantial share of the total cost burden of premature mortality due to smoking, accounting for over 75 % of total lifetime costs in the United States and 67 % of total lifetime costs in Brazil. Productivity costs were much lower using the friction cost approach among those of working age. Our PVLE model is a novel tool allowing researchers to incorporate the value of lost productivity due to premature mortality into economic analyses of treatments for diseases or health interventions. We provide PVLE estimates for a number of emerging and developed countries. Including productivity costs in a health economics study allows for a more comprehensive analysis, and, as demonstrated by our illustration, can have important effects on the results and conclusions.

Lost productivity due to premature mortality in developed and emerging countries: an application to smoking cessation

PubMed Central

2012-01-01

Background Researchers and policy makers have determined that accounting for productivity costs, or “indirect costs,” may be as important as including direct medical expenditures when evaluating the societal value of health interventions. These costs are also important when estimating the global burden of disease. The estimation of indirect costs is commonly done on a country-specific basis. However, there are few studies that evaluate indirect costs across countries using a consistent methodology. Methods Using the human capital approach, we developed a model that estimates productivity costs as the present value of lifetime earnings (PVLE) lost due to premature mortality. Applying this methodology, the model estimates productivity costs for 29 selected countries, both developed and emerging. We also provide an illustration of how the inclusion of productivity costs contributes to an analysis of the societal burden of smoking. A sensitivity analysis is undertaken to assess productivity costs on the basis of the friction cost approach. Results PVLE estimates were higher for certain subpopulations, such as men, younger people, and people in developed countries. In the case study, productivity cost estimates from our model showed that productivity loss was a substantial share of the total cost burden of premature mortality due to smoking, accounting for over 75 % of total lifetime costs in the United States and 67 % of total lifetime costs in Brazil. Productivity costs were much lower using the friction cost approach among those of working age. Conclusions Our PVLE model is a novel tool allowing researchers to incorporate the value of lost productivity due to premature mortality into economic analyses of treatments for diseases or health interventions. We provide PVLE estimates for a number of emerging and developed countries. Including productivity costs in a health economics study allows for a more comprehensive analysis, and, as demonstrated by our illustration, can have important effects on the results and conclusions. PMID:22731620

Time-driven activity-based costing of multivessel coronary artery bypass grafting across national boundaries to identify improvement opportunities: study protocol

PubMed Central

Erhun, F; Mistry, B; Platchek, T; Milstein, A; Narayanan, V G; Kaplan, R S

2015-01-01

Introduction Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease—a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32 201±$23 059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery. Methods and analysis We use time-driven activity-based costing (TDABC) to quantify the hospitals’ costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA. Ethics and dissemination All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings. PMID:26307621

Can Low-income Americans Afford to Satisfy MyPyramid Fruit and Vegetable Guidelines?

ERIC Educational Resources Information Center

Stewart, Hayden; Hyman, Jeffrey; Frazao, Elizabeth; Buzby, Jean C.; Carlson, Andrea

2011-01-01

Objective: To estimate the costs of satisfying MyPyramid fruit and vegetable guidelines, with a focus on whether low-income households can bear these costs. Design: Descriptive analysis of the 2008 National Consumer Panel with information on the food purchases of 64,440 households across the contiguous United States was used to analyze the cost of…

10 CFR Appendix E to Part 30 - Criteria Relating to Use of Financial Tests and Self-Guarantee For Providing Reasonable Assurance...

Code of Federal Regulations, 2013 CFR

2013-01-01

... guarantee that funds will be available for decommissioning costs and on a demonstration that the applicant... United States of at least $50 million, or at least 30 times the total current decommissioning cost... current decommissioning cost estimate (or the current amount required if certification is used) for all...

10 CFR Appendix E to Part 30 - Criteria Relating to Use of Financial Tests and Self-Guarantee For Providing Reasonable Assurance...

Code of Federal Regulations, 2014 CFR

2014-01-01

... guarantee that funds will be available for decommissioning costs and on a demonstration that the applicant... United States of at least $50 million, or at least 30 times the total current decommissioning cost... current decommissioning cost estimate (or the current amount required if certification is used) for all...

Land Warrior (LW)/Mounted Warrior (MW) DOTMLPF Assessment

DTIC Science & Technology

2007-06-01

the DOTMLPF impacts of equipping a Stryker battalion with MW and LW? 3) What is the estimated life cycle cost (LCC) of each LW BOIP alternative? 4...A R E D A T A Assessed costs included: - Support Equipment/Disposal. - Contractor Logistics Support. - Ensemble Hardware...DOTMLPF . 3 - Cost . LUT Navigation Experiment Lethality Experiment AMSAA TRAC-WSMR TRAC-WSMR ATEC LW Test Unit

[Cost-effectiveness of female sex worker interventions by using SEX 2.0 Tool in Dehong prefecture, Yunnan province].

PubMed

Guo, Hao-yan; Duan, Song; Xiang, Li-fen; Ye, Run-hua; Yang, Yue-cheng; Zhang, Hua; Yuan, Jian-hua; Cao, Wei-hua; Xing, Yan; Sun, Jiang-ping

2010-08-01

To perform cost-effectiveness analysis of interventions in female sex workers in Dehong prefecture in China, with an aim of providing evidence for rational resource allocation in female sex worker interventions in the future. The data of expenses for female sex worker interventions in Dehong from 2005 - 2007 were obtained through questionnaire survey. Meanwhile, the data from baseline survey in 2004, from surveillance of female sex workers from 2005 through 2007 as well as from the special survey on sexual transmission in 2007 were collected. Intervention effectiveness was estimated by using SEX 2.0 Tool recommended by UNAIDS. The cost-effectiveness ratio is calculated as the total cost divided by the number of estimated non-HIV patients due to these interventions. The total cost for female sex worker interventions is 916 400 RMB from 2005 through 2007, and a total of 3297 female sex workers were effectively intervened in these three years. Thus, the actual intervention cost for each female sex worker (unit cost) is 277.9 RMB. If all the intervention work is performed as required, the predicted unit cost for female sex worker intervention would be 500.5 RMB. During the period of 2005 through 2007, 69 female sex workers had been successfully prevented from HIV infection; therefore, the cost-effectiveness ratio is 13 282 RMB. Intervention among female sex workers is highly cost-effective.

Grid impacts of wind power: a summary of recent studies in the United States

NASA Astrophysics Data System (ADS)

Parsons, Brian; Milligan, Michael; Zavadil, Bob; Brooks, Daniel; Kirby, Brendan; Dragoon, Ken; Caldwell, Jim

2004-04-01

Several detailed technical investigations of grid ancillary service impacts of wind power plants in the United States have recently been performed. These studies were applied to Xcel Energy (in Minnesota) and PacifiCorp and the Bonneville Power Administration (both in the northwestern United States). Although the approaches vary, three utility time frames appear to be most at issue: regulation, load following and unit commitment. This article describes and compares the analytic frameworks from recent analysis and discusses the implications and cost estimates of wind integration. The findings of these studies indicate that relatively large-scale wind generation will have an impact on power system operation and costs, but these impacts and costs are relatively low at penetration rates that are expected over the next several years. Published in 2004 by John Wiley & Sons, Ltd.

A Cost Analysis of Colonoscopy using Microcosting and Time-and-motion Techniques

PubMed Central

Ness, Reid M.; Stiles, Renée A.; Shintani, Ayumi K.; Dittus, Robert S.

2007-01-01

Background The cost of an individual colonoscopy is an important determinant of the overall cost and cost-effectiveness of colorectal cancer screening. Published cost estimates vary widely and typically report institutional costs derived from gross-costing methods. Objective Perform a cost analysis of colonoscopy using micro-costing and time-and-motion techniques to determine the total societal cost of colonoscopy, which includes direct health care costs as well as direct non-health care costs and costs related to patients’ time. The design is prospective cohort. The participants were 276 contacted, eligible patients who underwent colonoscopy between July 2001 and June 2002, at either a Veterans’ Affairs Medical Center or a University Hospital in the Southeastern United States. Major results The median direct health care cost for colonoscopy was $379 (25%, 75%; $343, $433). The median direct non-health care and patient time costs were $226 (25%, 75%; $187, $323) and $274 (25%, 75%; $186, $368), respectively. The median total societal cost of colonoscopy was $923 (25%, 75%; $805, $1047). The median direct health care, direct non-health care, patient time costs, and total costs at the VA were $391, $288, $274, and $958, respectively; analogous costs at the University Hospital were $376, $189, $368, and $905, respectively. Conclusion Microcosting techniques and time-and-motion studies can produce accurate, detailed cost estimates for complex medical interventions. Cost estimates that inform health policy decisions or cost-effectiveness analyses should use total costs from the societal perspective. Societal cost estimates, which include patient and caregiver time costs, may affect colonoscopy screening rates. PMID:17665271

Estimating patient time costs associated with colorectal cancer care.

PubMed

Yabroff, K Robin; Warren, Joan L; Knopf, Kevin; Davis, William W; Brown, Martin L

2005-07-01

Nonmedical costs of care, such as patient time associated with travel to, waiting for, and seeking medical care, are rarely measured systematically with population-based data. The purpose of this study was to estimate patient time costs associated with colorectal cancer care. We identified categories of key medical services for colorectal cancer care and then estimated patient time associated with each service category using data from national surveys. To estimate average service frequencies for each service category, we used a nested case control design and SEER-Medicare data. Estimates were calculated by phase of care for cases and controls, using data from 1995 to 1998. Average service frequencies were then combined with estimates of patient time for each category of service, and the value of patient time assigned. Net patient time costs were calculated for each service category, summarized by phase of care, and compared with previously reported net direct costs of colorectal cancer care. Net patient time costs for the 3 phases of colorectal cancer care averaged dollar 4592 (95% confidence interval [CI] dollar 4427-4757) over the 12 months of the initial phase, dollar 2788 (95% CI dollar 2614-2963) over the 12 months of the terminal phase, and dollar 25 (95% CI: dollar 23-26) per month in the continuing phase of care. Hospitalizations accounted for more than two thirds of these estimates. Patient time costs were 19.3% of direct medical costs in the initial phase, 15.8% in the continuing phase, and 36.8% in the terminal phase of care. Patient time costs are an important component of the costs of colorectal cancer care. Application of this method to other tumor sites and inclusion of other components of the costs of medical care will be important in delineating the economic burden of cancer in the United States.

A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme.

PubMed

Brunelli, Alessandro; Tentzeris, Vasileios; Sandri, Alberto; McKenna, Alexandra; Liew, Shan Liung; Milton, Richard; Chaudhuri, Nilanjan; Kefaloyannis, Emmanuel; Papagiannopoulos, Kostas

2016-05-01

To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme. Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department. Baseline and surgical variables were tested for a possible association with total cost using a multivariable linear regression and bootstrap analyses. Costs were calculated in GBP and expressed in Euros (EUR:GBP exchange rate 1.4). The average total cost of a VATS lobectomy was €11 368 (range €6992-€62 535). Average intraoperative (including surgical and anaesthetic time, overhead, disposable materials) and postoperative costs [including ward stay, high dependency unit (HDU) or intensive care unit (ICU) and variable costs associated with management of complications] were €8226 (range €5656-€13 296) and €3029 (range €529-€51 970), respectively. The following variables remained reliably associated with total costs after linear regression analysis and bootstrap: carbon monoxide lung diffusion capacity (DLCO) <60% predicted value (P = 0.02, bootstrap 63%) and chronic obstructive pulmonary disease (COPD; P = 0.035, bootstrap 57%). The following model was developed to estimate the total costs: 10 523 + 1894 × COPD + 2376 × DLCO < 60%. The comparison between predicted and observed costs was repeated in 1000 bootstrapped samples to verify the stability of the model. The two values were not different (P > 0.05) in 86% of the samples. A hypothetical patient with COPD and DLCO less than 60% would cost €4270 more than a patient without COPD and with higher DLCO values (€14 793 vs €10 523). Risk-adjusting financial data can help estimate the total cost associated with VATS lobectomy based on clinical factors. This model can be used to audit the internal financial performance of a VATS lobectomy programme for budgeting, planning and for appropriate bundled payment reimbursements. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction.

PubMed

Gaziano, Thomas A; Fonarow, Gregg C; Claggett, Brian; Chan, Wing W; Deschaseaux-Voinet, Celine; Turner, Stuart J; Rouleau, Jean L; Zile, Michael R; McMurray, John J V; Solomon, Scott D

2016-09-01

The angiotensin receptor neprilysin inhibitor sacubitril/valsartan was associated with a reduction in cardiovascular mortality, all-cause mortality, and hospitalizations compared with enalapril. Sacubitril/valsartan has been approved for use in heart failure (HF) with reduced ejection fraction in the United States and cost has been suggested as 1 factor that will influence the use of this agent. To estimate the cost-effectiveness of sacubitril/valsartan vs enalapril in the United States. Data from US adults (mean [SD] age, 63.8 [11.5] years) with HF with reduced ejection fraction and characteristics similar to those in the PARADIGM-HF trial were used as inputs for a 2-state Markov model simulated HF. Risks of all-cause mortality and hospitalization from HF or other reasons were estimated with a 30-year time horizon. Quality of life was based on trial EQ-5D scores. Hospital costs combined Medicare and private insurance reimbursement rates; medication costs included the wholesale acquisition cost for sacubitril/valsartan and enalapril. A discount rate of 3% was used. Sensitivity analyses were performed on key inputs including: hospital costs, mortality benefit, hazard ratio for hospitalization reduction, drug costs, and quality-of-life estimates. Hospitalizations, quality-adjusted life-years (QALYs), costs, and incremental costs per QALY gained. The 2-state Markov model of US adult patients (mean age, 63.8 years) calculated that there would be 220 fewer hospital admissions per 1000 patients with HF treated with sacubitril/valsartan vs enalapril over 30 years. The incremental costs and QALYs gained with sacubitril/valsartan treatment were estimated at $35 512 and 0.78, respectively, compared with enalapril, equating to an incremental cost-effectiveness ratio (ICER) of $45 017 per QALY for the base-case. Sensitivity analyses demonstrated ICERs ranging from $35 357 to $75 301 per QALY. For eligible patients with HF with reduced ejection fraction, the Markov model calculated that sacubitril/valsartan would increase life expectancy at an ICER consistent with other high-value accepted cardiovascular interventions. Sensitivity analyses demonstrated sacubitril/valsartan would remain cost-effective vs enalapril.

Direct and Indirect Costs of Asthma Management in Greece: An Expert Panel Approach.

PubMed

Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Bakakos, Petros; Toumbis, Michalis; Loukides, Stelios; Vassilakopoulos, Theodoros

2017-01-01

Asthma is a major cause of morbidity and mortality and is associated with significant economic burden worldwide. The objectives of this study were to map current resource use associated with the disease management and to estimate the annual direct and indirect costs per adult patient with asthma. A Delphi panel with seven leading pulmonologists was conducted. A semistructured questionnaire was developed to elicit data on resource use and treatment patterns. Unit costs from official, published sources were subsequently assigned to resource use to estimate direct medical costs. Indirect costs were estimated as number of work loss days. Cost base year was 2015, and the perspective adopted was that of the National Organization of Health Care Services Provision, as well as the societal. Patients with asthma are mainly managed by pulmonologists (71.4%) and secondarily by general practitioners and internists (28.6%). The annual cost of managing exacerbations was estimated at €273.1, while maintenance costs were estimated at €1,100.2 per year. Total costs of managing asthma per patient per year were estimated at €2,281.8, 64.4% of which represented direct medical costs. Of the direct costs, pharmaceutical treatment was the key driver, accounting for 63.9 and 41.2% of direct and total costs, respectively. Direct non-medical costs (patient travel and waiting time) were estimated at €152.3. Indirect costs accounted for 28.9% of total costs. Asthma is a chronic condition, the management of which constrains the already limited Greek health care resources. The increasing prevalence of the disease raises concerns as it could translate per patient costs into a significant burden for the Greek health care system. Thus, the prevention, self-management, and improved quality of care for asthma should find a place in the health policy agenda in Greece.

Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States.

PubMed

Lo, Nathan C; Hotez, Peter J

2017-09-01

Routine childhood vaccination is declining in some regions of the United States due to vaccine hesitancy, which risks the resurgence of many infectious diseases with public health and economic consequences. There are ongoing policy debates on the state and national level, including legislation around nonmedical (personal-belief) exemptions for childhood vaccination and possibly a special government commission on vaccine safety, which may affect vaccine coverage. To estimate the number of measles cases in US children and the associated economic costs under scenarios of different levels of vaccine hesitancy, using the case example of measles, mumps, and rubella (MMR) vaccination and measles. Publicly available data from the US Centers for Disease Control and Prevention were used to simulate county-level MMR vaccination coverage in children (age 2-11 years) in the United States. A stochastic mathematical model was adapted for infectious disease transmission that estimated a distribution for outbreak size as it relates to vaccine coverage. Economic costs per measles case were obtained from the literature. The predicted effects of increasing the prevalence of vaccine hesitancy as well as the removal of nonmedical exemptions were estimated. The model was calibrated to annual measles cases in US children over recent years, and the model prediction was validated using an independent data set from England and Wales. Annual measles cases in the United States and the associated public sector costs. A 5% decline in MMR vaccine coverage in the United States would result in an estimated 3-fold increase in measles cases for children aged 2 to 11 years nationally every year, with an additional $2.1 million in public sector costs. The numbers would be substantially higher if unvaccinated infants, adolescents, and adult populations were also considered. There was variation around these estimates due to the stochastic elements of measles importation and sensitivity of some model inputs, although the trend was robust. This analysis predicts that even minor reductions in childhood vaccination, driven by vaccine hesitancy (nonmedical and personal belief exemptions), will have substantial public health and economic consequences. The results support an urgent need to address vaccine hesitancy in policy dialogues at the state and national level, with consideration of removing personal belief exemptions of childhood vaccination.

Cost-Effectiveness of Ibrutinib Compared With Obinutuzumab With Chlorambucil in Untreated Chronic Lymphocytic Leukemia Patients With Comorbidities in the United Kingdom.

PubMed

Sinha, Richa; Redekop, William Ken

2018-02-01

Ibrutinib shows superiority over obinutuzumab with chlorambucil (G-Clb) in untreated patients with chronic lymphocytic leukemia with comorbidities who cannot tolerate fludarabine-based therapy. However, ibrutinib is relatively more expensive than G-Clb. In this study we evaluated the cost-effectiveness of ibrutinib compared with G-Clb from the United Kingdom (UK) health care perspective. A 3-state semi-Markov model was parameterized to estimate the lifetime costs and benefits associated with ibrutinib compared with G-Clb as first-line treatment. Idelalisib with rituximab was considered as second-line treatment. Unit costs were derived from standard sources, (dis)utilities from UK elicitation studies, progression-free survival, progression, and death from clinical trials, and postprogression survival and background mortality from published sources. Additional analyses included threshold analyses with ibrutinib and idelalisib at various discount rates, and scenario analysis with ibrutinib as second-line treatment after G-Clb. An average gain of 1.49 quality-adjusted life-years (QALYs) was estimated for ibrutinib compared with G-Clb at an average additional cost of £112,835 per patient. To be cost-effective as per the UK thresholds, ibrutinib needs to be discounted at 30%, 40%, and 50% if idelalisib is discounted at 0%, 25%, and 50% respectively. The incremental cost-effectiveness ratio was £75,648 and £-143,279 per QALY gained for the base-case and scenario analyses, respectively. Sensitivity analyses showed the robustness of the results. As per base-case analyses, an adequate discount on ibrutinib is required to make it cost-effective as per the UK thresholds. The scenario analysis substantiates ibrutinib's cost-savings for the UK National Health Services and advocates patient's access to ibrutinib in the UK. Copyright © 2017 Elsevier Inc. All rights reserved.

Reducing the risk of injury from table saw use: the potential benefits and costs of automatic protection.

PubMed

Graham, John D; Chang, Joice

2015-02-01

The use of table saws in the United States is associated with approximately 28,000 emergency department (ED) visits and 2,000 cases of finger amputation per year. This article provides a quantitative estimate of the economic benefits of automatic protection systems that could be designed into new table saw products. Benefits are defined as reduced health-care costs, enhanced production at work, and diminished pain and suffering. The present value of the benefits of automatic protection over the life of the table saw are interpreted as the switch-point cost value, the maximum investment in automatic protection that can be justified by benefit-cost comparison. Using two alternative methods for monetizing pain and suffering, the study finds switch-point cost values of $753 and $561 per saw. These point estimates are sensitive to the values of inputs, especially the average cost of injury. The various switch-point cost values are substantially higher than rough estimates of the incremental cost of automatic protection systems. Uncertainties and future research needs are discussed. © 2014 Society for Risk Analysis.

A cross-sectional study of emergency care utilization and associated costs of violent-related (assault) injuries in the United States.

PubMed

Monuteaux, Michael C; Fleegler, Eric W; Lee, Lois K

2017-08-01

Violent-related (assault) injuries are a leading cause of death and disability in the United States. Many violent injury victims seek treatment in the emergency department (ED). Our objectives were to (1) estimate rates of violent-related injuries evaluated in United States EDs, (2) estimate linear trends in ED visits for violent-related injuries from 2000 to 2010, and (3) to determine the associated health care and work-loss costs. We examined adults 18 years and older from a nationally representative survey (the National Hospital Ambulatory Medical Care Survey) of ED visits, from 2000 to 2010. Violent injury was defined using International Classification of Diseases-9th Rev.-Clinical Modification, diagnosis and mechanism of injury codes. We calculated rates of ED visits for violent injuries. Medical and work-loss costs accrued by these injuries were calculated for 2005, inflation-adjusted to 2011 dollars using the WISQARS Cost of Injury Reports. An annual average of 1.4 million adults were treated for violent injuries in EDs from 2000 to 2010, comprising 1.6% (95% confidence interval, 1.5%-1.6%) of all US adult ED visits. Young adults (18-25 years), men, nonwhites, uninsured or publically insured patients, and those residing in high poverty urban areas were at increased risk for ED visits for violent injury. The 1-year, inflation-adjusted medical and work-loss cost of violent-inflicted injuries in adults in the United States was US $49.5 billion. Violent injuries account for over one million ED visits annually among adults, with no change in rates over the past decade. Young black men are at especially increased risk for ED visits for violent injuries. Overall, violent-related injuries resulted in substantial financial and societal costs. Epidemiological study, level III.

A cross-sectional study of emergency care utilization and associated costs of violent-related (assault) injuries in the United States.

PubMed

Monuteaux, Michael C; Fleegler, Eric W; Lee, Lois K

2017-11-01

Violent-related (assault) injuries are a leading cause of death and disability in the United States. Many violent injury victims seek treatment in the emergency department (ED). Our objectives were to (1) estimate rates of violent-related injuries evaluated in United States EDs, (2) estimate linear trends in ED visits for violent-related injuries from 2000 to 2010, and (3) to determine the associated health care and work-loss costs. We examined adults 18 years and older from a nationally representative survey (the National Hospital Ambulatory Medical Care Survey) of ED visits, from 2000 to 2010. Violent injury was defined using International Classification of Diseases-9th Rev.-Clinical Modification, diagnosis and mechanism of injury codes. We calculated rates of ED visits for violent injuries. Medical and work-loss costs accrued by these injuries were calculated for 2005, inflation-adjusted to 2011 dollars using the WISQARS Cost of Injury Reports. An annual average of 1.4 million adults were treated for violent injuries in EDs from 2000 to 2010, comprising 1.6% (95% confidence interval, 1.5%-1.6%) of all US adult ED visits. Young adults (18-25 years), men, nonwhites, uninsured or publically insured patients, and those residing in high poverty urban areas were at increased risk for ED visits for violent injury. The 1-year, inflation-adjusted medical and work-loss cost of violent-inflicted injuries in adults in the United States was US $49.5 billion. Violent injuries account for over one million ED visits annually among adults, with no change in rates over the past decade. Young black men are at especially increased risk for ED visits for violent injuries. Overall, violent-related injuries resulted in substantial financial and societal costs. Epidemiological study, level III.

Patient navigation for breast and colorectal cancer in 3 community hospital settings: an economic evaluation.

PubMed

Donaldson, Elisabeth A; Holtgrave, David R; Duffin, Renea A; Feltner, Frances; Funderburk, William; Freeman, Harold P

2012-10-01

The Ralph Lauren Cancer Center implemented patient navigation programs in sites across the United States building on the model pioneered by Harold P. Freeman, MD. Patient navigation targets medically underserved with the objective of reducing the time interval between an abnormal cancer finding, diagnostic resolution, and treatment initiation. In this study, the authors assessed the incremental cost effectiveness of adding patient navigation to standard cancer care in 3 community hospitals in the United States. A decision-analytic model was used to assess the cost effectiveness of a colorectal and breast cancer patient navigation program over the period of 1 year compared with standard care. Data sources included published estimates in the literature and primary costs, aggregate patient demographics, and outcome data from 3 patient navigation programs. After 1 year, compared with standard care alone, it was estimated that offering patient navigation with standard care would allow an additional 78 of 959 individuals with an abnormal breast cancer screening and an additional 21 of 411 individuals with abnormal colonoscopies to reach timely diagnostic resolution. Without including medical treatment costs saved, the cost-effectiveness ratio ranged from $511 to $2080 per breast cancer diagnostic resolution achieved and from $1192 to $9708 per colorectal cancer diagnostic resolution achieved. The current results indicated that implementing breast or colorectal cancer patient navigation in community hospital settings in which low-income populations are served may be a cost-effective addition to standard cancer care in the United States. Copyright © 2012 American Cancer Society.

Cost analysis of nursing home registered nurse staffing times.

PubMed

Dorr, David A; Horn, Susan D; Smout, Randall J

2005-05-01

To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.

Estimating Missing Unit Process Data in Life Cycle Assessment Using a Similarity-Based Approach.

PubMed

Hou, Ping; Cai, Jiarui; Qu, Shen; Xu, Ming

2018-05-01

In life cycle assessment (LCA), collecting unit process data from the empirical sources (i.e., meter readings, operation logs/journals) is often costly and time-consuming. We propose a new computational approach to estimate missing unit process data solely relying on limited known data based on a similarity-based link prediction method. The intuition is that similar processes in a unit process network tend to have similar material/energy inputs and waste/emission outputs. We use the ecoinvent 3.1 unit process data sets to test our method in four steps: (1) dividing the data sets into a training set and a test set; (2) randomly removing certain numbers of data in the test set indicated as missing; (3) using similarity-weighted means of various numbers of most similar processes in the training set to estimate the missing data in the test set; and (4) comparing estimated data with the original values to determine the performance of the estimation. The results show that missing data can be accurately estimated when less than 5% data are missing in one process. The estimation performance decreases as the percentage of missing data increases. This study provides a new approach to compile unit process data and demonstrates a promising potential of using computational approaches for LCA data compilation.

United States Foreign Policy in Africa: A Right Approach

DTIC Science & Technology

1990-04-01

a higher cost : Except for two of the platinum group metals (platinum and rhodium), andalusite, and a, specific type of industrial diamornd and grade...Defense Department officials, albeit at a higher cost . The Bureau of Mines report in 1988 estimated the 5-year cumulative direct economic cost of a US...the report understated the economic costs and overstated the ability of other mineral- producing nations to replace South African exports.7 Presently

Low cost solar array project: Experimental process system development unit for producing semiconductor-grade silicon using silane-to-silicon process

NASA Technical Reports Server (NTRS)

1980-01-01

The design, fabrication, and installation of an experimental process system development unit (EPSDU) were analyzed. Supporting research and development were performed to provide an information data base usable for the EPSDU and for technological design and economical analysis for potential scale-up of the process. Iterative economic analyses were conducted for the estimated product cost for the production of semiconductor grade silicon in a facility capable of producing 1000-MT/Yr.

The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey.

PubMed

Malhan, Simten; Pay, Salih; Ataman, Sebnem; Dalkilic, Ediz; Dinc, Ayhan; Erken, Eren; Ertenli, Ihsan; Ertugrul, Esin; Gogus, Feride; Hamuryudan, Vedat; Inanc, Murat; Karaarslan, Yasar; Karadag, Omer; Karakoc, Yuksel; Keskin, Goksal; Kisacik, Bunyamin; Kiraz, Sedat; Oksel, Fahrettin; Oksuz, Ergun; Pirildar, Timur; Sari, Ismail; Soy, Mehmet; Senturk, Taskin; Taylan, Ali

2012-01-01

To determine the direct and indirect costs due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients in Turkey. An expert panel was convened to estimate the direct and indirect costs of care of patients with RA and AS in Turkey. The panel was composed of 22 experts chosen from all national tertiary care rheumatology units (n=53). To calculate direct costs, the medical management of RA and AS patients was estimated using 'cost-of-illness' methodology. To measure indirect costs, the number of days of sick leave, the extent of disability, and the levels of early retirement and early death were also evaluated. Lost productivity costs were calculated using the 'human capital approach', based on the minimum wage. The total annual direct costs were 2,917.03 Euros per RA patient and 3,565.9 Euros for each AS patient. The direct costs were thus substantial, but the indirect costs were much higher because of extensive morbidity and mortality rates. The total annual indirect costs were 7,058.99 Euros per RA patient and 6,989.81 for each AS patient. Thus, the total cost for each RA patient was 9,976.01 Euros and that for an AS patient 10,555.72 Euros, in Turkey. From the societal perspective, both RA and AS have become burden in Turkey. The cost of lost productivity is higher than the medical cost. Another important conclusion is that indirect costs constitute 70% and 66% of total costs in patients with RA and AS, respectively.

The Cost of Universal Health Care in India: A Model Based Estimate

PubMed Central

Prinja, Shankar; Bahuguna, Pankaj; Pinto, Andrew D.; Sharma, Atul; Bharaj, Gursimer; Kumar, Vishal; Tripathy, Jaya Prasad; Kaur, Manmeet; Kumar, Rajesh

2012-01-01

Introduction As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. Methods We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. Results We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18–73) per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%–6.8%) of the GDP for universalizing health care services. Conclusion The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored. PMID:22299038

The cost of asthma in Kuwait.

PubMed

Khadadah, Mousa

2013-01-01

To evaluate the direct costs of treating asthma in Kuwait. Population figures were obtained from the 2005 census and projected to 2008. Treatment profiles were obtained from the Asthma Insights and Reality for the Gulf and Near East (AIRGNE) study. Asthma prevalence and unit cost estimates were based on results from a Delphi technique. These estimates were applied to the total Kuwaiti population aged 5 years and over to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise and the AIRGNE results were used to determine the number of asthma patients managed in government facilities. Direct drug costs were provided by the Ministry of Health. Treatment costs (Kuwaiti dinars, KD) were also calculated using the Delphi exercise and the AIRGNE data. The prevalence of asthma was estimated to be 15% of adults and 18% of children (93,923 adults; 70,158 children). Of these, 84,530 (90%) adults and 58,932 (84.0%) children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest portion of total direct costs (43%), followed by emergency room visits (29%), outpatient visits (21%) and medications (7%). The annual cost of treatment, excluding medications, was KD 29,946,776 (USD 107,076,063) for adults and KD 24,295,439 (USD 86,869,450) for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over KD 58 million (USD 207 million). Asthma costs Kuwait a huge sum of money, though the estimates were conservative because only Kuwaiti nationals were included. Given the high medical expenditures associated with emergency room and inpatient visits, relative to lower medication costs, efforts should be focused on improving asthma control rather than reducing expenditure on procurement of medication. Copyright © 2012 S. Karger AG, Basel.

How Does EIA Estimate Energy Consumption and End Uses in U.S. Homes?

EIA Publications

2011-01-01

The Energy Information Administration (EIA) administers the Residential Energy Consumption Survey (RECS) to a nationally representative sample of housing units. Specially trained interviewers collect energy characteristics on the housing unit, usage patterns, and household demographics. This information is combined with data from energy suppliers to these homes to estimate energy costs and usage for heating, cooling, appliances and other end uses information critical to meeting future energy demand and improving efficiency and building design.

Who Visits a National Park and What do They Get Out of It?: A Joint Visitor Cluster Analysis and Travel Cost Model for Yellowstone National Park

NASA Astrophysics Data System (ADS)

Benson, Charles; Watson, Philip; Taylor, Garth; Cook, Philip; Hollenhorst, Steve

2013-10-01

Yellowstone National Park visitor data were obtained from a survey collected for the National Park Service by the Park Studies Unit at the University of Idaho. Travel cost models have been conducted for national parks in the United States; however, this study builds on these studies and investigates how benefits vary by types of visitors who participate in different activities while at the park. Visitor clusters were developed based on activities in which a visitor participated while at the park. The clusters were analyzed and then incorporated into a travel cost model to determine the economic value (consumer surplus) that the different visitor groups received from visiting the park. The model was estimated using a zero-truncated negative binomial regression corrected for endogenous stratification. The travel cost price variable was estimated using both 1/3 and 1/4 the wage rate to test for sensitivity to opportunity cost specification. The average benefit across all visitor cluster groups was estimated at between 235 and 276 per person per trip. However, per trip benefits varied substantially across clusters; from 90 to 103 for the "value picnickers," to 185-263 for the "backcountry enthusiasts," 189-278 for the "do it all adventurists," 204-303 for the "windshield tourists," and 323-714 for the "creature comfort" cluster group.

Fast Quaternion Attitude Estimation from Two Vector Measurements

NASA Technical Reports Server (NTRS)

Markley, F. Landis; Bauer, Frank H. (Technical Monitor)

2001-01-01

Many spacecraft attitude determination methods use exactly two vector measurements. The two vectors are typically the unit vector to the Sun and the Earth's magnetic field vector for coarse "sun-mag" attitude determination or unit vectors to two stars tracked by two star trackers for fine attitude determination. Existing closed-form attitude estimates based on Wahba's optimality criterion for two arbitrarily weighted observations are somewhat slow to evaluate. This paper presents two new fast quaternion attitude estimation algorithms using two vector observations, one optimal and one suboptimal. The suboptimal method gives the same estimate as the TRIAD algorithm, at reduced computational cost. Simulations show that the TRIAD estimate is almost as accurate as the optimal estimate in representative test scenarios.

Cost of delivering secondary-level health care services through public sector district hospitals in India

PubMed Central

Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

2017-01-01

Background & objectives: Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Methods: Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. Results: The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was 844 (USD 15.5), i; 3481 (USD 64) and 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was 139 (USD 2.5). Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India. PMID:29355142

Time-driven activity-based costing.

PubMed

Kaplan, Robert S; Anderson, Steven R

2004-11-01

In the classroom, activity-based costing (ABC) looks like a great way to manage a company's limited resources. But executives who have tried to implement ABC in their organizations on any significant scale have often abandoned the attempt in the face of rising costs and employee irritation. They should try again, because a new approach sidesteps the difficulties associated with large-scale ABC implementation. In the revised model, managers estimate the resource demands imposed by each transaction, product, or customer, rather than relying on time-consuming and costly employee surveys. This method is simpler since it requires, for each group of resources, estimates of only two parameters: how much it costs per time unit to supply resources to the business's activities (the total overhead expenditure of a department divided by the total number of minutes of employee time available) and how much time it takes to carry out one unit of each kind of activity (as estimated or observed by the manager). This approach also overcomes a serious technical problem associated with employee surveys: the fact that, when asked to estimate time spent on activities, employees invariably report percentages that add up to 100. Under the new system, managers take into account time that is idle or unused. Armed with the data, managers then construct time equations, a new feature that enables the model to reflect the complexity of real-world operations by showing how specific order, customer, and activity characteristics cause processing times to vary. This Tool Kit uses concrete examples to demonstrate how managers can obtain meaningful cost and profitability information, quickly and inexpensively. Rather than endlessly updating and maintaining ABC data,they can now spend their time addressing the deficiencies the model reveals: inefficient processes, unprofitable products and customers, and excess capacity.

Child Care: How Do Military and Civilian Center Costs Compare? United States General Accounting Office Report to Congressional Requesters.

ERIC Educational Resources Information Center

Fagnoni, Cynthia M.

The Department of Defense's (DOD) child development program has been identified as a model for the rest of the nation. To provide a benchmark cost estimate for Congress as it addresses child care issues, this report identifies the objectives of the military child development program, describes its operation, determines the full costs of DOD…

Calibration and Validation of the Sage Software Cost/Schedule Estimating System to United States Air Force Databases

DTIC Science & Technology

1997-09-01

factor values are identified. For SASET, revised cost estimating relationships are provided ( Apgar et al., 1991). A 1991 AFIT thesis by Gerald Ourada...description of the model is a paragraph directly quoted from the user’s manual . This is not to imply that a lack of a thorough analysis indicates...constraints imposed by the system. The effective technology rating is computed from the basic technology rating by the following equation ( Apgar et al., 1991

Economic evaluation of nebulized magnesium sulphate in acute severe asthma in children.

PubMed

Petrou, Stavros; Boland, Angela; Khan, Kamran; Powell, Colin; Kolamunnage-Dona, Ruwanthi; Lowe, John; Doull, Iolo; Hood, Kerry; Williamson, Paula

2014-10-01

The aim of this study was to estimate the cost-effectiveness of nebulized magnesium sulphate (MgSO4) in acute asthma in children from the perspective of the UK National Health Service and personal social services. An economic evaluation was conducted based on evidence from a randomized placebo controlled multi-center trial of nebulized MgSO4 in severe acute asthma in children. Participants comprised 508 children aged 2-16 years presenting to an emergency department or a children's assessment unit with severe acute asthma across thirty hospitals in the United Kingdom. Children were randomly allocated to receive nebulized salbutamol and ipratropium bromide mixed with either 2.5 ml of isotonic MgSO4 or 2.5 ml of isotonic saline on three occasions at 20-min intervals. Cost-effectiveness outcomes were constructed around the Yung Asthma Severity Score (ASS) after 60 min of treatment; whilst cost-utility outcomes were constructed around the quality-adjusted life-year (QALY) metric. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves at alternative cost-effectiveness thresholds for either: (i) a unit reduction in ASS; or (ii) an additional QALY. MgSO4 had a 75.1 percent probability of being cost-effective at a GBP 1,000 (EUR 1,148) per unit decrement in ASS threshold, an 88.0 percent probability of being more effective (in terms of reducing the ASS) and a 36.6 percent probability of being less costly. MgSO4 also had a 67.6 percent probability of being cost-effective at a GBP 20,000 (EUR 22,957) per QALY gained threshold, an 8.5 percent probability of being more effective (in terms of generating increased QALYs) and a 69.1 percent probability of being less costly. Sensitivity analyses showed that the results of the economic evaluation were particularly sensitive to the methods used for QALY estimation. The probability of cost-effectiveness of nebulized isotonic MgSO4, given as an adjuvant to standard treatment of severe acute asthma in children, is less than 70 percent across accepted cost-effectiveness thresholds for an additional QALY.

Continued investigation of solid propulsion economics. Task 1B: Large solid rocket motor case fabrication methods - Supplement process complexity factor cost technique

NASA Technical Reports Server (NTRS)

Baird, J.

1967-01-01

This supplement to Task lB-Large Solid Rocket Motor Case Fabrication Methods supplies additional supporting cost data and discusses in detail the methodology that was applied to the task. For the case elements studied, the cost was found to be directly proportional to the Process Complexity Factor (PCF). The PCF was obtained for each element by identifying unit processes that are common to the elements and their alternative manufacturing routes, by assigning a weight to each unit process, and by summing the weighted counts. In three instances of actual manufacture, the actual cost per pound equaled the cost estimate based on PCF per pound, but this supplement, recognizes that the methodology is of limited, rather than general, application.

75 FR 27385 - Petition for Waiver of Compliance

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... identifying mark, type of car, year built, number of windows and the estimated replacement glazing cost for...'s arguments in favor of relief. United Railroad Historical Society of New Jersey [Docket Number FRA-2010-0079] The United Railroad Historical Society of New Jersey (URHS) of Jackson, New Jersey, has...

48 CFR 252.237-7013 - Instruction to offerors (bulk weight).

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Offers shall be submitted on a unit price per pound of serviced laundry. Unit prices shall include all costs to the Government of providing the service, including pickup and delivery charges. (b) The Contracting Officer will evaluate bids based on the estimated pounds of serviced laundry stated in the...

7 CFR 1753.56 - General.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) The Force Account Proposals (FAPs) are subject to review and approval by RUS. (e) The FAP is approved by RUS on the basis of estimated labor and material costs. The FAP is closed based on the borrower's... by the completed assembly units priced at the unit prices in the approved FAP. (Approved by the...

7 CFR 1753.56 - General.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) The Force Account Proposals (FAPs) are subject to review and approval by RUS. (e) The FAP is approved by RUS on the basis of estimated labor and material costs. The FAP is closed based on the borrower's... by the completed assembly units priced at the unit prices in the approved FAP. (Approved by the...

7 CFR 1753.56 - General.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) The Force Account Proposals (FAPs) are subject to review and approval by RUS. (e) The FAP is approved by RUS on the basis of estimated labor and material costs. The FAP is closed based on the borrower's... by the completed assembly units priced at the unit prices in the approved FAP. (Approved by the...

7 CFR 1753.56 - General.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) The Force Account Proposals (FAPs) are subject to review and approval by RUS. (e) The FAP is approved by RUS on the basis of estimated labor and material costs. The FAP is closed based on the borrower's... by the completed assembly units priced at the unit prices in the approved FAP. (Approved by the...

7 CFR 1753.56 - General.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) The Force Account Proposals (FAPs) are subject to review and approval by RUS. (e) The FAP is approved by RUS on the basis of estimated labor and material costs. The FAP is closed based on the borrower's... by the completed assembly units priced at the unit prices in the approved FAP. (Approved by the...

Comparing Costs of Traditional and Specialty Probation for People With Serious Mental Illness.

PubMed

Skeem, Jennifer L; Montoya, Lina; Manchak, Sarah M

2018-05-15

Specialty mental health probation reduces the likelihood of rearrest for people with mental illness, who are overrepresented in the justice system. This study tested whether specialty probation was associated with lower costs than traditional probation during the two years after placement in probation. A longitudinal, matched study compared costs of behavioral health care and criminal justice contacts among 359 probationers with mental illness at prototypic specialty or traditional agencies. Compared with traditional officers, specialty officers supervised smaller caseloads, established better relationships with supervisees, and participated more in treatment. Participants and officers were interviewed, and administrative databases were integrated to capture service use and criminal justice contacts. Unit costs were attached to these data to estimate costs incurred by each participant over two years. Cost differences were estimated by using machine-learning algorithms combined with targeted maximum-likelihood estimation (TMLE), a double-robust estimator that accounts for associations between confounders and both treatment assignment and outcomes. Specialty probation cost $11,826 (p<.001) less per participant than traditional probation, with overall savings of about 51%. Specialty and traditional probation did not differ in criminal justice costs because the additional costs for supervision of specialty caseloads were offset by reduced recidivism. However, for behavioral health care, specialty probation cost an estimated $14,049 (p<.001) less per client than traditional probation. Greater outpatient costs were more than offset by reduced emergency, inpatient, and residential costs. Well-implemented specialty probation yielded substantial savings-and should be considered in justice reform efforts for people with mental illness.

The economic impact of assisted reproductive technology: a review of selected developed countries.

PubMed

Chambers, Georgina M; Sullivan, Elizabeth A; Ishihara, Osamu; Chapman, Michael G; Adamson, G David

2009-06-01

To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. Comparative policy and economic analysis. Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births.

A cost-effectiveness evaluation of hospital discharge counseling by pharmacists.

PubMed

Chinthammit, Chanadda; Armstrong, Edward P; Warholak, Terri L

2012-04-01

This study estimated the cost-effectiveness of pharmacist discharge counseling on medication-related morbidity in both the high-risk elderly and general US population. A cost-effectiveness decision analytic model was developed using a health care system perspective based on published clinical trials. Costs included direct medical costs, and the effectiveness unit was patients discharged without suffering a subsequent adverse drug event. A systematic review of published studies was conducted to estimate variable probabilities in the cost-effectiveness model. To test the robustness of the results, a second-order probabilistic sensitivity analysis (Monte Carlo simulation) was used to run 10 000 cases through the model sampling across all distributions simultaneously. Pharmacist counseling at hospital discharge provided a small, but statistically significant, clinical improvement at a similar overall cost. Pharmacist counseling was cost saving in approximately 48% of scenarios and in the remaining scenarios had a low willingness-to-pay threshold for all scenarios being cost-effective. In addition, discharge counseling was more cost-effective in the high-risk elderly population compared to the general population. This cost-effectiveness analysis suggests that discharge counseling by pharmacists is quite cost-effective and estimated to be cost saving in over 48% of cases. High-risk elderly patients appear to especially benefit from these pharmacist services.

Estimating the long-term costs of ischemic and hemorrhagic stroke for Australia: new evidence derived from the North East Melbourne Stroke Incidence Study (NEMESIS).

PubMed

Cadilhac, Dominique A; Carter, Rob; Thrift, Amanda G; Dewey, Helen M

2009-03-01

Stroke is associated with considerable societal costs. Cost-of-illness studies have been undertaken to estimate lifetime costs; most incorporating data up to 12 months after stroke. Costs of stroke, incorporating data collected up to 12 months, have previously been reported from the North East Melbourne Stroke Incidence Study (NEMESIS). NEMESIS now has patient-level resource use data for 5 years. We aimed to recalculate the long-term resource utilization of first-ever stroke patients and compare these to previous estimates obtained using data collected to 12 months. Population structure, life expectancy, and unit prices within the original cost-of-illness models were updated from 1997 to 2004. New Australian stroke survival and recurrence data up to 10 years were incorporated, as well as cross-sectional resource utilization data at 3, 4, and 5 years from NEMESIS. To enable comparisons, 1997 costs were inflated to 2004 prices and discounting was standardized. In 2004, 27 291 ischemic stroke (IS) and 4291 intracerebral hemorrhagic stroke (ICH) first-ever events were estimated. Average annual resource use after 12 months was AU$6022 for IS and AU$3977 for ICH. This is greater than the 1997 estimates for IS (AU$4848) and less than those for ICH (previously AU$10 692). The recalculated average lifetime costs per first-ever case differed for IS (AU$57 106 versus AU$52 855 [1997]), but differed more for ICH (AU$49 995 versus AU$92 308 [1997]). Basing lifetime cost estimates on short-term data overestimated the costs for ICH and underestimated those for IS. Patterns of resource use varied by stroke subtype and, overall, the societal cost impact was large.

Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study

PubMed Central

Lee, Kun Yun; Ong, Tiong Kiam; Low, Ee Vien; Liow, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng Bang; Ali, Rosli Mohd; Ismail, Omar; Ahmad, Wan Azman Wan; Said, Mas Ayu; Dahlui, Maznah

2017-01-01

Objectives Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability. Design This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates. Setting Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions. Participants The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded. Primary and secondary outcome measures The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost. Results The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost. Conclusions Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations. Registration Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR). PMID:28552843

Estimating the costs of landslide damage in the United States

USGS Publications Warehouse

Fleming, Robert W.; Taylor, Fred A.

1980-01-01

Landslide damages are one of the most costly natural disasters in the United States. A recent estimate of the total annual cost of landslide damage is in excess of $1 billion {Schuster, 1978}. The damages can be significantly reduced, however, through the combined action of technical experts, government, and the public. Before they can be expected to take action, local governments need to have an appreciation of costs of damage in their areas of responsibility and of the reductions in losses that can be achieved. Where studies of cost of landslide damages have been conducted, it is apparent that {1} costs to the public and private sectors of our economy due to landslide damage are much larger than anticipated; {2} taxpayers and public officials generally are unaware of the magnitude of the cost, owing perhaps to the lack of any centralization of data; and {3} incomplete records and unavailability of records result in lower reported costs than actually were incurred. The U.S. Geological Survey has developed a method to estimate the cost of landslide damages in regional and local areas and has applied the method in three urban areas and one rural area. Costs are for different periods and are unadjusted for inflation; therefore, strict comparisons of data from different years should be avoided. Estimates of the average annual cost of landslide damage for the urban areas studied are $5,900,000 in the San Francisco Bay area; $4,000,000 in Allegheny County, Pa.; and $5,170,000 in Hamilton County, Ohio. Adjusting these figures for the population of each area, the annual cost of damages per capita are $1.30 in the nine-county San Francisco Bay region; $2.50 in Allegheny County, Pa.; and $5.80 in Hamilton County, Ohio. On the basis of data from other sources, the estimated annual damages on a per capita basis for the City of Los Angeles, Calif., are about $1.60. If the costs were available for the damages from landslides in Los Angeles in 1977-78 and 1979-80, the annual per capita costs probably would be much larger. The landslide near the rural community of Manti, Utah, caused an expenditure of about $1,800,000 or about $1,000 per person during the period 1974-76. Because a recurrence for such a landslide cannot be established, it is not possible to develop a meaningful estimate of annual per capita damages. Communities are urged to examine their costs of landslide damage and to evaluate the feasibility of several alternative programs that, for a modest investment, could significantly reduce these losses.

Key cost drivers of pharmaceutical clinical trials in the United States.

PubMed

Sertkaya, Aylin; Wong, Hui-Hsing; Jessup, Amber; Beleche, Trinidad

2016-04-01

The increasing cost of clinical research has significant implications for public health, as it affects drug companies' willingness to undertake clinical trials, which in turn limits patient access to novel treatments. Thus, gaining a better understanding of the key cost drivers of clinical research in the United States is important. The study which is based on a report prepared by Eastern Research Group, Inc., for the US Department of Health and Human Services, examined different factors, such as therapeutic area, patient recruitment, administrative staff, and clinical procedure expenditures, and their contribution to pharmaceutical clinical trial costs in the United States by clinical trial phase. The study used aggregate data from three proprietary databases on clinical trial costs provided by Medidata Solutions. We evaluated per-study costs across therapeutic areas by aggregating detailed (per patient and per site) cost information. We also compared average expenditures on cost drivers with the use of weighted mean and standard deviation statistics. Therapeutic area was an important determinant of clinical trial costs by phase. The average cost of a Phase 1 study conducted at a US site ranged from US$1.4 million (pain and anesthesia) to US$6.6 million (immunomodulation), including estimated site overhead and monitoring costs of the sponsoring organization. A Phase 2 study cost from US$7.0 million (cardiovascular) to US$19.6 million (hematology), whereas a Phase 3 study cost ranged from US$11.5 million (dermatology) to US$52.9 (pain and anesthesia) on average. Across all study phases and excluding estimated site overhead costs and costs for sponsors to monitor the study, the top three cost drivers of clinical trial expenditures were clinical procedure costs (15%-22% of total), administrative staff costs (11%-29% of total), and site monitoring costs (9%-14% of total). The data were from 2004 through 2012 and were not adjusted for inflation. Additionally, the databases used represented a convenience, that is, non-probability, sample and did not allow for statistically valid estimates of cost drivers. Finally, the data were from trials funded by the global pharmaceutical and biotechnology industry only. Hence, our study findings are limited to that segment. Therapeutic area being studied as well as number and types of clinical procedures involved were the key drivers of direct costs in Phase 1 through Phase 3 studies. Research shows that strategies exist for reducing the price tag of some of these major direct cost components. Therefore, to increase clinical trial efficiency and reduce costs, gaining a better understanding of the key direct cost drivers is an important step. © The Author(s) 2016.

Ecosystem services impacts associated with environmental ...

EPA Pesticide Factsheets

Nitrogen release to the environment from human activities can have important and costly impacts on human health, recreation, transportation, fisheries, and ecosystem health. Recent efforts to quantify these damage costs have identified annual damages associated with reactive nitrogen release to the EU and US in the hundreds of billions of US dollars (USD). The general approach used to estimate these damages associated with reactive nitrogen are derived from a variety of methods to estimate economic damages, for example, impacts to human respiratory health in terms of hospital visits and mortality, willingness to pay to improve a water body and costs to replace or treat drinking water systems affected by nitrate or cyanotoxin contamination. These values are then extrapolated to other areas to develop the damage cost estimates that are probably best seen as potential damage costs, particularly for aquatic ecosystems. We seek to provide an additional verification of these potential damages using data assembled by the US EPA for case studies of measured costs of nutrient impacts across the US from 2000-2012. We compare the spatial distribution and the magnitude of these costs with the spatial distribution and magnitude of costs from HUC8 watershed units across the US by Sobota et al. (2015). We anticipate that this analysis will provide a ground truthing of existing damage cost estimates, and continue to support the incorporation of cost and benefit informatio

Cost-Conscious of Anesthesia Physicians: An awareness survey.

PubMed

Hakimoglu, Sedat; Hancı, Volkan; Karcıoglu, Murat; Tuzcu, Kasım; Davarcı, Isıl; Kiraz, Hasan Ali; Turhanoglu, Selim

2015-01-01

Increasing competitive pressure and health performance system in the hospitals result in pressure to reduce the resources allocated. The aim of this study was to evaluate the anesthesiology and intensive care physicians awareness of the cost of the materials used and to determine the factors that influence it. This survey was conducted between September 2012 and September 2013 after the approval of the local ethics committee. Overall 149 anesthetists were included in the study. Participants were asked to estimate the cost of 30 products used by anesthesiology and intensive care units. One hundred forty nine doctors, 45% female and 55% male, participated in this study. Of the total 30 questions the averages of cost estimations were 5.8% accurate estimation, 35.13% underestimation and 59.16% overestimation. When the participants were divided into the different groups of institution, duration of working in this profession and sex, there were no statistically significant differences regarding accurate estimation. However, there was statistically significant difference in underestimation. In underestimation, there was no significant difference between 16-20 year group and >20 year group but these two groups have more price overestimation than the other groups (p=0.031). Furthermore, when all the participants were evaluated there were no significant difference between age-accurate cost estimation and profession time-accurate cost estimation. Anesthesiology and intensive care physicians in this survey have an insufficient awareness of the cost of the drugs and materials that they use. The institution and experience are not effective factors for accurate estimate. Programs for improving the health workers knowledge creating awareness of cost should be planned in order to use the resources more efficiently and cost effectively.

Costs of a work-family intervention: evidence from the work, family, and health network.

PubMed

Barbosa, Carolina; Bray, Jeremy W; Brockwood, Krista; Reeves, Daniel

2014-01-01

To estimate the cost to the workplace of implementing initiatives to reduce work-family conflict. Prospective cost analysis conducted alongside a group-randomized multisite controlled experimental study, using a microcosting approach. An information technology firm. Employees (n = 1004) and managers (n = 141) randomized to the intervention arm. STAR (Start. Transform. Achieve. Results.) to enhance employees' control over their work time, increase supervisor support for employees to manage work and family responsibilities, and reorient the culture toward results. A taxonomy of activities related to customization, start-up, and implementation was developed. Resource use and unit costs were estimated for each activity, excluding research-related activities. Economic costing approach (accounting and opportunity costs). Sensitivity analyses on intervention costs. The total cost of STAR was $709,654, of which $389,717 was labor costs and $319,937 nonlabor costs (including $313,877 for intervention contract). The cost per employee participation in the intervention was $340 (95% confidence interval: $330-$351); $597 ($561-$634) for managers and $300 ($292-$308) for other employees (2011 prices). A detailed activity costing approach allows for more accurate cost estimates and identifies key drivers of cost. The key cost driver was employees' time spent on receiving the intervention. Ignoring this cost, which is usual in studies that cost workplace interventions, would seriously underestimate the cost of a workplace initiative.

The evaluation of cost-of-illness due to use of cost-of-illness-based chemicals.

PubMed

Hong, Jiyeon; Lee, Yongjin; Lee, Geonwoo; Lee, Hanseul; Yang, Jiyeon

2015-01-01

This study is conducted to estimate the cost paid by the public suffering from disease possibly caused by chemical and to examine the effect on public health. Cost-benefit analysis is an important factor in analysis and decision-making and is an important policy decision tool in many countries. Cost-of-illness (COI), a kind of scale-based analysis method, estimates the potential value lost as a result of illness as a monetary unit and calculates the cost in terms of direct, indirect and psychological costs. This study estimates direct medical costs, transportation fees for hospitalization and outpatient treatment, and nursing fees through a number of patients suffering from disease caused by chemicals in order to analyze COI, taking into account the cost of productivity loss as an indirect cost. The total yearly cost of the diseases studied in 2012 is calculated as 77 million Korean won (KRW) per person. The direct and indirect costs being 52 million KRW and 23 million KRW, respectively. Within the total cost of illness, mental and behavioral disability costs amounted to 16 million KRW, relevant blood immunological parameters costs were 7.4 million KRW, and disease of the nervous system costs were 6.7 million KRW. This study reports on a survey conducted by experts regarding diseases possibly caused by chemicals and estimates the cost for the general public. The results can be used to formulate a basic report for a social-economic evaluation of the permitted use of chemicals and limits of usage.

Systems analysis of solid fuel nuclear engines in cislunar space

NASA Astrophysics Data System (ADS)

Thomas, U.; Koelle, H. H.; Balzer-Sieb, R.; Bernau, D.; Czarnitzki, J.; Floete, A.; Goericke, D.; Lindenthal, A.; Protsch, R.; Teschner, O.

1984-12-01

The use of nuclear engines in cislunar space was studied and the restrictions imposed on nuclear ferries by the chemical Earth to lower Earth orbit (LEO) transportation system were analyzed. The operating conditions are best met by tungsten-water-moderated reactors due to a high specific impulse and long durability. Specific transportation cost for LEO to geostationary orbit (GEO) and LEO to lunar orbit flights were calculated for a transportation system life of 50 yr. Average transportation costs are estimated to be 141 $/kg. No difference is made for both routes. An additional analysis of smaller and larger flight units shows only small cost reductions by employing larger ferries but a significant cost increase in case smaller flight units are used.

Cost-Effectiveness of a Clinical Childhood Obesity Intervention.

PubMed

Sharifi, Mona; Franz, Calvin; Horan, Christine M; Giles, Catherine M; Long, Michael W; Ward, Zachary J; Resch, Stephen C; Marshall, Richard; Gortmaker, Steven L; Taveras, Elsie M

2017-11-01

To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence. Copyright © 2017 by the American Academy of Pediatrics.

Cost-effectiveness of pneumococcal conjugate vaccine: evidence from the first 5 years of use in the United States incorporating herd effects.

PubMed

Ray, G Thomas; Whitney, Cynthia G; Fireman, Bruce H; Ciuryla, Vincent; Black, Steven B

2006-06-01

Pneumococcal conjugate vaccine (PCV) has been in routine use in the United States for 5 years. Prior U.S. cost-effectiveness analyses have not taken into account the effect of the vaccine on nonvaccinated persons. We revised a previously published model to simulate the effects of PCV on children vaccinated between 2000 and 2004, and to incorporate the effect of the vaccine in reducing invasive pneumococcal disease (IPD) in nonvaccinated persons during those years. Data from the Active Bacterial Core Surveillance of the Centers for Disease Control and Prevention (2000-2004) were used to estimate changes in the burden of IPD in nonvaccinated adults since the introduction of PCV (compared with the baseline years 1997-1999). Results combined the simulated effects of the vaccine on the vaccinated and nonvaccinated populations. Before incorporating herd effects in the model, the PCV was estimated to have averted 38,000 cases of IPD during its first 5 years of use at a cost of dollar 112,000 per life-year saved. After incorporating the reductions in IPD for nonvaccinated individuals, the vaccine averted 109,000 cases of IPD at a cost of dollar 7500 per life-year saved. When the herd effect was assumed to be half that of the base case, the cost per life-year saved was dollar 18,000. IPD herd effects in the nonvaccinated population substantially reduce the cost, and substantially improve the cost-effectiveness, of PCV. The cost-effectiveness of PCV in actual use has been more favorable than predicted by estimates created before the vaccine was licensed.

Social/economic costs and health-related quality of life in patients with juvenile idiopathic arthritis in Europe.

PubMed

Kuhlmann, A; Schmidt, T; Treskova, M; López-Bastida, J; Linertová, R; Oliva-Moreno, J; Serrano-Aguilar, P; Posada-de-la-Paz, M; Kanavos, P; Taruscio, D; Schieppati, A; Iskrov, G; Péntek, M; Delgado, C; von der Schulenburg, J M; Persson, U; Chevreul, K; Fattore, G

2016-04-01

The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with juvenile idiopathic arthritis (JIA) in Europe. We conducted a cross-sectional study of patients with JIA from Germany, Italy, Spain, France, the United Kingdom, Bulgaria, and Sweden. Data on demographic characteristics, healthcare resource utilization, informal care, labor productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D-5L) questionnaire. A total of 162 patients (67 Germany, 34 Sweden, 33 Italy, 23 United Kingdom, 4 France, and 1 Bulgaria) completed the questionnaire. Excluding Bulgarian results, due to small sample size, country-specific annual health care costs ranged from €18,913 to €36,396 (reference year: 2012). Estimated direct healthcare costs ranged from €11,068 to €22,138; direct non-healthcare costs ranged from €7837 to €14,155 and labor productivity losses ranged from €0 to €8715. Costs are also shown to differ between children and adults. The mean EQ-5D index score for JIA patients was estimated at between 0.44 and 0.88, and the mean EQ-5D visual analogue scale score was estimated at between 62 and 79. JIA patients incur considerable societal costs and experience substantial deterioration in HRQOL in some countries. Compared with previous studies, our results show a remarkable increase in annual healthcare costs for JIA patients. Reasons for the increase are the inclusion of non-professional caregiver costs, a wider use of biologics, and longer hospital stays.

40 CFR 258.72 - Financial assurance for post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... care. 258.72 Section 258.72 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... dollars, of the cost of hiring a third party to conduct post-closure care for the MSWLF unit in compliance with the post-closure plan developed under § 258.61 of this part. The post-closure cost estimate used...

Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA

PubMed Central

Herzer, Kurt R; Niessen, Louis; Constenla, Dagna O; Ward, William J; Pronovost, Peter J

2014-01-01

Objective To assess the cost-effectiveness of a multifaceted quality improvement programme focused on reducing central line-associated bloodstream infections in intensive care units. Design Cost-effectiveness analysis using a decision tree model to compare programme to non-programme intensive care units. Setting USA. Population Adult patients in the intensive care unit. Costs Economic costs of the programme and of central line-associated bloodstream infections were estimated from the perspective of the hospital and presented in 2013 US dollars. Main outcome measures Central line-associated bloodstream infections prevented, deaths averted due to central line-associated bloodstream infections prevented, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was performed. Results Compared with current practice, the programme is strongly dominant and reduces bloodstream infections and deaths at no additional cost. The probabilistic sensitivity analysis showed that there was an almost 80% probability that the programme reduces bloodstream infections and the infections’ economic costs to hospitals. The opportunity cost of a bloodstream infection to a hospital was the most important model parameter in these analyses. Conclusions This multifaceted quality improvement programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections. PMID:25256190

Estimating Renewable Energy Economic Potential in the United States: Methodology and Initial Results

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

Brown, Austin; Beiter, Philipp; Heimiller, Donna

The report describes a geospatial analysis method to estimate the economic potential of several renewable resources available for electricity generation in the United States. Economic potential, one measure of renewable generation potential, is defined in this report as the subset of the available resource technical potential where the cost required to generate the electricity (which determines the minimum revenue requirements for development of the resource) is below the revenue available in terms of displaced energy and displaced capacity.

Estimated costs of production and potential prices for the WHO Essential Medicines List

PubMed Central

Hill, Andrew M; Barber, Melissa J

2018-01-01

Introduction There are persistent gaps in access to affordable medicines. The WHO Model List of Essential Medicines (EML) includes medicines considered necessary for functional health systems. Methods A generic price estimation formula was developed by reviewing published analyses of cost of production for medicines and assuming manufacture in India, which included costs of formulation, packaging, taxation and a 10% profit margin. Data on per-kilogram prices of active pharmaceutical ingredient exported from India were retrieved from an online database. Estimated prices were compared with the lowest globally available prices for HIV/AIDS, tuberculosis (TB) and malaria medicines, and current prices in the UK, South Africa and India. Results The estimation formula had good predictive accuracy for HIV/AIDS, TB and malaria medicines. Estimated generic prices ranged from US$0.01 to US$1.45 per unit, with most in the lower end of this range. Lowest available prices were greater than estimated generic prices for 214/277 (77%) comparable items in the UK, 142/212 (67%) in South Africa and 118/298 (40%) in India. Lowest available prices were more than three times above estimated generic price for 47% of cases compared in the UK and 22% in South Africa. Conclusion A wide range of medicines in the EML can be profitably manufactured at very low cost. Most EML medicines are sold in the UK and South Africa at prices significantly higher than those estimated from production costs. Generic price estimation and international price comparisons could empower government price negotiations and support cost-effectiveness calculations. PMID:29564159

Cost analysis of routine immunisation in Zambia.

PubMed

Schütte, Carl; Chansa, Collins; Marinda, Edmore; Guthrie, Teresa A; Banda, Stanley; Nombewu, Zipozihle; Motlogelwa, Katlego; Lervik, Marita; Brenzel, Logan; Kinghorn, Anthony

2015-05-07

This study aimed to inform planning and funding by providing updated, detailed information on total and unit costs of routine immunisation (RI) in Zambia, a GAVI-eligible lower middle-income country with a population of 13 million. The exercise was part of a multi-country study on costs and financing of routine immunisation (EPIC) that utilized a common, ingredients-based approach to costing. Data on inputs, prices and outputs were collected in a stratified, random sample of 51 facilities in nine districts between December 2012 and March 2013 using a pre-tested questionnaire. Shared inputs were allocated to RI costs on the basis of tracing factors developed for the study. A comprehensive set of costs were analysed to obtain total and unit costs, at facility and above-facility levels. The total annual economic cost of RI was $38.16 million, equivalent to approximately 10% of government health spending. Government contributed 83% of finances. Labour accounted for the lion's share (49%) of total costs followed by vaccines (16%) and travel allowances (12%). Analysis of specific activity costs showed that outreach and facility-based services accounted for half of total economic costs. Costs for managing the program at district, provincial and national levels (above-facility costs) represented 24% of total costs. Average unit costs were $7.18 per dose, $59.32 per infant and $65.89 per DPT3 immunised child, with markedly higher unit costs in rural facilities. Analyses suggest that greater efficiency is associated with higher utilisation levels and urban facility type. Total and unit costs, and government's contribution, were considerably higher than previous Zambian estimates and international benchmarks. These findings have substantial implications for planners, efficiency improvement and sustainable financing, particularly as new vaccines are introduced. Variations in immunisation costs at facility level warrant further statistical analyses. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

PubMed Central

Peck, Richard M.; Babb, Stephen D.

2014-01-01

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

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

PubMed

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

2014-10-02

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

A practical approach for calculating reliable cost estimates from observational data: application to cost analyses in maternal and child health.

PubMed

Salemi, Jason L; Comins, Meg M; Chandler, Kristen; Mogos, Mulubrhan F; Salihu, Hamisu M

2013-08-01

Comparative effectiveness research (CER) and cost-effectiveness analysis are valuable tools for informing health policy and clinical care decisions. Despite the increased availability of rich observational databases with economic measures, few researchers have the skills needed to conduct valid and reliable cost analyses for CER. The objectives of this paper are to (i) describe a practical approach for calculating cost estimates from hospital charges in discharge data using publicly available hospital cost reports, and (ii) assess the impact of using different methods for cost estimation in maternal and child health (MCH) studies by conducting economic analyses on gestational diabetes (GDM) and pre-pregnancy overweight/obesity. In Florida, we have constructed a clinically enhanced, longitudinal, encounter-level MCH database covering over 2.3 million infants (and their mothers) born alive from 1998 to 2009. Using this as a template, we describe a detailed methodology to use publicly available data to calculate hospital-wide and department-specific cost-to-charge ratios (CCRs), link them to the master database, and convert reported hospital charges to refined cost estimates. We then conduct an economic analysis as a case study on women by GDM and pre-pregnancy body mass index (BMI) status to compare the impact of using different methods on cost estimation. Over 60 % of inpatient charges for birth hospitalizations came from the nursery/labor/delivery units, which have very different cost-to-charge markups (CCR = 0.70) than the commonly substituted hospital average (CCR = 0.29). Using estimated mean, per-person maternal hospitalization costs for women with GDM as an example, unadjusted charges ($US14,696) grossly overestimated actual cost, compared with hospital-wide ($US3,498) and department-level ($US4,986) CCR adjustments. However, the refined cost estimation method, although more accurate, did not alter our conclusions that infant/maternal hospitalization costs were significantly higher for women with GDM than without, and for overweight/obese women than for those in a normal BMI range. Cost estimates, particularly among MCH-related services, vary considerably depending on the adjustment method. Our refined approach will be valuable to researchers interested in incorporating more valid estimates of cost into databases with linked hospital discharge files.

Applications of a stump-to-mill computer model to cable logging planning

Treesearch

Chris B. LeDoux

1986-01-01

Logging cost simulators and data from logging cost studies have been assembled and converted into a series of simple equations that can be used to estimate the stump-to-mill cost of cable logging in mountainous terrain of the Eastern United States. These equations are based on the use of two small and four medium-sized cable yarders and are applicable for harvests of...

MPEG-1 low-cost encoder solution

NASA Astrophysics Data System (ADS)

Grueger, Klaus; Schirrmeister, Frank; Filor, Lutz; von Reventlow, Christian; Schneider, Ulrich; Mueller, Gerriet; Sefzik, Nicolai; Fiedrich, Sven

1995-02-01

A solution for real-time compression of digital YCRCB video data to an MPEG-1 video data stream has been developed. As an additional option, motion JPEG and video telephone streams (H.261) can be generated. For MPEG-1, up to two bidirectional predicted images are supported. The required computational power for motion estimation and DCT/IDCT, memory size and memory bandwidth have been the main challenges. The design uses fast-page-mode memory accesses and requires only one single 80 ns EDO-DRAM with 256 X 16 organization for video encoding. This can be achieved only by using adequate access and coding strategies. The architecture consists of an input processing and filter unit, a memory interface, a motion estimation unit, a motion compensation unit, a DCT unit, a quantization control, a VLC unit and a bus interface. For using the available memory bandwidth by the processing tasks, a fixed schedule for memory accesses has been applied, that can be interrupted for asynchronous events. The motion estimation unit implements a highly sophisticated hierarchical search strategy based on block matching. The DCT unit uses a separated fast-DCT flowgraph realized by a switchable hardware unit for both DCT and IDCT operation. By appropriate multiplexing, only one multiplier is required for: DCT, quantization, inverse quantization, and IDCT. The VLC unit generates the video-stream up to the video sequence layer and is directly coupled with an intelligent bus-interface. Thus, the assembly of video, audio and system data can easily be performed by the host computer. Having a relatively low complexity and only small requirements for DRAM circuits, the developed solution can be applied to low-cost encoding products for consumer electronics.

Learning and forgetting in the jet fighter aircraft industry.

PubMed

Bongers, Anelí

2017-01-01

A recent strategy carried out by the aircraft industry to reduce the total cost of the new generation fighters has consisted in the development of a single airframe with different technical and operational specifications. This strategy has been designed to reduce costs in the Research, Design and Development phase with the ultimate objective of reducing the final unit price per aircraft. This is the case of the F-35 Lightning II, where three versions, with significant differences among them, are produced simultaneously based on a single airframe. Whereas this strategy seems to be useful to cut down pre-production sunk costs, their effects on production costs remain to be studied. This paper shows that this strategy can imply larger costs in the production phase by reducing learning acquisition and hence, the total effect on the final unit price of the aircraft is indeterminate. Learning curves are estimated based on the flyaway cost for the latest three fighter aircraft models: The A/F-18E/F Super Hornet, the F-22A Raptor, and the F-35A Lightning II. We find that learning rates for the F-35A are significantly lower (an estimated learning rate of around 9%) than for the other two models (around 14%).

Learning and forgetting in the jet fighter aircraft industry

PubMed Central

2017-01-01

A recent strategy carried out by the aircraft industry to reduce the total cost of the new generation fighters has consisted in the development of a single airframe with different technical and operational specifications. This strategy has been designed to reduce costs in the Research, Design and Development phase with the ultimate objective of reducing the final unit price per aircraft. This is the case of the F-35 Lightning II, where three versions, with significant differences among them, are produced simultaneously based on a single airframe. Whereas this strategy seems to be useful to cut down pre-production sunk costs, their effects on production costs remain to be studied. This paper shows that this strategy can imply larger costs in the production phase by reducing learning acquisition and hence, the total effect on the final unit price of the aircraft is indeterminate. Learning curves are estimated based on the flyaway cost for the latest three fighter aircraft models: The A/F-18E/F Super Hornet, the F-22A Raptor, and the F-35A Lightning II. We find that learning rates for the F-35A are significantly lower (an estimated learning rate of around 9%) than for the other two models (around 14%). PMID:28957359

Costs of occupational injuries in agriculture.

PubMed Central

Leigh, J. P.; McCurdy, S. A.; Schenker, M. B.

2001-01-01

OBJECTIVE: This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992. METHODS: The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance. RESULTS: Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion. CONCLUSIONS: The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs. PMID:12034913

Costs of occupational injuries in agriculture.

PubMed

Leigh, J P; McCurdy, S A; Schenker, M B

2001-01-01

This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992. The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance. Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion. The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs.

Three essays in energy economics

NASA Astrophysics Data System (ADS)

Kim, Dae-Wook

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

Health and Economic Impact of Switching from a 4-Valent to a 9-Valent HPV Vaccination Program in the United States.

PubMed

Brisson, Marc; Laprise, Jean-François; Chesson, Harrell W; Drolet, Mélanie; Malagón, Talía; Boily, Marie-Claude; Markowitz, Lauri E

2016-01-01

Randomized clinical trials have shown the 9-valent human papillomavirus (HPV) vaccine to be highly effective against types 31/33/45/52/58 compared with the 4-valent. Evidence on the added health and economic benefit of the 9-valent is required for policy decisions. We compare population-level effectiveness and cost-effectiveness of 9- and 4-valent HPV vaccination in the United States. We used a multitype individual-based transmission-dynamic model of HPV infection and disease (anogenital warts and cervical, anogenital, and oropharyngeal cancers), 3% discount rate, and societal perspective. The model was calibrated to sexual behavior and epidemiologic data from the United States. In our base-case, we assumed 95% vaccine-type efficacy, lifelong protection, and a cost/dose of $145 and $158 for the 4- and 9-valent vaccine, respectively. Predictions are presented using the mean (80% uncertainty interval [UI] = 10(th)-90(th) percentiles) of simulations. Under base-case assumptions, the 4-valent gender-neutral vaccination program is estimated to cost $5500 (80% UI = 2400-9400) and $7300 (80% UI = 4300-11 000)/quality-adjusted life-year (QALY) gained with and without cross-protection, respectively. Switching to a 9-valent gender-neutral program is estimated to be cost-saving irrespective of cross-protection assumptions. Finally, the incremental cost/QALY gained of switching to a 9-valent gender-neutral program (vs 9-valent girls/4-valent boys) is estimated to be $140 200 (80% UI = 4200->1 million) and $31 100 (80% UI = 2100->1 million) with and without cross-protection, respectively. Results are robust to assumptions about HPV natural history, screening methods, duration of protection, and healthcare costs. Switching to a 9-valent gender-neutral HPV vaccination program is likely to be cost-saving if the additional cost/dose of the 9-valent is less than $13. Giving females the 9-valent vaccine provides the majority of benefits of a gender-neutral strategy. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Epidemiology and costs of cervical cancer screening and cervical dysplasia in Italy

PubMed Central

Rossi, Paolo Giorgi; Ricciardi, Alessandro; Cohet, Catherine; Palazzo, Fabio; Furnari, Giacomo; Valle, Sabrina; Largeron, Nathalie; Federici, Antonio

2009-01-01

Background We estimated the number of women undergoing cervical cancer screening annually in Italy, the rates of cervical abnormalities detected, and the costs of screening and management of abnormalities. Methods The annual number of screened women was estimated from National Health Interview data. Data from the Italian Group for Cervical Cancer Screening were used to estimate the number of positive, negative and unsatisfactory Pap smears. The incidence of CIN (cervical intra-epithelial neoplasia) was estimated from the Emilia Romagna Cancer Registry. Patterns of follow-up and treatment costs were estimated using a typical disease management approach based on national guidelines and data from the Italian Group for Cervical Cancer Screening. Treatment unit costs were obtained from Italian National Health Service and Hospital Information System of the Lazio Region. Results An estimated 6.4 million women aged 25–69 years undergo screening annually in Italy (1.2 million and 5.2 million through organized and opportunistic screening programs, respectively). Approximately 2.4% of tests have positive findings. There are approximately 21,000 cases of CIN1 and 7,000–17,000 cases of CIN2/3. Estimated costs to the healthcare service amount to €158.5 million for screening and €22.9 million for the management of cervical abnormalities. Conclusion Although some cervical abnormalities might have been underestimated, the total annual cost of cervical cancer prevention in Italy is approximately €181.5 million, of which 87% is attributable to screening. PMID:19243586

Proposal of a New SI Base Unit for Value. An Hedonic Estimation of the Physical Purchasing Power (PhPP) of Money.

NASA Astrophysics Data System (ADS)

Defilla, Steivan

2006-03-01

Hitherto, the purchasing power of money, i.e. its transaction value, has been measured in terms of inflation index numbers and consumer baskets. Consumer baskets are variable phenomena and their use as measurement units for value confuses the measuring with the measurand. We propose an invariant numeraire, or value unit, based on the market value of a Planck energy (1956 MJ). Planck units form a natural system of units independent of any civilization. The hedonic estimation of the PhPP of a currency differentiates energy by product as well as by thermodynamic quality (exergy). Following SI rules, we propose to name the value unit walras (Wal) in honour of the economist Leon Walras (1834 - 1910). One Wal can also be interpreted as the minimum cost of physiological life of a reference person during one year. The study uses official disaggregated Swiss Producer and Consumer Price Index data and estimates the PhPP of the Swiss franc in 2003.

Effect of a Patient-Repositioning Device in an Intensive Care Unit On Hospital-Acquired Pressure Injury Occurences and Cost: A Before-After Study.

PubMed

Edger, Melinda

The principal aim of this study was to determine the hospital-acquired pressure injury (HAPI) rate before and after introduction of a repositioning device, measure staff-perceived level of exertion with device use, and assess return on investment. 1 group, before-and-after study. The sample comprised 717 patients cared for in a 17-bed intensive care unit. The study setting was the neonatal intensive care unit at Bon Secours Maryview Medical Center located in the mid-Atlantic United States (Portsmouth, Virginia). A safe patient-handling intervention was implemented as part of a quality improvement initiative. The effect of this system was measured using several outcome measures: (1) HAPI occurrences on the sacral area and buttocks, (2) perceived effort of use by staff, and (3) cost analysis. We used the validated Borg Scale to measure perceived exertion that was ranked on a scale from 6 to 20, where higher scores indicate greater exertion. Cost comparisons were completed before and after introduction of the patient-repositioning system. Cost analysis was determined using internal dollar amounts calculated for each stage of pressure injury. The return on investment was calculated by comparing the cost of HAPIs and the product after the intervention with the costs of HAPIs before the intervention. Analysis revealed a statistically significant reduction in HAPI occurrence from 1.3% to 0% (P = .004) when baseline manual repositioning (standard of care) was compared with use of the repositioning system. Caregivers reported significantly less exertion when using the repositioning device as compared with standard of care repositioning (P < .001). The return on investment was estimated to be $16,911. Use of a repositioning device resulted in significantly reduced HAPIs. Perceived exertion for repositioning the patient with a repositioning device was significantly less than repositioning with standard of care. A cost analysis estimated a return on investment as a result of the intervention on HAPI prevention.

Economic impact of Tegaderm chlorhexidine gluconate (CHG) dressing in critically ill patients.

PubMed

Thokala, Praveen; Arrowsmith, Martin; Poku, Edith; Martyn-St James, Marissa; Anderson, Jeff; Foster, Steve; Elliott, Tom; Whitehouse, Tony

2016-09-01

To estimate the economic impact of a Tegaderm TM chlorhexidine gluconate (CHG) gel dressing compared with a standard intravenous (i.v.) dressing (defined as non-antimicrobial transparent film dressing), used for insertion site care of short-term central venous and arterial catheters (intravascular catheters) in adult critical care patients using a cost-consequence model populated with data from published sources. A decision analytical cost-consequence model was developed which assigned each patient with an indwelling intravascular catheter and a standard dressing, a baseline risk of associated dermatitis, local infection at the catheter insertion site and catheter-related bloodstream infections (CRBSI), estimated from published secondary sources. The risks of these events for patients with a Tegaderm CHG were estimated by applying the effectiveness parameters from the clinical review to the baseline risks. Costs were accrued through costs of intervention (i.e. Tegaderm CHG or standard intravenous dressing) and hospital treatment costs depended on whether the patients had local dermatitis, local infection or CRBSI. Total costs were estimated as mean values of 10,000 probabilistic sensitivity analysis (PSA) runs. Tegaderm CHG resulted in an average cost-saving of £77 per patient in an intensive care unit. Tegaderm CHG also has a 98.5% probability of being cost-saving compared to standard i.v. dressings. The analyses suggest that Tegaderm CHG is a cost-saving strategy to reduce CRBSI and the results were robust to sensitivity analyses.

Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes.

PubMed

Dalziel, Kim; Segal, Leonie

2012-09-01

There is a body of published research on the effectiveness of home visiting for the prevention of child maltreatment, but little in the peer reviewed literature on cost-effectiveness or value to society. The authors sought to determine the cost-effectiveness of alternative home visiting programmes to inform policy. All trials reporting child maltreatment outcomes were identified through systematic review. Information on programme effectiveness and components were taken from identified studies, to which 2010 Australian unit costs were applied. Lifetime cost offsets associated with maltreatment were derived from a recent Australian study. Cost-effectiveness results were estimated as programme cost per case of maltreatment prevented and net benefit estimated by incorporating downstream cost savings. Sensitivity analyses were conducted. 33 home visiting programmes were evaluated and cost-effectiveness estimates derived for the 25 programmes not dominated. The incremental cost of home visiting compared to usual care ranged from A$1800 to A$30 000 (US$1800-US$30 000) per family. Cost-effectiveness estimates ranged from A$22 000 per case of maltreatment prevented to several million. Seven of the 22 programmes (32%) of at least adequate quality were cost saving when including lifetime cost offsets. There is great variation in the cost-effectiveness of home visiting programmes for the prevention of maltreatment. The most cost-effective programmes use professional home visitors in a multi-disciplinary team, target high risk populations and include more than just home visiting. Home visiting programmes must be carefully selected and well targeted if net social benefits are to be realised.

Cost-effectiveness in fall prevention for older women.

PubMed

Hektoen, Liv F; Aas, Eline; Lurås, Hilde

2009-08-01

The aim of this study was to estimate the cost-effectiveness of implementing an exercise-based fall prevention programme for home-dwelling women in the > or = 80-year age group in Norway. The impact of the home-based individual exercise programme on the number of falls is based on a New Zealand study. On the basis of the cost estimates and the estimated reduction in the number of falls obtained with the chosen programme, we calculated the incremental costs and the incremental effect of the exercise programme as compared with no prevention. The calculation of the average healthcare cost of falling was based on assumptions regarding the distribution of fall injuries reported in the literature, four constructed representative case histories, assumptions regarding healthcare provision associated with the treatment of the specified cases, and estimated unit costs from Norwegian cost data. We calculated the average healthcare costs per fall for the first year. We found that the reduction in healthcare costs per individual for treating fall-related injuries was 1.85 times higher than the cost of implementing a fall prevention programme. The reduction in healthcare costs more than offset the cost of the prevention programme for women aged > or = 80 years living at home, which indicates that health authorities should increase their focus on prevention. The main intention of this article is to stipulate costs connected to falls among the elderly in a transparent way and visualize the whole cost picture. Cost-effectiveness analysis is a health policy tool that makes politicians and other makers of health policy conscious of this complexity.

Using decision modeling to determine pricing of new pharmaceuticals: the case of neurokinin-1 receptor antagonist antiemetics for cancer chemotherapy.

PubMed

Dranitsaris, George; Leung, Pauline

2004-01-01

Decision analysis is commonly used to perform economic evaluations of new pharmaceuticals. The outcomes of such studies are often reported as an incremental cost per quality-adjusted life year (QALY) gained with the new agent. Decision analysis can also be used in the context of estimating drug cost before market entry. The current study used neurokinin-1 (NK-1) receptor antagonists, a new class of antiemetics for cancer patients, as an example to illustrate the process using an incremental cost of dollars Can20,000 per QALY gained as the target threshold. A decision model was developed to simulate the control of acute and delayed emesis after cisplatin-based chemotherapy. The model compared standard therapy with granisetron and dexamethasone to the same protocol with the addition of an NK-1 before chemotherapy and continued twice daily for five days. The rates of complete emesis control were abstracted from a double-blind randomized trial. Costs of standard antiemetics and therapy for breakthrough vomiting were obtained from hospital sources. Utility estimates characterized as quality-adjusted emesis-free days were determined by interviewing twenty-five oncology nurses and pharmacists by using the Time Trade-Off technique. These data were then used to estimate the unit cost of the new antiemetic using a target threshold of dollars Can20,000 per QALY gained. A cost of dollars Can6.60 per NK-1 dose would generate an incremental cost of dollars Can20,000 per QALY. The sensitivity analysis on the unit cost identified a range from dollars Can4.80 to dollars Can10.00 per dose. For the recommended five days of therapy, the total cost should be dollars Can66.00 (dollars Can48.00-dollars Can100.00) for optimal economic efficiency relative to Canada's publicly funded health-care system. The use of decision modeling for estimating drug cost before product launch is a powerful technique to ensure value for money. Such information can be of value to both drug manufacturers and formulary committees, because it would facilitate negotiations for optimal pricing in a given jurisdiction.

Economic analysis of electronic waste recycling: modeling the cost and revenue of a materials recovery facility in California.

PubMed

Kang, Hai-Yong; Schoenung, Julie M

2006-03-01

The objectives of this study are to identify the various techniques used for treating electronic waste (e-waste) at material recovery facilities (MRFs) in the state of California and to investigate the costs and revenue drivers for these techniques. The economics of a representative e-waste MRF are evaluated by using technical cost modeling (TCM). MRFs are a critical element in the infrastructure being developed within the e-waste recycling industry. At an MRF, collected e-waste can become marketable output products including resalable systems/components and recyclable materials such as plastics, metals, and glass. TCM has two main constituents, inputs and outputs. Inputs are process-related and economic variables, which are directly specified in each model. Inputs can be divided into two parts: inputs for cost estimation and for revenue estimation. Outputs are the results of modeling and consist of costs and revenues, distributed by unit operation, cost element, and revenue source. The results of the present analysis indicate that the largest cost driver for the operation of the defined California e-waste MRF is the materials cost (37% of total cost), which includes the cost to outsource the recycling of the cathode ray tubes (CRTs) (dollar 0.33/kg); the second largest cost driver is labor cost (28% of total cost without accounting for overhead). The other cost drivers are transportation, building, and equipment costs. The most costly unit operation is cathode ray tube glass recycling, and the next are sorting, collecting, and dismantling. The largest revenue source is the fee charged to the customer; metal recovery is the second largest revenue source.

Economic evaluation of the Good School Toolkit: an intervention for reducing violence in primary schools in Uganda.

PubMed

Greco, Giulia; Knight, Louise; Ssekadde, Willington; Namy, Sophie; Naker, Dipak; Devries, Karen

2018-01-01

This paper presents the cost and cost-effectiveness of the Good School Toolkit (GST), a programme aimed at reducing physical violence perpetrated by school staff to students in Uganda. The effectiveness of the Toolkit was tested with a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. A full economic costing evaluation and cost-effectiveness analysis were conducted alongside the trial. Both financial and economic costs were collected retrospectively from the provider's perspective to estimate total and unit costs. The total cost of setting up and running the Toolkit over the 18-month trial period is estimated at US$397 233, excluding process monitor (M&E) activities. The cost to run the intervention is US$7429 per school annually, or US$15 per primary school pupil annually, in the trial intervention schools. It is estimated that the intervention has averted 1620 cases of past-week physical violence during the 18-month implementation period. The total cost per case of violence averted is US$244, and the annual implementation cost is US$96 per case averted during the trial. The GST is a cost-effective intervention for reducing violence against pupils in primary schools in Uganda. It compares favourably against other violence reduction interventions in the region.

Global cost of correcting vision impairment from uncorrected refractive error.

PubMed

Fricke, T R; Holden, B A; Wilson, D A; Schlenther, G; Naidoo, K S; Resnikoff, S; Frick, K D

2012-10-01

To estimate the global cost of establishing and operating the educational and refractive care facilities required to provide care to all individuals who currently have vision impairment resulting from uncorrected refractive error (URE). The global cost of correcting URE was estimated using data on the population, the prevalence of URE and the number of existing refractive care practitioners in individual countries, the cost of establishing and operating educational programmes for practitioners and the cost of establishing and operating refractive care facilities. The assumptions made ensured that costs were not underestimated and an upper limit to the costs was derived using the most expensive extreme for each assumption. There were an estimated 158 million cases of distance vision impairment and 544 million cases of near vision impairment caused by URE worldwide in 2007. Approximately 47 000 additional full-time functional clinical refractionists and 18 000 ophthalmic dispensers would be required to provide refractive care services for these individuals. The global cost of educating the additional personnel and of establishing, maintaining and operating the refractive care facilities needed was estimated to be around 20 000 million United States dollars (US$) and the upper-limit cost was US$ 28 000 million. The estimated loss in global gross domestic product due to distance vision impairment caused by URE was US$ 202 000 million annually. The cost of establishing and operating the educational and refractive care facilities required to deal with vision impairment resulting from URE was a small proportion of the global loss in productivity associated with that vision impairment.

Economic Evaluation of the HF-ACTION Randomized Controlled Trial: An Exercise Training Study of Patients With Chronic Heart Failure

PubMed Central

Reed, Shelby D.; Whellan, David J.; Li, Yanhong; Friedman, Joëlle Y.; Ellis, Stephen J.; Piña, Ileana L.; Settles, Sharon J.; Davidson-Ray, Linda; Johnson, Johanna L.; Cooper, Lawton S.; O’Connor, Christopher M.; Schulman, Kevin A.

2011-01-01

Background HF-ACTION assigned 2331 outpatients with medically stable heart failure to exercise training or usual care. We compared medical resource use and costs incurred by these patients during follow-up. Methods and Results Extensive data on medical resource use and hospital bills were collected throughout the trial for estimates of direct medical costs. Intervention costs were estimated using patient-level trial data, administrative records, and published unit costs. Mean follow-up was 2.5 years. There were 2297 hospitalizations in the exercise group and 2332 in the usual care group (P = .92). The mean number of inpatient days was 13.6 (SD, 27.0) in the exercise group and 15.0 (SD, 31.4) in the usual care group (P = .23). Other measures of resource use were similar between groups, except for trends indicating that fewer patients in the exercise group underwent high-cost inpatient procedures. Total direct medical costs per participant were an estimated $50,857 (SD, $81,488) in the exercise group and $56,177 (SD, $92,749) in the usual care group (95% confidence interval for the difference, $–12,755 to $1547; P = .10). The direct cost of exercise training was an estimated $1006 (SD, $337). Patient time costs were an estimated $5018 (SD, $4600). Conclusions The cost of exercise training was relatively low for the health care system, but patients incurred significant time costs. In this economic evaluation, there was little systematic benefit in terms of overall medical resource use with this intervention. Trial Registration clinicaltrials.gov Identifier: NCT00047437 PMID:20551371

The macroeconomic impact of pandemic influenza: estimates from models of the United Kingdom, France, Belgium and The Netherlands.

PubMed

Keogh-Brown, Marcus Richard; Smith, Richard D; Edmunds, John W; Beutels, Philippe

2010-12-01

The 2003 outbreak of severe acute respiratory syndrome (SARS) showed that infectious disease outbreaks can have notable macroeconomic impacts. The current H1N1 and potential H5N1 flu pandemics could have a much greater impact. Using a multi-sector single country computable general equilibrium model of the United Kingdom, France, Belgium and The Netherlands, together with disease scenarios of varying severity, we examine the potential economic cost of a modern pandemic. Policies of school closure, vaccination and antivirals, together with prophylactic absence from work are evaluated and their cost impacts are estimated. Results suggest GDP losses from the disease of approximately 0.5-2% but school closure and prophylactic absenteeism more than triples these effects. Increasing school closures from 4 weeks at the peak to entire pandemic closure almost doubles the economic cost, but antivirals and vaccinations seem worthwhile. Careful planning is therefore important to ensure expensive policies to mitigate the pandemic are effective in minimising illness and deaths.

Treatment costs in Hodgkin's disease: a cost-utility analysis.

PubMed

Norum, J; Angelsen, V; Wist, E; Olsen, J A

1996-08-01

The aim of this study was to estimate costs of treatment for Hodgkin's disease (HD) and the outcome in health in terms of quality-adjusted life-years (QALYs), and compare these to a constructed nontreatment alternative. All 55 patients treated for HD at the oncological unit of the University Hospital of Tromsø between 1985 and 1993 were included. The total treatment costs (medication, hospital stay, hospital hotel stay, radiotherapy, travelling, loss in production, i.e. work) were retrospectively estimated for all patients. In December 1994, the 49 survivors were sent a EuroQol questionnaire recording quality of life: 42 responded. The mean quality of life score was 0.78 on a 0-1 scale, and the mean total cost of treatment was pounds 12512. The total treatment costs were significantly higher in patients with advanced clinical stages of the disease (P = 0.0006), B-symptoms (fever, sweats, weight loss) (P = 0.0027) and relapse (P < 0.0001). The costs of one QALY (with production gains included and using a 10% discount rate) were estimated at pounds 1651. When excluding production gains and using a 5% discount rate, the figures became pounds 1327. This makes HD one of the most cost-effective malignancies to treat.

Comparison of Permanent Change of Station Costs for Women and Men Transferred Prematurely from Ships (Computer Diskette).

DTIC Science & Technology

requirements: Post-script. The Objective of this report was to determine whether transferring pregnant women from ships costs the Navy more permanent...change of station (PCS) funds than transferring men and nonpregnant women information was extracted from the enlisted master record concerning gender...from gender-integrated afloat units. The direct costs of transfer prior to PRD was compared for men and women and an estimate of PCS costs, if the ships were not gender-integrated, was also calculated.

The financial burden of out-of-pocket expenses in the United States and Canada: How different is the United States?

PubMed Central

Baird, Katherine E

2016-01-01

Background: This article compares the burden that medical cost-sharing requirements place on households in the United States and Canada. It estimates the probability that individuals with similar demographic features in the two countries have large medical expenses relative to income. Method: The study uses 2010 nationally representative household survey data harmonized for cross-national comparisons to identify individuals with high medical expenses relative to income. Using logistic regression, it estimates the probability of high expenses occurring among 10 different demographic groups in the two countries. Results: The results show the risk of large medical expenses in the United States is 1.5–4 times higher than it is in Canada, depending on the demographic group and spending threshold used. The United States compares least favorably when evaluating poorer citizens and when using a higher spending threshold. Conclusion: Recent health care reforms can be expected to reduce Americans’ catastrophic health expenses, but it will take very large reductions in out-of-pocket expenditures—larger than can be expected—if poorer and middle-class families are to have the financial protection from high health care costs that their counterparts in Canada have. PMID:26985389

Adherence to the Otitis Media with Effusion Clinical Practice Guideline By Providers in a United States Air Force Medical Treatment Facility

DTIC Science & Technology

1999-03-18

In the United States, office visits for otitis media increased by 150 percent between 1975 and 1990, to 24.5 million (annually), with children under...visits for otitis media , they also had the greatest increase in number of visits between 1975 and 1990: 224 percent. Of significance, is the increase in...expenditure. Gates (1996) estimated the costs to be about five billion dollars annually. Cost is not the only factor important in the management of otitis media with

Cost-effectiveness of obinutuzumab for chronic lymphocytic leukaemia in The Netherlands.

PubMed

Blommestein, Hedwig M; de Groot, Saskia; Aarts, Mieke J; Vemer, Pepijn; de Vries, Robin; van Abeelen, Annet F M; Posthuma, E F M Ward; Uyl-de Groot, Carin A

2016-11-01

Obinutuzumab combined with chlorambucil (GClb) has shown to be superior to rituximab combined with chlorambucil (RClb) and chlorambucil (Clb) in newly diagnosed patients with chronic lymphocytic leukaemia (CLL). This study evaluates the cost-effectiveness per life-year and quality-adjusted life-year (QALY) of GClb compared to RClb, Clb, and ofatumumab plus chlorambucil (OClb) in The Netherlands. A Markov model was developed to assess the cost-effectiveness of GClb, RClb, Clb and other treatments in the United Kingdom. A country adaptation was made to estimate the cost-effectiveness of these therapies in The Netherlands using Dutch unit costs and Dutch data sources for background mortality and post-progression survival. An incremental gain of 1.06 and 0.64 QALYs was estimated for GClb compared to Clb and RClb respectively, at additional costs of €23,208 and €7254 per patient. Corresponding incremental cost-effectiveness ratios (ICERs) were €21,823 and €11,344 per QALY. Indirect treatment comparisons showed an incremental gain varying from 0.44 to 0.77 QALYs for GClb compared to OClb and additional costs varying from €7041 to €5028 per patient. The ICER varied from €6556 to €16,180 per QALY. Sensitivity analyses showed the robustness of the results. GClb appeared to be a cost-effective treatment strategy compared to RClb, OClb and Clb. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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

PubMed Central

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

2016-01-01

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

What is the cost of palliative care in the UK? A systematic review.

PubMed

Gardiner, Clare; Ryan, Tony; Gott, Merryn

2018-04-13

Little is known about the cost of a palliative care approach in the UK, and there is an absence of robust activity and unit cost data. The aim of this study was to review evidence on the costs of specialist and generalist palliative care in the UK, and to explore different approaches used for capturing activity and unit cost data. A systematic review with narrative synthesis. Four electronic databases were searched for empirical literature on the costs of a palliative care approach in the UK, and a narrative method was used to synthesise the data. Ten papers met our inclusion criteria. The studies displayed significant variation in their estimates of the cost of palliative care, therefore it was not possible to present an accurate aggregate cost of palliative care in the UK. The majority of studies explored costs from a National Health Service perspective and only two studies included informal care costs. Approaches to estimating activity and costs varied. Particular challenges were noted with capturing activity and cost data for hospice and informal care. The data are limited, and the heterogeneity is such that it is not possible to provide an aggregate cost of palliative care in the UK. It is notable that the costs of hospice care and informal care are often neglected in economic studies. Further work is needed to address methodological and practical challenges in order to gain a more complete understanding of the costs of palliative care. © 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.

The impact of external donor support through the U.S. President’s Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004–2011

PubMed Central

Pitman, John P.; Bocking, Adele; Wilkinson, Robert; Postma, Maarten J.; Basavaraju, Sridhar V.; von Finckenstein, Bjorn; Mataranyika, Mary; Marfin, Anthony A.; Lowrance, David W.; Sibinga, Cees Th. Smit

2015-01-01

Background External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004–2011, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. Material and methods A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004–2009) and the 2 years in which PEPFAR support began to decline (2010–2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. Results Between 2004–2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. Discussion PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn. PMID:25369616

The impact of external donor support through the U.S. President's Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004-2011.

PubMed

Pitman, John P; Bocking, Adele; Wilkinson, Robert; Postma, Maarten J; Basavaraju, Sridhar V; von Finckenstein, Bjorn; Mataranyika, Mary; Marfin, Anthony A; Lowrance, David W; Sibinga, Cees Th Smit

2015-04-01

External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004-2011, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004-2009) and the 2 years in which PEPFAR support began to decline (2010-2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. Between 2004-2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn.

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

PubMed

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

2018-04-01

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

Time-driven activity-based costing of multivessel coronary artery bypass grafting across national boundaries to identify improvement opportunities: study protocol.

PubMed

Erhun, F; Mistry, B; Platchek, T; Milstein, A; Narayanan, V G; Kaplan, R S

2015-08-25

Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease--a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32, 201 ± $23,059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery. We use time-driven activity-based costing (TDABC) to quantify the hospitals' costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA. All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings. 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.

Manufacturing cost analysis of a parabolic dish concentrator (General Electric design) for solar thermal electric power systems in selected production volumes

NASA Technical Reports Server (NTRS)

1981-01-01

The manufacturing cost of a General Electric 12 meter diameter concentrator was estimated. This parabolic dish concentrator for solar thermal system was costed in annual production volumes of 100 - 1,000 - 5,000 - 10,000 - 50,000 100,000 - 400,000 and 1,000,000 units. Presented for each volume are the costs of direct labor, material, burden, tooling, capital equipment and buildings. Also presented is the direct labor personnel and factory space requirements. All costs are based on early 1981 economics.

TBC costing. [test bed concentrator

NASA Technical Reports Server (NTRS)

Kaminski, H. L.

1980-01-01

Procedures to be used in determining the cost of producing and installing a parabolic dish collector in annual production volumes of 10,000, 50,000, 100,000, and 1,000,000 units include (1) evaluating each individual part for material cost and for the type and number of operations required to work the raw material into the finished part; (2) costing labor, burden, tooling, gaging, machinery, and equipment; (3) estimating facilities requirements for each production volume; and (4) considering suggestions for design and material alterations that could result in cost reduction.

REGIONAL ESTIMATION OF CURRENT AND FUTURE FOREST BIOMASS. (R828785)

EPA Science Inventory

The 90,674 wildland fires that burned 2.9 million ha at an estimated suppression cost of $1.6 billion in the United States during the 2000 fire season demonstrated that forest fuel loading has become a hazard to life, property, and ecosystem health as a result of past fire exc...

Utilization of BIM for automation of quantity takeoffs and cost estimation in transport infrastructure construction projects in the Czech Republic

NASA Astrophysics Data System (ADS)

Vitásek, Stanislav; Matějka, Petr

2017-09-01

The article deals with problematic parts of automated processing of quantity takeoff (QTO) from data generated in BIM model. It focuses on models of road constructions, and uses volumes and dimensions of excavation work to create an estimate of construction costs. The article uses a case study and explorative methods to discuss possibilities and problems of data transfer from a model to a price system of construction production when such transfer is used for price estimates of construction works. Current QTOs and price tenders are made with 2D documents. This process is becoming obsolete because more modern tools can be used. The BIM phenomenon enables partial automation in processing volumes and dimensions of construction units and matching the data to units in a given price scheme. Therefore price of construction can be estimated and structured without lengthy and often imprecise manual calculations. The use of BIM for QTO is highly dependent on local market budgeting systems, therefore proper push/pull strategy is required. It also requires proper requirements specification, compatible pricing database and software.

Analyzing the requirements for mass production of small wind turbine generators

NASA Astrophysics Data System (ADS)

Anuskiewicz, T.; Asmussen, J.; Frankenfield, O.

Mass producibility of small wind turbine generators to give manufacturers design and cost data for profitable production operations is discussed. A 15 kW wind turbine generator for production in annual volumes from 1,000 to 50,000 units is discussed. Methodology to cost the systems effectively is explained. The process estimate sequence followed is outlined with emphasis on the process estimate sheets compiled for each component and subsystem. These data enabled analysts to develop cost breakdown profiles crucial in manufacturing decision-making. The appraisal also led to various design recommendations including replacement of aluminum towers with cost effective carbon steel towers. Extensive cost information is supplied in tables covering subassemblies, capital requirements, and levelized energy costs. The physical layout of the plant is depicted to guide manufacturers in taking advantage of the growing business opportunity now offered in conjunction with the national need for energy development.

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2012-04-01

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

Costs of a school-based dental mobile service in South Africa.

PubMed

Molete, M P; Chola, L; Hofman, K J

2016-10-19

The burden of untreated tooth decay remains high and oral healthcare utilisation is low for the majority of children in South Africa. There is need for alternative methods of improving access to low cost oral healthcare. The mobile dental unit of the University of the Witwatersrand (Wits) has been operational for over 25 years, providing alternative oral healthcare to children and adults who otherwise would not have access. The aim of this study was to conduct a cost-analysis of a school based oral healthcare program in the Wits mobile dental unit. The objectives were to estimate the general costs of the school based program, costs of oral healthcare per patient and the economic implications of providing services at scale. In 2012, the Wits mobile dental unit embarked on a 5 month project to provide oral healthcare in four schools located around Johannesburg. Cost and service use data were retrospectively collected from the program records for the cost analysis, which was undertaken from a provider perspective. The costs considered included both financial and economic costs. Capital costs were annualised and discounted at 6 %. One way sensitivity tests were conducted for uncertain parameters. The total economic costs were R813.701 (US$76,048). The cost of screening and treatment per patient were R331 (US$31) and R743 (US$69) respectively. Furthermore, fissure sealants cost the least out of the treatments provided. The sensitivity analysis indicated that the Wits mobile dental unit was cost efficient at 25 % allocation of staff time and that a Dental Therapy led service could save costs by 9.1 %. Expanding the services to a wider population of children and utilising Dental Therapists as key personnel could improve the efficiency of mobile dental healthcare provision.

Flood control surveys in the northeast

Treesearch

Arthur Bevan

1947-01-01

Floods are a grave danger to our Nation's resources. It is estimated that floods cost the United States at least $100 million every year. The recent Mississippi floods, which dramatically brought the seriousness of the situation to public attention, cost half a billion dollars in direct-damages. The Northeast carries a heavy burden of flood losses. In 1936, floods...

A Fresh Look at the Benefits and Costs of the US Acid Rain Program

EPA Science Inventory

The US Acid Rain Program (Title IV of the 1990 Clean Air Act Amendments) has achieved substantial reductions in emissions of sulfur dioxide (SO2) and nitrogen oxides (NOx) from power plants in the United States. We compare new estimates of the benefits and costs of Title IV to th...

Predicting the economic costs and property value losses attributed to sudden oak death damage in California (2010-2020)

Treesearch

Kent Kovacs; Tomas Václavík; Robert G. Haight; Arwin Pang; Nik J. Cunniffe; Christopher A. Gilligan; Ross K. Meentemeyer

2011-01-01

Phytophthora ramorum, cause of sudden oak death, is a quarantined, non-native, invasive forest pathogen resulting in substantial mortality in coastal live oak (Quercus agrifolia) and several other related tree species on the Pacific Coast of the United States. We estimate the discounted cost of oak treatment, removal, and...

Global Hawk: Root Cause Analysis of Projected Unit Cost Growth

DTIC Science & Technology

2011-05-01

December 2009 Selected Acquisition Report (SAR), an Initial Operational Test & v Evaluation (“ IOT &E Phase II”) was planned for July–October 2010. The...PAT & mod facility 8% Diminishing Mfg Sources 3% “ IOT &E Replan” 3% ASIP calibration facility 1% Revised Cost Estimates Missing CDD Content...Diminishing Manufacturing Sources (DMS) ..............................................20 j. “ IOT &E Replan

Understanding and Measuring the Cost of Foster Family Care.

ERIC Educational Resources Information Center

Culley, James D.; And Others

This report presents an instrument for estimating the direct and indirect costs of raising foster children in different regions of the United States. It also contains three primary research studies on foster care delivery systems, an in-depth study of foster parents in Delaware, a summary of major differences and similarities in payment systems,…

A travel cost analysis of nonconsumptive wildlife-associated recreation in the United States

Treesearch

William T. Zawacki; Allan Marsinko; J. Michael Bowker

2000-01-01

Increased emphasis on sustainable resource management in forestry has effectuated a demand for various nontimber values. Nonconsumptive wildlife recreation is an important nontimber service produced on forest and rangeland. Travel cost models and data from the 1991 National Survey of Fishing, Hunting and Wildlife-Associated Recreation are used to estimate the demand...

Efficiency, Costs, Rankings and Heterogeneity: The Case of US Higher Education

ERIC Educational Resources Information Center

Agasisti, Tommaso; Johnes, Geraint

2015-01-01

Among the major trends in the higher education (HE) sector, the development of rankings as a policy and managerial tool is of particular relevance. However, despite the diffusion of these instruments, it is still not clear how they relate with traditional performance measures, like unit costs and efficiency scores. In this paper, we estimate a…

24 CFR 15.110 - What fees will HUD charge?

Code of Federal Regulations, 2013 CFR

2013-04-01

... duplicating machinery. The computer run time includes the cost of operating a central processing unit for that... Applies. (6) Computer run time (includes only mainframe search time not printing) The direct cost of... estimated fee is more than $250.00 or you have a history of failing to pay FOIA fees to HUD in a timely...

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study.

PubMed

Toscano, Cristiana M; Sugita, Tatiana H; Rosa, Michelle Q M; Pedrosa, Hermelinda C; Rosa, Roger Dos S; Bahia, Luciana R

2018-01-08

The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.

Economic analysis of biomass gasification for generating electricity in rural areas in Indonesia

NASA Astrophysics Data System (ADS)

Susanto, H.; Suria, T.; Pranolo, S. H.

2018-03-01

The gaseous fuel from biomass gasification might reduce the consumption of diesel fuel by 70%. The investment cost of the whole unit with a capacity of 45 kWe was about IDR 220 million in 2008 comprised of 24% for gasification unit, 54% for diesel engine and electric generator, 22% for transportation of the whole unit from Bandung to the site in South Borneo. The gasification unit was made in local workshop in Bandung, while the diesel-generator was purchased also in a local market. To anticipate the development of biomass based electricity in remote areas, an economic analysis has been made for implementations in 2019. A specific investment cost of 600 USD/kW has been estimated taking account to the escalation and capacity factors. Using a discounted factor of 11% and biomass cost in the range of 0.03-0.07 USD/kg, the production cost of electricity would be in the range of 0.09-0.16 USD/kWh. This production cost was lower than that of diesel engine fueled with full oil commonly implemented in many remote areas in Indonesia at this moment. This production cost was also lower than the Feed in Tariff in some regions established by Indonesian government in 2017.

[Opportunity cost for men who visit family medicine units in the city of Querétaro, Mexico].

PubMed

Martínez Carranza, Edith Olimpia; Villarreal Ríos, Enrique; Vargas Daza, Emma Rosa; Galicia Rodríguez, Liliana; Martínez González, Lidia

2010-12-01

To determine the opportunity cost for men who seek care in the family medicine units (FMU) of the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) in the city of Querétaro. A sample was selected of 807 men, ages 20 to 59 years, who sought care through the family medicine, laboratory, and pharmacy services provided by the FMU at the IMSS in Querétaro. Patients referred for emergency services and those who left the facilities without receiving care were excluded. The sample (n = 807) was calculated using the averages for an infinite population formula, with a confidence interval of 95% (CI95%) and an average opportunity cost of US$5.5 for family medicine, US$3.1 for laboratory services, and US$2.3 for pharmacy services. Estimates included the amount of time spent on travel, waiting, and receiving care; the number of people accompanying the patient, and the cost per minute of paid and unpaid job activities. The opportunity cost was calculated using the estimated cost per minute for travel, waiting, and receiving care for patients and their companions. The opportunity cost for the patient travel was estimated at US$0.97 (CI95%: 0.81-1.15), while wait time was US$5.03 (CI95%: 4.08-6.09) for family medicine, US$0.06 (CI95%: 0.05-0.08) for pharmacy services, and US$1.89 (CI95%: 1.56-2.25) for laboratory services. The average opportunity cost for an unaccompanied patient visit varied between US$1.10 for pharmacy services alone and US$8.64 for family medicine, pharmacy, and laboratory services. The weighted opportunity cost for family medicine was US$6.24. Given that the opportunity cost for men who seek services in FMU corresponds to more than half of a minimum salary, it should be examined from an institutional perspective whether this is the best alternative for care.

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

PubMed

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

2017-01-01

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

Estimated cost per HIV infection diagnosed through routine HIV testing offered in acute general medical admission units and general practice settings in England.

PubMed

Ong, K J; Thornton, A C; Fisher, M; Hutt, R; Nicholson, S; Palfreeman, A; Perry, N; Stedman-Bryce, G; Wilkinson, P; Delpech, V; Nardone, A

2016-04-01

Following national guidelines to expand HIV testing in high-prevalence areas in England, a number of pilot studies were conducted in acute general medical admission units (ACUs) and general practices (GPs) to assess the feasibility and acceptability of testing in these settings. The aim of this study was to estimate the cost per HIV infection diagnosed through routine HIV testing in these settings. Resource use data from four 2009/2010 Department of Health pilot studies (two ACUs; two GPs) were analysed. Data from the pilots were validated and supplemented with information from other sources. We constructed possible scenarios to estimate the cost per test carried out through expanded HIV testing in ACUs and GPs, and the cost per diagnosis. In the pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs, respectively. In scenario analyses we fixed offer time, diagnostic test cost and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40% for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000 tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed by either hospital consultants or GPs. Expanded HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of a shorter offer time, higher patient uptake, higher HIV positivity and lower diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV positivity, expanded HIV testing should be promoted in high HIV prevalence areas. © 2015 British HIV Association.

Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis

PubMed Central

Clarke, Philip M.; Glasziou, Paul; Patel, Anushka; Chalmers, John; Woodward, Mark; Harrap, Stephen B.; Salomon, Joshua A.

2010-01-01

Background Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries. Methods and Findings Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$), which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%–96% across regions) and lowest for nephropathy (15%–26%). The average numbers of days in hospital given at least one admission were greatest for stroke (17–32 d across region) and heart failure (16–31 d) and lowest for nephropathy (12–23 d). Considering regional differences, probabilities of hospitalization were lowest in Asia and highest in Established Market Economies; on the other hand, lengths of stay were highest in Asia and lowest in Established Market Economies. Overall estimated annual hospital costs for patients with none of the specified events or event histories ranged from Int$76 in Asia to Int$296 in Established Market Economies. All complications included in this analysis led to significant increases in hospital costs; coronary events, cerebrovascular events, and heart failure were the most costly, at more than Int$1,800, Int$3,000, and Int$4,000 in Asia, Eastern Europe, and Established Market Economies, respectively. Conclusions Major complications of diabetes significantly increase hospital use and costs across various settings and are likely to impose a high economic burden on health care systems. Please see later in the article for the Editors' Summary PMID:20186272

Costs of occupational injuries in construction in the United States.

PubMed

Waehrer, Geetha M; Dong, Xiuwen S; Miller, Ted; Haile, Elizabeth; Men, Yurong

2007-11-01

This paper presents costs of fatal and nonfatal injuries for the construction industry using 2002 national incidence data from the Bureau of Labor Statistics and a comprehensive cost model that includes direct medical costs, indirect losses in wage and household productivity, as well as an estimate of the quality of life costs due to injury. Costs are presented at the three-digit industry level, by worker characteristics, and by detailed source and event of injury. The total costs of fatal and nonfatal injuries in the construction industry were estimated at $11.5 billion in 2002, 15% of the costs for all private industry. The average cost per case of fatal or nonfatal injury is $27,000 in construction, almost double the per-case cost of $15,000 for all industry in 2002. Five industries accounted for over half the industry's total fatal and nonfatal injury costs. They were miscellaneous special trade contractors (SIC 179), followed by plumbing, heating and air-conditioning (SIC 171), electrical work (SIC 173), heavy construction except highway (SIC 162), and residential building construction (SIC 152), each with over $1 billion in costs.

Health care expenditures among elderly patients with epilepsy in the United States.

PubMed

Lekoubou, Alain; Bishu, Kinfe G; Ovbiagele, Bruce

2018-06-19

The purpose of this study was to evaluate health care expenditures among elderly patients with epilepsy in the United States. We performed an analysis of weighted 37 738 607 US participants aged 65 years to estimate health care expenditures in the elderly with and without epilepsy using the Medical Expenditure Panel Survey Household Component, with 2003-2014 data. Unadjusted health care expenditures were estimated. Independent health care expenditures were estimated, using a 2-part model. We identified 416 496 (1.1%) older individuals with epilepsy. Comorbidities were more prevalent among older individuals with epilepsy versus younger individuals. Mean unadjusted yearly medical cost of epilepsy in elderly patients with epilepsy was $18 712 (95% confidence interval [CI] = $15 947-$21 476) during the pooled period 2003-2014, which was nearly double the equivalent cost in elderly subjects without epilepsy at $10 168 (95% CI = $9925-$10 410). Mean unadjusted annual medical cost of epilepsy in the elderly increased by $2135 from $15 850 (95% CI = $10 668-$21 032) in 2003-2006 to $17 985 (95% CI = $13 710-$22 260) in 2011-2014. Adjusted mean total health care expenditures per person per year for elderly patients with epilepsy were $12 526 in 2003-2006, $13 423 in 2007-2010, and $10 569 in 2011-2014. Adjusted incremental health care costs associated with epilepsy in the elderly accrued by $4595 (95% CI = $2399-$6791) when compared to elderly subjects without epilepsy. We estimated the mean annual aggregate cost of epilepsy at $7.8 billion to the US population. Epilepsy is common among elderly individuals, and health care expenditures among this growing group are 2 times higher than in those without epilepsy. Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.

The use of the transition cost accounting system in health services research

PubMed Central

Azoulay, Arik; Doris, Nadine M; Filion, Kristian B; Caron, Joanna; Pilote, Louise; Eisenberg, Mark J

2007-01-01

The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States to calculate the costs of patient care. Our objectives were to review the use of hospital-based cost accounting systems to measure costs of treatment and discuss potential use of the Transition cost accounting system in health services research. Such systems provide internal reports to administrators for formulating major policies and strategic plans for future activities. Our review suggests that the Transition cost accounting information system may useful for estimating in-hospital costs of treatment. PMID:17686148

The use of the transition cost accounting system in health services research.

PubMed

Azoulay, Arik; Doris, Nadine M; Filion, Kristian B; Caron, Joanna; Pilote, Louise; Eisenberg, Mark J

2007-08-08

The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States to calculate the costs of patient care. Our objectives were to review the use of hospital-based cost accounting systems to measure costs of treatment and discuss potential use of the Transition cost accounting system in health services research. Such systems provide internal reports to administrators for formulating major policies and strategic plans for future activities. Our review suggests that the Transition cost accounting information system may useful for estimating in-hospital costs of treatment.

Coal supply and cost under technological and environmental uncertainty

NASA Astrophysics Data System (ADS)

Chan, Melissa

This thesis estimates available coal resources, recoverability, mining costs, environmental impacts, and environmental control costs for the United States under technological and environmental uncertainty. It argues for a comprehensive, well-planned research program that will resolve resource uncertainty, and innovate new technologies to improve recovery and environmental performance. A stochastic process and cost (constant 2005) model for longwall, continuous, and surface mines based on current technology and mining practice data was constructed. It estimates production and cost ranges within 5-11 percent of 2006 prices and production rates. The model was applied to the National Coal Resource Assessment. Assuming the cheapest mining method is chosen to extract coal, 250-320 billion tons are recoverable. Two-thirds to all coal resource can be mined at a cost less than 4/mmBTU. If U.S. coal demand substantially increases, as projected by alternate Energy Information Administration (EIA), resources might not last more than 100 years. By scheduling cost to meet EIA projected demand, estimated cost uncertainty increases over time. It costs less than 15/ton to mine in the first 10 years of a 100 year time period, 10-30/ton in the following 50 years, and 15-$90/ton thereafter. Environmental impacts assessed are subsidence from underground mines, surface mine pit area, erosion, acid mine drainage, air pollutant and methane emissions. The analysis reveals that environmental impacts are significant and increasing as coal demand increases. Control technologies recommended to reduce these impacts are backfilling underground mines, surface pit reclamation, substitution of robotic underground mining systems for surface pit mining, soil replacement for erosion, placing barriers between exposed coal and the elements to avoid acid formation, and coalbed methane development to avoid methane emissions during mining. The costs to apply these technologies to meet more stringent environmental regulation scenarios are estimated. The results show that the cost of meeting these regulatory scenarios could increase mining costs two to six times the business as usual cost, which could significantly affect the cost of coal-powered electricity generation. This thesis provides a first estimate of resource availability, mining cost, and environmental impact assessment and cost analysis. Available resource is not completely reported, so the available estimate is lower than actual resource. Mining costs are optimized, so provide a low estimate of potential costs. Environmental impact estimates are on the high end of potential impact that may be incurred because it is assumed that impact is unavoidable. Control costs vary. Estimated cost to control subsidence and surface mine pit impacts are suitable estimates of the cost to reduce land impacts. Erosion control and robotic mining system costs are lower, and methane and acid mine drainage control costs are higher, than they may be in the case that these impacts must be reduced.

2013 Cost of Wind Energy Review

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

Mone, C.; Smith, A.; Maples, B.

2015-02-01

This report uses representative project types to estimate the levelized cost of wind energy (LCOE) in the United States for 2013. Scheduled to be published on an annual basis, it relies on both market and modeled data to maintain a current understanding of wind generation cost trends and drivers. It is intended to provide insight into current component-level costs and a basis for understanding current component-level costs and a basis for understanding variability in the LCOE across the industry. Data and tools developed from this analysis are used to inform wind technology cost projections, goals, and improvement opportunities.

1170 MW/sub t/ HTGR steamer cogeneration plant: design and cost study

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

None

A conceptual design and cost study is presented for intermediate size high temperature gas-cooled reactor (HTGR) for industrial energy applications performed by United Engineers and Constructors Inc., (UE and C) and The General Atomic Company (GAC). The study is part of a program at ORNL and has the objective to provide support in the evaluation of the technical and economic feasibility of a single unit 1170 MW/sub t/ HTGR steam cycle cogeneration plant (referred to as the Steamer plant) for the production of industrial process energy. Inherent in the achievement of this objective, it was essential to perform a numbermore » of basic tasks such as the development of plant concept, capital cost estimate, project schedule and annual operation and maintenance (O and M) cost.« less

Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system.

PubMed

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.

Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique

PubMed Central

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.

PubMed

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.

Hydroxyurea is associated with lower costs of care of young children with sickle cell anemia.

PubMed

Wang, Winfred C; Oyeku, Suzette O; Luo, Zhaoyu; Boulet, Sheree L; Miller, Scott T; Casella, James F; Fish, Billie; Thompson, Bruce W; Grosse, Scott D

2013-10-01

In the BABY HUG trial, young children with sickle cell anemia randomized to receive hydroxyurea had fewer episodes of pain, hospitalization, and transfusions. With anticipated broader use of hydroxyurea in this population, we sought to estimate medical costs of care in treated versus untreated children. The BABY HUG database was used to compare inpatient events in subjects receiving hydroxyurea with those receiving placebo. Unit costs were estimated from the 2009 MarketScan Multi-state Medicaid Database for children with sickle cell disease, aged 1 to 3 years. Inpatient costs were based on length of hospital stay, modified by the occurrence of acute chest syndrome, splenic sequestration, or transfusion. Outpatient expenses were based on the schedule required for BABY HUG and a "standard" schedule for 1- to 3-year-olds with sickle cell anemia. There were 232 hospitalizations in the subjects receiving hydroxyurea and 324 in those on placebo; length of hospital stay was similar in the 2 groups. Estimated outpatient expenses were greater in those receiving hydroxyurea, but these were overshadowed by inpatient costs. The total estimated annual cost for those on hydroxyurea ($11 072) was 21% less than the cost of those on placebo ($13 962; P = .038). Savings on inpatient care resulted in a significantly lower overall estimated medical care cost for young children with sickle cell anemia who were receiving hydroxyurea compared with those receiving placebo. Because cost savings are likely to increase with age, these data provide additional support for broad use of hydroxyurea treatment in this population.

Hydroxyurea Is Associated With Lower Costs of Care of Young Children With Sickle Cell Anemia

PubMed Central

Oyeku, Suzette O.; Luo, Zhaoyu; Boulet, Sheree L.; Miller, Scott T.; Casella, James F.; Fish, Billie; Thompson, Bruce W.; Grosse, Scott D.

2013-01-01

BACKGROUND AND OBJECTIVE: In the BABY HUG trial, young children with sickle cell anemia randomized to receive hydroxyurea had fewer episodes of pain, hospitalization, and transfusions. With anticipated broader use of hydroxyurea in this population, we sought to estimate medical costs of care in treated versus untreated children. METHODS: The BABY HUG database was used to compare inpatient events in subjects receiving hydroxyurea with those receiving placebo. Unit costs were estimated from the 2009 MarketScan Multi-state Medicaid Database for children with sickle cell disease, aged 1 to 3 years. Inpatient costs were based on length of hospital stay, modified by the occurrence of acute chest syndrome, splenic sequestration, or transfusion. Outpatient expenses were based on the schedule required for BABY HUG and a “standard” schedule for 1- to 3-year-olds with sickle cell anemia. RESULTS: There were 232 hospitalizations in the subjects receiving hydroxyurea and 324 in those on placebo; length of hospital stay was similar in the 2 groups. Estimated outpatient expenses were greater in those receiving hydroxyurea, but these were overshadowed by inpatient costs. The total estimated annual cost for those on hydroxyurea ($11 072) was 21% less than the cost of those on placebo ($13 962; P = .038). CONCLUSIONS: Savings on inpatient care resulted in a significantly lower overall estimated medical care cost for young children with sickle cell anemia who were receiving hydroxyurea compared with those receiving placebo. Because cost savings are likely to increase with age, these data provide additional support for broad use of hydroxyurea treatment in this population. PMID:23999955

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs.

PubMed Central

Hirth, R A; Held, P J; Orzol, S M; Dor, A

1999-01-01

OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement. PMID:10029498

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs.

PubMed

Hirth, R A; Held, P J; Orzol, S M; Dor, A

1999-02-01

To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement.

Estimating the impact of adopting the revised United Kingdom acetaminophen treatment nomogram in the U.S. population.

PubMed

Levine, Michael; Stellpflug, Sam; Pizon, Anthony F; Traub, Stephen; Vohra, Rais; Wiegand, Timothy; Traub, Nicole; Tashman, David; Desai, Shoma; Chang, Jamie; Nathwani, Dhruv; Thomas, Stephen

2017-07-01

Acetaminophen toxicity is common in clinical practice. In recent years, several European countries have lowered the treatment threshold, which has resulted in increased number of patients being treated at a questionable clinical benefit. The primary objective of this study is to estimate the cost and associated burden to the United States (U.S.) healthcare system, if such a change were adopted in the U.S. This study is a retrospective review of all patients age 14 years or older who were admitted to one of eight different hospitals located throughout the U.S. with acetaminophen exposures during a five and a half year span, encompassing from 1 January 2008 to 30 June 2013. Those patients who would be treated with the revised nomogram, but not the current nomogram were included. The cost of such treatment was extrapolated to a national level. 139 subjects were identified who would be treated with the revised nomogram, but not the current nomogram. Extrapolating these numbers nationally, an additional 4507 (95%CI 3641-8751) Americans would be treated annually for acetaminophen toxicity. The cost of lowering the treatment threshold is estimated to be $45 million (95%CI 36,400,000-87,500,000) annually. Adopting the revised treatment threshold in the U.S. would result in a significant cost, yet provide an unclear clinical benefit.

The cost of atrial fibrillation in Italy: a five-year analysis of healthcare expenditure in the general population. From the Italian Survey of Atrial Fibrillation Management (ISAF) study.

PubMed

Zoni Berisso, M; Landolina, M; Ermini, G; Parretti, D; Zingarini, G L; Degli Esposti, L; Cricelli, C; Boriani, G

2017-01-01

Atrial fibrillation (AF) is a relevant item of expenditure for the National Healthcare systems. The aim of the study was to estimate the annual costs of AF in Italy. The Italian Survey of Atrial Fibrillation Management Study enrolled 6.036 patients with AF among 295.906 subjects representative of the Italian population. Data were collected by 233 General Practitioners (GPs) distributed across Italy. Quantities of resources used during the 5 years preceding the ISAF screening were inferred from the survey data and multiplied by the current Italian unit costs of 2015 in order to estimate the mean per patient annual cumulative cost of AF. Patients were subdivided on the basis of the number of hospitalizations, invasive/non-invasive diagnostic tests and invasive therapeutic procedures in 3 different clinical subsets: "low cost", " medium cost" and "high cost clinical scenario". The estimated mean costs per patient per year were 613 €, 891 € and 1213 € for the "Low cost", "Medium cost" and "High Cost Clinical Scenario" respectively. Hospitalizations and inpatient interventional procedures accounted for more than 80% of the cumulative annual costs. The mean annual costs among patients pursuing "Rhythm control" strategy was 956 €. In Italy, the estimated costs of AF per patient per year are lower than those reported in other developed countries and vary widely related to the different characteristics of AF patients. Hospitalizations and interventional procedures are the main drivers of costs. The mean annual cost of AF is mainly influenced by the duration of the period of observation and the patients' characteristics. Measures to reduce hospitalizations are needed.

Total and state-specific medical and absenteeism costs of COPD among adults aged ≥ 18 years in the United States for 2010 and projections through 2020.

PubMed

Ford, Earl S; Murphy, Louise B; Khavjou, Olga; Giles, Wayne H; Holt, James B; Croft, Janet B

2015-01-01

COPD remains a leading cause of morbidity and mortality. The objectives of this study were to estimate (1) national US COPD-attributable annual medical costs by payer (direct) and absenteeism (indirect) in 2010 and projected medical costs through 2020 and (2) state-specific COPD-attributable medical and absenteeism costs in 2010. We used the 2006-2010 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, and 2010 Centers for Medicare and Medicaid Services data to generate cost estimates and 2010 census data to project medical costs through 2020. In 2010, total national medical costs attributable to COPD and its sequelae were estimated at $32.1 billion, and total absenteeism costs were $3.9 billion, for a total burden of COPD-attributable costs of $36 billion. An estimated 16.4 million days of work were lost because of COPD. Of the medical costs, 18% was paid for by private insurance, 51% by Medicare, and 25% by Medicaid. National medical costs are projected to increase from $32.1 billion in 2010 to $49.0 billion in 2020. Total state-specific costs in 2010 ranged from $49.1 million in Wyoming to $2.8 billion in California: medical costs ranged from $42.5 million in Alaska to $2.5 billion in Florida and absenteeism costs ranged from $8.4 million in Wyoming to $434.0 million in California. Costs attributable to COPD and its sequelae are substantial and are projected to increase through 2020. Evidence-based interventions that prevent tobacco use and reduce the clinical complications of COPD may result in potential decreased COPD-attributable costs.

Estimating the returns to United Kingdom publicly funded musculoskeletal disease research in terms of net value of improved health outcomes.

PubMed

Glover, Matthew; Montague, Erin; Pollitt, Alexandra; Guthrie, Susan; Hanney, Stephen; Buxton, Martin; Grant, Jonathan

2018-01-10

Building on an approach applied to cardiovascular and cancer research, we estimated the economic returns from United Kingdom public- and charitable-funded musculoskeletal disease (MSD) research that arise from the net value of the improved health outcomes in the United Kingdom. To calculate the economic returns from MSD-related research in the United Kingdom, we estimated (1) the public and charitable expenditure on MSD-related research in the United Kingdom between 1970 and 2013; (2) the net monetary benefit (NMB), derived from the health benefit in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of £25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1994 to 2013; (3) the proportion of NMB attributable to United Kingdom research; and (4) the elapsed time between research funding and health gain. The data collected from these four key elements were used to estimate the internal rate of return (IRR) from MSD-related research investments on health benefits. We analysed the uncertainties in the IRR estimate using a one-way sensitivity analysis. Expressed in 2013 prices, total expenditure on MSD-related research from 1970 to 2013 was £3.5 billion, and for the period used to estimate the rate of return, 1978-1997, was £1.4 billion. Over the period 1994-2013 the key interventions analysed produced 871,000 QALYs with a NMB of £16 billion, allowing for the net NHS costs resulting from them and valuing a QALY at £25,000. The proportion of benefit attributable to United Kingdom research was 30% and the elapsed time between funding and impact of MSD treatments was 16 years. Our best estimate of the IRR from MSD-related research was 7%, which is similar to the 9% for CVD and 10% for cancer research. Our estimate of the IRR from the net health gain to public and charitable funding of MSD-related research in the United Kingdom is substantial, and justifies the research investments made between 1978 and 1997. We also demonstrated the applicability of the approach previously used in assessing the returns from cardiovascular and cancer research. Inevitably, with a study of this kind, there are a number of important assumptions and caveats that we highlight, and these can inform future research.

Costs and cost-effectiveness of HIV community services: quantity and quality of studies published 1986-2011.

PubMed

Beck, Eduard J; Fasawe, Olufunke; Ongpin, Patricia; Ghys, Peter; Avilla, Carlos; De Lay, Paul

2013-06-01

Community services comprise an important part of a country's HIV response. English language cost and cost-effectiveness studies of HIV community services published between 1986 and 2011 were reviewed but only 74 suitable studies were identified, 66% of which were performed in five countries. Mean study scores by continent varied from 42 to 69% of the maximum score, reflecting variation in topics covered and the quality of coverage: 38% of studies covered key and 11% other vulnerable populations - a country's response is most effective and efficient if these populations are identified given they are key to a successful response. Unit costs were estimated using different costing methods and outcomes. Community services will need to routinely collect and analyze information on their use, cost, outcome and impact using standardized costing methods and outcomes. Cost estimates need to be disaggregated into relevant cost items and stratified by severity and existing comorbidities. Expenditure tracking and costing of services are complementary aspects of the health sector 'resource cycle' that feed into a country's investment framework and the development and implementation of national strategic plans.

Estimating the variable cost for high-volume and long-haul transportation of densified biomass and biofuel

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

Jacob J. Jacobson; Erin Searcy; Md. S. Roni

This article analyzes rail transportation costs of products that have similar physical properties as densified biomass and biofuel. The results of this cost analysis are useful to understand the relationship and quantify the impact of a number of factors on rail transportation costs of denisfied biomass and biofuel. These results will be beneficial and help evaluate the economic feasibility of high-volume and long-haul transportation of biomass and biofuel. High-volume and long-haul rail transportation of biomass is a viable transportation option for biofuel plants, and for coal plants which consider biomass co-firing. Using rail optimizes costs, and optimizes greenhouse gas (GHG)more » emissions due to transportation. Increasing bioenergy production would consequently result in lower GHG emissions due to displacing fossil fuels. To estimate rail transportation costs we use the carload waybill data, provided by Department of Transportation’s Surface Transportation Board for products such as grain and liquid type commodities for 2009 and 2011. We used regression analysis to quantify the relationship between variable transportation unit cost ($/ton) and car type, shipment size, rail movement type, commodity type, etc. The results indicate that: (a) transportation costs for liquid is $2.26/ton–$5.45/ton higher than grain type commodity; (b) transportation costs in 2011 were $1.68/ton–$5.59/ton higher than 2009; (c) transportation costs for single car shipments are $3.6/ton–$6.68/ton higher than transportation costs for multiple car shipments of grains; (d) transportation costs for multiple car shipments are $8.9/ton and $17.15/ton higher than transportation costs for unit train shipments of grains.« less

Time-driven activity-based costing to estimate cost of care at multidisciplinary aerodigestive centers.

PubMed

Garcia, Jordan A; Mistry, Bipin; Hardy, Stephen; Fracchia, Mary Shannon; Hersh, Cheryl; Wentland, Carissa; Vadakekalam, Joseph; Kaplan, Robert; Hartnick, Christopher J

2017-09-01

Providing high-value healthcare to patients is increasingly becoming an objective for providers including those at multidisciplinary aerodigestive centers. Measuring value has two components: 1) identify relevant health outcomes and 2) determine relevant treatment costs. Via their inherent structure, multidisciplinary care units consolidate care for complex patients. However, their potential impact on decreasing healthcare costs is less clear. The goal of this study was to estimate the potential cost savings of treating patients with laryngeal clefts at multidisciplinary aerodigestive centers. Retrospective chart review. Time-driven activity-based costing was used to estimate the cost of care for patients with laryngeal cleft seen between 2008 and 2013 at the Massachusetts Eye and Ear Infirmary Pediatric Aerodigestive Center. Retrospective chart review was performed to identify clinic utilization by patients as well as patient diet outcomes after treatment. Patients were stratified into neurologically complex and neurologically noncomplex groups. The cost of care for patients requiring surgical intervention was five and three times as expensive of the cost of care for patients not requiring surgery for neurologically noncomplex and complex patients, respectively. Following treatment, 50% and 55% of complex and noncomplex patients returned to normal diet, whereas 83% and 87% of patients experienced improved diets, respectively. Additionally, multidisciplinary team-based care for children with laryngeal clefts potentially achieves 20% to 40% cost savings. These findings demonstrate how time-driven activity-based costing can be used to estimate and compare patient costs in multidisciplinary aerodigestive centers. 2c. Laryngoscope, 127:2152-2158, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Estimating the value of a Country's built assets: investment-based exposure modelling for global risk assessment

NASA Astrophysics Data System (ADS)

Daniell, James; Pomonis, Antonios; Gunasekera, Rashmin; Ishizawa, Oscar; Gaspari, Maria; Lu, Xijie; Aubrecht, Christoph; Ungar, Joachim

2017-04-01

In order to quantify disaster risk, there is a demand and need for determining consistent and reliable economic value of built assets at national or sub national level exposed to natural hazards. The value of the built stock in the context of a city or a country is critical for risk modelling applications as it allows for the upper bound in potential losses to be established. Under the World Bank probabilistic disaster risk assessment - Country Disaster Risk Profiles (CDRP) Program and rapid post-disaster loss analyses in CATDAT, key methodologies have been developed that quantify the asset exposure of a country. In this study, we assess the complementary methods determining value of building stock through capital investment data vs aggregated ground up values based on built area and unit cost of construction analyses. Different approaches to modelling exposure around the world, have resulted in estimated values of built assets of some countries differing by order(s) of magnitude. Using the aforementioned methodology of comparing investment data based capital stock and bottom-up unit cost of construction values per square meter of assets; a suitable range of capital stock estimates for built assets have been created. A blind test format was undertaken to compare the two types of approaches from top-down (investment) and bottom-up (construction cost per unit), In many cases, census data, demographic, engineering and construction cost data are key for bottom-up calculations from previous years. Similarly for the top-down investment approach, distributed GFCF (Gross Fixed Capital Formation) data is also required. Over the past few years, numerous studies have been undertaken through the World Bank Caribbean and Central America disaster risk assessment program adopting this methodology initially developed by Gunasekera et al. (2015). The range of values of the building stock is tested for around 15 countries. In addition, three types of costs - Reconstruction cost (building back to the standard required by building codes); Replacement cost (gross capital stock) and Book value (net capital stock - depreciated value of assets) are discussed and the differences in methodologies assessed. We then examine historical costs (reconstruction and replacement) and losses (book value) of natural disasters versus this upper bound of capital stock in various locations to examine the impact of a reasonable capital stock estimate. It is found that some historic loss estimates in publications are not reasonable given the value of assets at the time of the event. This has applications for quantitative disaster risk assessment and development of country disaster risk profiles, economic analyses and benchmarking upper loss limits of built assets damaged due to natural hazards.

Economics of Malignant Gliomas: A Critical Review

PubMed Central

Raizer, Jeffrey J.; Fitzner, Karen A.; Jacobs, Daniel I.; Bennett, Charles L.; Liebling, Dustin B.; Luu, Thanh Ha; Trifilio, Steven M.; Grimm, Sean A.; Fisher, Matthew J.; Haleem, Meraaj S.; Ray, Paul S.; McKoy, Judith M.; DeBoer, Rebecca; Tulas, Katrina-Marie E.; Deeb, Mohammed; McKoy, June M.

2015-01-01

Purpose: Approximately 18,500 persons are diagnosed with malignant glioma in the United States annually. Few studies have investigated the comprehensive economic costs. We reviewed the literature to examine costs to patients with malignant glioma and their families, payers, and society. Methods: A total of 18 fully extracted studies were included. Data were collected on direct and indirect costs, and cost estimates were converted to US dollars using the conversion rate calculated from the study's publication date, and updated to 2011 values after adjustment for inflation. A standardized data abstraction form was used. Data were extracted by one reviewer and checked by another. Results: Before approval of effective chemotherapeutic agents for malignant gliomas, estimated total direct medical costs in the United States for surgery and radiation therapy per patient ranged from $50,600 to $92,700. The addition of temozolomide (TMZ) and bevacizumab to glioblastoma treatment regimens has resulted in increased overall costs for glioma care. Although health care costs are now less front-loaded, they have increased over the course of illness. Analysis using a willingness-to-pay threshold of $50,000 per quality-adjusted life-year suggests that the benefits of TMZ fall on the edge of acceptable therapies. Furthermore, indirect medical costs, such as productivity losses, are not trivial. Conclusion: With increased chemotherapy use for malignant glioma, the paradigm for treatment and associated out-of-pocket and total medical costs continue to evolve. Larger out-of-pocket costs may influence the choice of chemotherapeutic agents, the economic implications of which should be evaluated prospectively. PMID:25466707

Economics of Malignant Gliomas: A Critical Review.

PubMed

Raizer, Jeffrey J; Fitzner, Karen A; Jacobs, Daniel I; Bennett, Charles L; Liebling, Dustin B; Luu, Thanh Ha; Trifilio, Steven M; Grimm, Sean A; Fisher, Matthew J; Haleem, Meraaj S; Ray, Paul S; McKoy, Judith M; DeBoer, Rebecca; Tulas, Katrina-Marie E; Deeb, Mohammed; McKoy, June M

2015-01-01

Approximately 18,500 persons are diagnosed with malignant glioma in the United States annually. Few studies have investigated the comprehensive economic costs. We reviewed the literature to examine costs to patients with malignant glioma and their families, payers, and society. A total of 18 fully extracted studies were included. Data were collected on direct and indirect costs, and cost estimates were converted to US dollars using the conversion rate calculated from the study's publication date, and updated to 2011 values after adjustment for inflation. A standardized data abstraction form was used. Data were extracted by one reviewer and checked by another. Before approval of effective chemotherapeutic agents for malignant gliomas, estimated total direct medical costs in the United States for surgery and radiation therapy per patient ranged from $50,600 to $92,700. The addition of temozolomide (TMZ) and bevacizumab to glioblastoma treatment regimens has resulted in increased overall costs for glioma care. Although health care costs are now less front-loaded, they have increased over the course of illness. Analysis using a willingness-to-pay threshold of $50,000 per quality-adjusted life-year suggests that the benefits of TMZ fall on the edge of acceptable therapies. Furthermore, indirect medical costs, such as productivity losses, are not trivial. With increased chemotherapy use for malignant glioma, the paradigm for treatment and associated out-of-pocket and total medical costs continue to evolve. Larger out-of-pocket costs may influence the choice of chemotherapeutic agents, the economic implications of which should be evaluated prospectively. Copyright © 2015 by American Society of Clinical Oncology.

From the ground up: groundwater, surface water runoff, and air as pathogen routes for food contamination

USDA-ARS?s Scientific Manuscript database

Foodborne infectious disease transmission of 31 pathogen types is estimated to account for 9.4 million illnesses, 56,000 hospitalizations, and 1,300 deaths in the United States annually (Scallan et al. 2011). The economic costs from foodborne illness in the United States are more than $50 billion pe...

Economic Impacts of Non-Native Forest Insects in the Continental United States

Treesearch

Juliann E. Aukema; Brian Leung; Kent Kovacs; Corey Chivers; Jeffrey Englin; Susan J. Frankel; Robert G. Haight; Thomas P. Holmes; Andrew M. Liebhold; Deborah G. McCullough; Betsy Von Holle

2011-01-01

Reliable estimates of the impacts and costs of biological invasions are critical to developing credible management, trade and regulatory policies. Worldwide, forests and urban trees provide important ecosystem services as well as economic and social benefits, but are threatened by non-native insects. More than 450 non-native forest insects are established in the United...

Software Measurement Guidebook. Version 02.00.02

DTIC Science & Technology

1992-12-01

Compatibility Testing Process .............................. 9-5 Figure 9-3. Development Effort Planning Curve ................................. 9-7 Figure 10-1...requirements, design, code, and test and for analyzing this data. "* Proposal Manager. The person responsible for describing and supporting the estimated...designed, build/elease ranges, variances, and comparisons size growth; costs; completions; and content, units completing test , units with historical

Economic Analysis of Anatomic Plating Versus Tubular Plating for the Treatment of Fibula Fractures.

PubMed

Chang, Gerard; Bhat, Suneel B; Raikin, Steven M; Kane, Justin M; Kay, Andrew; Ahmad, Jamal; Pedowitz, David I; Krieg, James

2018-03-01

Ankle fractures are among the most common injuries requiring operative management. Implant choices include one-third tubular plates and anatomically precontoured plates. Although cadaveric studies have not revealed biomechanical differences between various plate constructs, there are substantial cost differences. This study sought to characterize the economic implications of implant choice. A retrospective review was undertaken of 201 consecutive patients with operatively treated OTA type 44B and 44C ankles. A Nationwide Inpatient Sample query was performed to estimate the incidence of ankle fractures requiring fibular plating, and a Monte Carlo simulation was conducted with the estimated at-risk US population for associated plate-specific costs. The authors estimated an annual incidence of operatively treated ankle fractures in the United States of 59,029. The average cost was $90.86 (95% confidence interval, $90.84-$90.87) for a one-third tubular plate vs $746.97 (95% confidence interval, $746.55-$747.39) for an anatomic plate. Across the United States, use of only one-third tubular plating over anatomic plating would result in statistically significant savings of $38,729,517 (95% confidence interval, $38,704,773-$38,754,261; P<.0001). General use of one-third tubular plating instead of anatomic plating whenever possible for fibula fractures could result in cost savings of up to nearly $40 million annually in the United States. Unless clinically justifiable on a per-case basis, or until the advent of studies showing substantial clinical benefit, there currently is no reason for the increased expense from widespread use of anatomic plating for fractures amenable to one-third tubular plating. [Orthopedics. 2018; 41(2):e252-e256.]. Copyright 2018, SLACK Incorporated.

Cancer Statistics

MedlinePlus

... 1,790 died of the disease. Estimated national expenditures for cancer care in the United States in 2017 were $147.3 billion. In future years, costs are likely to increase as the population ages and cancer prevalence increases. ...

10 CFR 455.112 - Davis-Bacon wage rate requirement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Applicant Responsibilities-Grants to... measure or group of measures in a building, funded under this part, has a total estimated cost for...

Econometrics of inventory holding and shortage costs: the case of refined gasoline

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

Krane, S.D.

1985-01-01

This thesis estimates a model of a firm's optimal inventory and production behavior in order to investigate the link between the role of inventories in the business cycle and the microeconomic incentives for holding stocks of finished goods. The goal is to estimate a set of structural cost function parameters that can be used to infer the optimal cyclical response of inventories and production to shocks in demand. To avoid problems associated with the use of value based aggregate inventory data, an industry level physical unit data set for refined motor gasoline is examined. The Euler equations for a refiner'smore » multiperiod decision problem are estimated using restrictions imposed by the rational expectations hypothesis. The model also embodies the fact that, in most periods, the level of shortages will be zero, and even when positive, the shortages are not directly observable in the data set. These two concerns lead us to use a generalized method of moments estimation technique on a functional form that resembles the formulation of a Tobit problem. The estimation results are disappointing; the model and data yield coefficient estimates incongruous with the cost function interpretations of the structural parameters. These is only some superficial evidence that production smoothing is significant and that marginal inventory shortage costs increase at a faster rate than do marginal holding costs.« less

Direct cost of pars plana vitrectomy for the treatment of macular hole, epiretinal membrane and vitreomacular traction: a bottom-up approach.

PubMed

Nicod, Elena; Jackson, Timothy L; Grimaccia, Federico; Angelis, Aris; Costen, Marc; Haynes, Richard; Hughes, Edward; Pringle, Edward; Zambarakji, Hadi; Kanavos, Panos

2016-11-01

The direct cost to the National Health Service (NHS) in England of pars plana vitrectomy (PPV) is unknown since a bottom-up costing exercise has not been undertaken. Healthcare resource group (HRG) costing relies on a top-down approach. We aimed to quantify the direct cost of intermediate complexity PPV. Five NHS vitreoretinal units prospectively recorded all consumables, equipment and staff salaries during PPV undertaken for vitreomacular traction, epiretinal membrane and macular hole. Out-of-surgery costs between admission and discharge were estimated using a representative accounting method. The average patient time in theatre for 57 PPVs was 72 min. The average in-surgery cost for staff was £297, consumables £619, and equipment £82 (total £997). The average out-of-surgery costs were £260, including nursing and medical staff, other consumables, eye drops and hospitalisation. The total cost was therefore £1634, including 30 % overheads. This cost estimate was an under-estimate because it did not include out-of-theatre consumables or equipment. The average reimbursed HRG tariff was £1701. The cost of undertaking PPV of intermediate complexity is likely to be higher than the reimbursed tariff, except for hospitals with high throughput, where amortisation costs benefit from economies of scale. Although this research was set in England, the methodology may provide a useful template for other countries.

The Economic Impact of Acetabular Labral Tears: A Cost-effectiveness Analysis Comparing Hip Arthroscopic Surgery and Structured Rehabilitation Alone in Patients Without Osteoarthritis.

PubMed

Lodhia, Parth; Gui, Chengcheng; Chandrasekaran, Sivashankar; Suarez-Ahedo, Carlos; Dirschl, Douglas R; Domb, Benjamin G

2016-07-01

Hip arthroscopic surgery has emerged as a successful procedure to manage acetabular labral tears and concurrent hip injuries, which if left untreated, may contribute to hip osteoarthritis (OA). Therefore, it is essential to analyze the economic impact of this treatment option. To investigate the cost-effectiveness of hip arthroscopic surgery versus structured rehabilitation alone for acetabular labral tears, to examine the effects of age on cost-effectiveness, and to estimate the rate of symptomatic OA and total hip arthroplasty (THA) in both treatment arms over a lifetime horizon. Economic and decision analysis; Level of evidence, 2. A cost-effectiveness analysis of hip arthroscopic surgery compared with structured rehabilitation for symptomatic labral tears was performed using a Markov decision model constructed over a lifetime horizon. It was assumed that patients did not have OA. Direct costs (in 2014 United States dollars), utilities of health states (in quality-adjusted life years [QALYs] gained), and probabilities of transitioning between health states were estimated from a comprehensive literature review. Costs were estimated using national averages of Medicare reimbursements, adjusted for all payers in the United States from a societal perspective. Utilities were estimated from the Harris Hip Score. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to determine the effect of uncertainty on the model outcomes. For a cohort representative of patients undergoing hip arthroscopic surgery at our facility, arthroscopic surgery was more costly (additional $2653) but generated more utility (additional 3.94 QALYs) compared with rehabilitation over a lifetime. The mean ICER was $754/QALY, well below the conventional willingness to pay of $50,000/QALY. Arthroscopic surgery was cost-effective for 94.5% of patients. Although arthroscopic surgery decreased in cost-effectiveness with increasing age, arthroscopic surgery remained more cost-effective than rehabilitation for patients in the second to seventh decades of life. The lifetime incidence of symptomatic hip OA was over twice as high for patients treated with rehabilitation compared with arthroscopic surgery. The preferred treatment was sensitive to the utility after successful hip arthroscopic surgery, although the utility at which arthroscopic surgery becomes less cost-effective than rehabilitation is far below our best estimate. For older patients, the lifetime cost of arthroscopic surgery was greater, while the lifetime utility of arthroscopic surgery was less, approaching that of the rehabilitation arm. Hip arthroscopic surgery is more cost-effective and results in a considerably lower incidence of symptomatic OA than structured rehabilitation alone in treating symptomatic labral tears of patients in the second to seventh decades of life without pre-existing OA. © 2016 The Author(s).

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

PubMed

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

2009-06-01

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

The cost of pressure ulcers in the United Kingdom.

PubMed

Dealey, C; Posnett, J; Walker, A

2012-06-01

To provide an estimate of the costs of treating pressure ulcers in the UK at August 2011 prices, as a means of highlighting the importance of pressure ulcer prevention. Resource use was derived from a bottom-up methodology, based on the daily resources required to deliver protocols of care reflecting good clinical practice, with prices reflecting costs to the health and social care system in the UK. This approach was used to estimate treatment costs per episode of care and per patient for ulcers of different severity and level of complications. The cost of treating a pressure ulcer varies from £1,214 (category 1) to £14,108 (category IV). Costs increase with ulcer severity because the time to heal is longer and the incidence of complications is higher in more severe cases. Pressure ulcers represent a significant cost burden in the UK, both to patients and to health-care providers. Without concerted effort, this cost is likely to increase in the future as the population ages. The estimates reported here provide a basis for assessment of the cost-effectiveness of measures to reduce the incidence of hospital-acquired ulcers. Heron Evidence Development Ltd. was funded for this work by Mölnlycke Health Care (UK). The authors have no other conflicts of interest to declare.

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

PubMed

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

2018-05-18

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

Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain.

PubMed

González-Ramallo, V J; Mirón-Rubio, M; Mujal, A; Estrada, O; Forné, C; Aragón, B; Rivera, A J

2017-07-01

The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189-7406]. The mean cost per OPAT episode was €1356 (95% CI €1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947-4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Estimating the benefits of public health policies that reduce harmful consumption.

PubMed

Ashley, Elizabeth M; Nardinelli, Clark; Lavaty, Rosemarie A

2015-05-01

For products such as tobacco and junk food, where policy interventions are often designed to decrease consumption, affected consumers gain utility from improvements in lifetime health and longevity but also lose utility associated with the activity of consuming the product. In the case of anti-smoking policies, even though published estimates of gross health and longevity benefits are up to 900 times higher than the net consumer benefits suggested by a more direct willingness-to-pay estimation approach, there is little recognition in the cost-benefit and cost-effectiveness literature that gross estimates will overstate intrapersonal welfare improvements when utility losses are not netted out. This paper presents a general framework for analyzing policies that are designed to reduce inefficiently high consumption and provides a rule of thumb for the relationship between net and gross consumer welfare effects: where there exists a plausible estimate of the tax that would allow consumers to fully internalize health costs, the ratio of the tax to the per-unit long-term cost can provide an upper bound on the ratio of net to gross benefits. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

United States biomass energy: An assessment of costs and infrastructure for alternative uses of biomass energy crops as an energy feedstock

NASA Astrophysics Data System (ADS)

Morrow, William Russell, III

Reduction of the negative environmental and human health externalities resulting from both the electricity and transportation sectors can be achieved through technologies such as clean coal, natural gas, nuclear, hydro, wind, and solar photovoltaic technologies for electricity; reformulated gasoline and other fossil fuels, hydrogen, and electrical options for transportation. Negative externalities can also be reduced through demand reductions and efficiency improvements in both sectors. However, most of these options come with cost increases for two primary reasons: (1) most environmental and human health consequences have historically been excluded from energy prices; (2) fossil energy markets have been optimizing costs for over 100 years and thus have achieved dramatic cost savings over time. Comparing the benefits and costs of alternatives requires understanding of the tradeoffs associated with competing technology and lifestyle choices. As bioenergy is proposed as a large-scale feedstock within the United States, a question of "best use" of bioenergy becomes important. Bioenergy advocates propose its use as an alternative energy resource for electricity generation and transportation fuel production, primarily focusing on ethanol. These advocates argue that bioenergy offers environmental and economic benefits over current fossil energy use in each of these two sectors as well as in the U.S. agriculture sector. Unfortunately, bioenergy research has offered very few comparisons of these two alternative uses. This thesis helps fill this gap. This thesis compares the economics of bioenergy utilization by a method for estimating total financial costs for each proposed bioenergy use. Locations for potential feedstocks and bio-processing facilities (co-firing switchgrass and coal in existing coal fired power plants and new ethanol refineries) are estimated and linear programs are developed to estimate large-scale transportation infrastructure costs for each sector. Each linear program minimizes required bioenergy distribution and infrastructure costs. Truck and rail are the only two transportation modes allowed as they are the most likely bioenergy transportation modes. Switchgrass is chosen as a single bioenergy feedstock. All resulting costs are presented in units which reflect current energy markets price norms (¢/kWh, $/gal). The use of a common metric, carbon-dioxide emissions, allows a comparison of the two proposed uses. Additional analysis is provided to address aspects of each proposed use which are not reflected by a carbon-dioxide reduction metric. (Abstract shortened by UMI.)

Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study.

PubMed

Lee, Kun Yun; Ong, Tiong Kiam; Low, Ee Vien; Liow, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng Bang; Ali, Rosli Mohd; Ismail, Omar; Ahmad, Wan Azman Wan; Said, Mas Ayu; Dahlui, Maznah

2017-05-28

Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability. This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates. Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions. The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded. The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost. The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost. Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations. Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A cross-national study of prescription nonadherence due to cost: data from the Joint Canada-United States Survey of Health.

PubMed

Kennedy, Jae; Morgan, Steve

2006-08-01

In Canada and the United States, patients who have difficulty paying for prescribed medications are less likely to obtain them and may experience increased risks for morbidity and mortality and/or increased health care costs due to nonadherence. As prescription drug costs have risen, the ability to pay for medications has emerged as a critical public health issue. The objectives of this study were to estimate the rates of cost-associated nonadherence in Canada and the United States, and to identify factors that predict cost-associated nonadherence in both countries. This original analysis used data from the 2002/2003 Joint Canada-US Survey of Health, a household phone survey jointly conducted by Statistics Canada (Ottawa, Ontario, Canada) and the US National Center for Health Statistics (Hyattsville, Maryland). The sample included 3505 adults in Canada and 5183 adults in the United States. Weighted group comparisons and logistic regression analyses were used to identify population factors predictive of cost-associated prescription nonadherence. Residents of Canada were much less likely than residents of the United States to report cost-associated nonadherence (5.1% vs 9.9%; P < 0.001). Americans without health insurance (28.2%) and Americans and Canadians without prescription-drug coverage (16.2%) were significantly more likely than those with insurance (6.2%) to report cost-associated nonadherence (P < 0.001). In addition to country of residence and insurance coverage, significant risk factors predictive of nonadherence were young age, poor health, chronic pain, and low household income. The results of this analysis suggest that people with low incomes and inadequate insurance, as well as those with poor health and/or chronic symptoms, are more likely to report failing to fill a prescription due to cost. The overall rate of cost-associated nonadherence was significantly higher in the United States than in Canada, even when other person-level factors were controlled for, including health insurance and prescription-drug coverage.

Cost-Effectiveness Analysis of Breast Cancer Control Interventions in Peru

PubMed Central

Zelle, Sten G.; Vidaurre, Tatiana; Abugattas, Julio E.; Manrique, Javier E.; Sarria, Gustavo; Jeronimo, José; Seinfeld, Janice N.; Lauer, Jeremy A.; Sepulveda, Cecilia R.; Venegas, Diego; Baltussen, Rob

2013-01-01

Objectives In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. Methods We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. Results The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Conclusions Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced. PMID:24349314

Unit Costing of Health Extension Worker Activities in Ethiopia: A Model for Managers at the District and Health Facility Level

PubMed Central

Canavan, Maureen E.; Linnander, Erika; Ahmed, Shirin; Mohammed, Halima; Bradley, Elizabeth H.

2018-01-01

Background: Over the last decade, Ethiopia has made impressive national improvements in health outcomes, including reductions in maternal, neonatal, infant, and child mortality attributed in large part to their Health Extension Program (HEP). As this program continues to evolve and improve, understanding the unit cost of health extension worker (HEW) services is fundamental to planning for future growth and ensuring adequate financial support to deliver effective primary care throughout the country. Methods: We sought to examine and report the data needed to generate a HEW fee schedule that would allow for full cost recovery for HEW services. Using HEW activity data and estimates from national studies and local systems we were able to estimate salary costs and the average time spent by an HEW per patient/community encounter for each type of services associated with specific users. Using this information, we created separate fee schedules for activities in urban and rural settings with two estimates of non-salary multipliers to calculate the total cost for HEW services. Results: In the urban areas, the HEW fees for full cost recovery of the provision of services (including salary, supplies, and overhead costs) ranged from 55.1 birr to 209.1 birr per encounter. The rural HEW fees ranged from 19.6 birr to 219.4 birr. Conclusion: Efforts to support health system strengthening in low-income settings have often neglected to generate adequate, actionable data on the costs of primary care services. In this study, we have combined time-motion and available financial data to generate a fee schedule that allows for full cost recovery of the provision of services through billable health education and service encounters provided by Ethiopian HEWs. This may be useful in other country settings where managers seek to make evidence-informed planning and resource allocation decisions to address high burden of disease within the context of weak administrative data systems and severe financial constraints. PMID:29764103

The cost-effectiveness of male HPV vaccination in the United States.

PubMed

Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Dunne, Eileen F; Markowitz, Lauri E

2011-10-26

The objective of this study was to estimate the cost-effectiveness of adding human papillomavirus (HPV) vaccination of 12-year-old males to a female-only vaccination program for ages 12-26 years in the United States. We used a simplified model of HPV transmission to estimate the reduction in the health and economic burden of HPV-associated diseases in males and females as a result of HPV vaccination. Estimates of the incidence, cost-per-case, and quality-of-life impact of HPV-associated health outcomes were based on the literature. The HPV-associated outcomes included were: cervical intraepithelial neoplasia (CIN); genital warts; juvenile-onset recurrent respiratory papillomatosis (RRP); and cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers. The cost-effectiveness of male vaccination depended on vaccine coverage of females. When including all HPV-associated outcomes in the analysis, the incremental cost per quality-adjusted life year (QALY) gained by adding male vaccination to a female-only vaccination program was $23,600 in the lower female coverage scenario (20% coverage at age 12 years) and $184,300 in the higher female coverage scenario (75% coverage at age 12 years). The cost-effectiveness of male vaccination appeared less favorable when compared to a strategy of increased female vaccination coverage. For example, we found that increasing coverage of 12-year-old girls would be more cost-effective than adding male vaccination even if the increased female vaccination strategy incurred program costs of $350 per additional girl vaccinated. HPV vaccination of 12-year-old males might potentially be cost-effective, particularly if female HPV vaccination coverage is low and if all potential health benefits of HPV vaccination are included in the analysis. However, increasing female coverage could be a more efficient strategy than male vaccination for reducing the overall health burden of HPV in the population. Published by Elsevier Ltd.

Cost-effectiveness analysis of breast cancer control interventions in Peru.

PubMed

Zelle, Sten G; Vidaurre, Tatiana; Abugattas, Julio E; Manrique, Javier E; Sarria, Gustavo; Jeronimo, José; Seinfeld, Janice N; Lauer, Jeremy A; Sepulveda, Cecilia R; Venegas, Diego; Baltussen, Rob

2013-01-01

In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.