[Cost per capita in outpatients by gender].

PubMed

Villarreal-Ríos, Enrique; Campos Esparza, Maribel; Galicia Rodríguez, Liliana; Martínez González, Lidia; Vargas Daza, Emma Rosa; Torres Labra, Guadalupe; Patiño Vega, Adolfo; Rivera Martínez, María Teresa; Aparicio Rojas, Raúl; Juárez Durán, Martín

2011-03-01

The objective of this study is to identify the annual cost per capita by gender in first level of attention. It is a cost study in Family Physician Units in Mexico. The information corresponded to the year of 2004 and the study divided in the use profile and cost attention. USE PROFILE OF SERVICES: it was studied 1,585 clinical registries of patients, use profile defined by average and attention reasons by department, gender and age group. COST ATTENTION: considered in American dollars it included fixed unit cost (departmentalization adjusted by productivity), variable unit cost (micro cost technical), department unite cost by type attention, and department unit cost by age and gender. The life expectancy was of 73 years for men and 78 for women. Three scenes were identified. The annual cost per capita is superior among woman [US$73.24 (IC 95% $11.38 - $197.49)] than in man [$ 53.11 (IC 95% 2.51 - 207.71)]. The conclusion found that in the first level of attention the cost per capita is greater in woman than in man.

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…

Cost Experience of Automated Guideway Transit Systems. (Supplement V) Costs and Trends for the Period 1976-1982.

DOT National Transportation Integrated Search

1984-04-01

This report summarizes the cost experiences and trends of sixteen domestic AGT systems. Capital costs, operation and maintenance costs, system characteristics, operational statistics, and unit cost measures are presented to provide useful information...

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

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

[Calculation of standardised unit costs from a societal perspective for health economic evaluation].

PubMed

Bock, J-O; Brettschneider, C; Seidl, H; Bowles, D; Holle, R; Greiner, W; König, H H

2015-01-01

Due to demographic aging, economic evaluation of health care technologies for the elderly becomes more important. A standardised questionnaire to measure the health-related resource utilisation has been designed. The monetary valuation of the resource use documented by the questionnaire is a central step towards the determination of the corresponding costs. The aim of this paper is to provide unit costs for the resources in the questionnaire from a societal perspective. The unit costs are calculated pragmatically based on regularly published sources. Thus, an easy update is possible. This paper presents the calculated unit costs for outpatient medical care, inpatient care, informal and formal nursing care and pharmaceuticals from a societal perspective. The calculated unit costs can serve as a reference case in health economic evaluations and hence help to increase their comparability. © Georg Thieme Verlag KG Stuttgart · New York.

[Costs and consumption of material resources in pediatric intensive and semi-intensive care units].

PubMed

Zuliani, Larissa Lenotti; Jericó, Marli de Carvalho; de Castro, Liliana Cristina; Soler, Zaida Aurora Sperli Geraldes

2012-01-01

Cost management of hospital material resources is a trendy research topic, especially in specialized health units. Nurses are pointed out as the main managers for costs and consumption of hospital materials resources. This study aimed to characterize Pediatric Intensive and Semi-Intensive Care Units of a teaching hospital and investigate costs and consumption of material resources used to treat patients admitted to these units. This is a descriptive exploratory study with retrospective data and quantitative approach. Data were obtained from a Hospital Information System and analyzed according to the ABC classification. The average expenditures were similar in both the neonatal and cardiac units, and lower in Pediatric Intensive and Semi-Intensive care units. There was a significant variation in the monthly consumption of materials. Higher cost materials had a greater impact on the budget of the studied units. The data revealed the importance of using a systematic method for the analysis of materials consumption and expenditure in pediatric units. They subsidize administrative and economic actions.

Fly Photoreceptors Demonstrate Energy-Information Trade-Offs in Neural Coding

PubMed Central

Niven, Jeremy E; Anderson, John C; Laughlin, Simon B

2007-01-01

Trade-offs between energy consumption and neuronal performance must shape the design and evolution of nervous systems, but we lack empirical data showing how neuronal energy costs vary according to performance. Using intracellular recordings from the intact retinas of four flies, Drosophila melanogaster, D. virilis, Calliphora vicina, and Sarcophaga carnaria, we measured the rates at which homologous R1–6 photoreceptors of these species transmit information from the same stimuli and estimated the energy they consumed. In all species, both information rate and energy consumption increase with light intensity. Energy consumption rises from a baseline, the energy required to maintain the dark resting potential. This substantial fixed cost, ∼20% of a photoreceptor's maximum consumption, causes the unit cost of information (ATP molecules hydrolysed per bit) to fall as information rate increases. The highest information rates, achieved at bright daylight levels, differed according to species, from ∼200 bits s−1 in D. melanogaster to ∼1,000 bits s−1 in S. carnaria. Comparing species, the fixed cost, the total cost of signalling, and the unit cost (cost per bit) all increase with a photoreceptor's highest information rate to make information more expensive in higher performance cells. This law of diminishing returns promotes the evolution of economical structures by severely penalising overcapacity. Similar relationships could influence the function and design of many neurons because they are subject to similar biophysical constraints on information throughput. PMID:17373859

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.

Cost and results of information systems for health and poverty indicators in the United Republic of Tanzania.

PubMed Central

Rommelmann, Vanessa; Setel, Philip W.; Hemed, Yusuf; Angeles, Gustavo; Mponezya, Hamisi; Whiting, David; Boerma, Ties

2005-01-01

OBJECTIVE: To examine the costs of complementary information generation activities in a resource-constrained setting and compare the costs and outputs of information subsystems that generate the statistics on poverty, health and survival required for monitoring, evaluation and reporting on health programmes in the United Republic of Tanzania. METHODS: Nine systems used by four government agencies or ministries were assessed. Costs were calculated from budgets and expenditure data made available by information system managers. System coverage, quality assurance and information production were reviewed using questionnaires and interviews. Information production was characterized in terms of 38 key sociodemographic indicators required for national programme monitoring. FINDINGS: In 2002-03 approximately US$ 0.53 was spent per Tanzanian citizen on the nine information subsystems that generated information on 37 of the 38 selected indicators. The census and reporting system for routine health service statistics had the largest participating populations and highest total costs. Nationally representative household surveys and demographic surveillance systems (which are not based on nationally representative samples) produced more than half the indicators and used the most rigorous quality assurance. Five systems produced fewer than 13 indicators and had comparatively high costs per participant. CONCLUSION: Policy-makers and programme planners should be aware of the many trade-offs with respect to system costs, coverage, production, representativeness and quality control when making investment choices for monitoring and evaluation. In future, formal cost-effectiveness studies of complementary information systems would help guide investments in the monitoring, evaluation and planning needed to demonstrate the impact of poverty-reduction and health programmes. PMID:16184275

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

[Analysis of cost and efficiency of a medical nursing unit using time-driven activity-based costing].

PubMed

Lim, Ji Young; Kim, Mi Ja; Park, Chang Gi

2011-08-01

Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

Cost-volume-profit analysis and expected benefit of health services: a study of cardiac catheterization services.

PubMed

Younis, Mustafa Z; Jabr, Samer; Smith, Pamela C; Al-Hajeri, Maha; Hartmann, Michael

2011-01-01

Academic research investigating health care costs in the Palestinian region is limited. Therefore, this study examines the costs of the cardiac catheterization unit of one of the largest hospitals in Palestine. We focus on costs of a cardiac catheterization unit and the increasing number of deaths over the past decade in the region due to cardiovascular diseases (CVDs). We employ cost-volume-profit (CVP) analysis to determine the unit's break-even point (BEP), and investigate expected benefits (EBs) of Palestinian government subsidies to the unit. Findings indicate variable costs represent 56 percent of the hospital's total costs. Based on the three functions of the cardiac catheterization unit, results also indicate that the number of patients receiving services exceed the break-even point in each function, despite the unit receiving a government subsidy. Our findings, although based on one hospital, will permit hospital management to realize the importance of unit costs in order to make informed financial decisions. The use of break-even analysis will allow area managers to plan minimum production capacity for the organization. The economic benefits for patients and the government from the unit may encourage government officials to focus efforts on increasing future subsidies to the hospital.

The Relationship between Return on Profitability and Costs of Outsourcing Information Technology Technical Support

ERIC Educational Resources Information Center

Odion, Segun

2011-01-01

The purpose of this quantitative correlational research study was to examine the relationship between costs of operation and total return on profitability of outsourcing information technology technical support in a two-year period of outsourcing operations. United States of America list of Fortune 1000 companies' chief information officers…

An Exploration of Turnover Experience of IT Professionals in the District of Columbia

ERIC Educational Resources Information Center

Edeh, George

2016-01-01

Turnover among information technology professionals costs organization in revenues. According to Computer Economics (2008), the cost of replacing one information technology employee is $50,000. Reports from the United States Department of Commerce and Office of Technology Policy showed that turnover rate in Information Technology has exceeded 20%…

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; Musial, Walter; Smith, Aaron

This report describes a comprehensive effort undertaken by the National Renewable Energy Laboratory (NREL) to understand the cost of offshore wind energy for markets in the United States. The study models the cost impacts of a range of offshore wind locational cost variables for more than 7,000 potential coastal sites in U.S. offshore wind resource areas. It also assesses the impact of more than 50 technology innovations on potential future costs for both fixed-bottom and floating wind systems. Comparing these costs to an initial site-specific assessment of local avoided generating costs, the analysis provides a framework for estimating the economicmore » potential for offshore wind. The analysis is intended to inform a broad set of stakeholders and enable an assessment of offshore wind as part of energy development and energy portfolio planning. It provides information that federal and state agencies and planning commissions could use to inform initial strategic decisions about offshore wind developments in the United States.« less

A systematic review of the unit costs of allied health and community services used by older people in Australia.

PubMed

Farag, Inez; Sherrington, Cathie; Ferreira, Manuela; Howard, Kirsten

2013-02-20

An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.

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.

49 CFR 19.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... projects can be readily quantified, such quantitative data should be related to cost data for computation... information including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e... performance data from recipients. ...

22 CFR 518.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... projects can be readily quantified, such quantitative data should be related to cost data for computation... information including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e... performance data from recipients. ...

Food Assistance: Financial Information on WIC Nutrition Services and Administrative Costs. United States General Accounting Office Report to Congressional Committees.

ERIC Educational Resources Information Center

Robertson, Robert E.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded nutrition assistance program administered by the Department of Agriculture's (USDA) Food and Nutrition Service (FNS). Responding to Congressional requests for information regarding program costs, this report provides information on: (1) funding…

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.

Unifying cost and information in information-theoretic competitive learning.

PubMed

Kamimura, Ryotaro

2005-01-01

In this paper, we introduce costs into the framework of information maximization and try to maximize the ratio of information to its associated cost. We have shown that competitive learning is realized by maximizing mutual information between input patterns and competitive units. One shortcoming of the method is that maximizing information does not necessarily produce representations faithful to input patterns. Information maximizing primarily focuses on some parts of input patterns that are used to distinguish between patterns. Therefore, we introduce the cost, which represents average distance between input patterns and connection weights. By minimizing the cost, final connection weights reflect input patterns well. We applied the method to a political data analysis, a voting attitude problem and a Wisconsin cancer problem. Experimental results confirmed that, when the cost was introduced, representations faithful to input patterns were obtained. In addition, improved generalization performance was obtained within a relatively short learning time.

24 CFR 84.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... programs or projects can be readily quantified, such quantitative data should be related to cost data for... information including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e... when requesting performance data from recipients. ...

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.

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

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

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.

30 CFR 725.23 - Reports.

Code of Federal Regulations, 2014 CFR

2014-07-01

... productivity data, including unit cost information. This quantitative information will be reported on Forms OSM-51A and OSM-51B or OSM-51C, Quantitative Program Management Information, as applicable. (c) The...

30 CFR 735.26 - Reports.

Code of Federal Regulations, 2014 CFR

2014-07-01

... productivity data, including unit cost information. This quantitative information will be reported on Forms OSM-51A and OSM-51B or OSM-51C, Quantitative Program Management Information, as applicable. (c) The...

30 CFR 725.23 - Reports.

Code of Federal Regulations, 2012 CFR

2012-07-01

... productivity data, including unit cost information. This quantitative information will be reported on Forms OSM-51A and OSM-51B or OSM-51C, Quantitative Program Management Information, as applicable. (c) The...

30 CFR 735.26 - Reports.

Code of Federal Regulations, 2011 CFR

2011-07-01

... productivity data, including unit cost information. This quantitative information will be reported on Forms OSM-51A and OSM-51B or OSM-51C, Quantitative Program Management Information, as applicable. (c) The...

30 CFR 735.26 - Reports.

Code of Federal Regulations, 2012 CFR

2012-07-01

... productivity data, including unit cost information. This quantitative information will be reported on Forms OSM-51A and OSM-51B or OSM-51C, Quantitative Program Management Information, as applicable. (c) The...

30 CFR 725.23 - Reports.

Code of Federal Regulations, 2011 CFR

2011-07-01

... productivity data, including unit cost information. This quantitative information will be reported on Forms OSM-51A and OSM-51B or OSM-51C, Quantitative Program Management Information, as applicable. (c) The...

An Examination of Information Technology and Its Perceived Quality Issues in Single System Hospitals in the United States

ERIC Educational Resources Information Center

Byrd, Linda W.

2009-01-01

The safety and quality of healthcare is of great concern in the United States. The positive effects of information technology reported in past research, especially case studies, has encouraged expectations that information technology may increase the quality of healthcare while reducing costs of healthcare. The goals of this study was to examine…

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital

PubMed Central

Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

2016-01-01

Background: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. Objective: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. Methods: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. Results: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. Conclusion: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department. PMID:26234974

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

PubMed

Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

2015-05-17

Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.‎ This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.‎ The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

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...

Wireless structural monitoring for homeland security applications

NASA Astrophysics Data System (ADS)

Kiremidjian, Garo K.; Kiremidjian, Anne S.; Lynch, Jerome P.

2004-07-01

This paper addresses the development of a robust, low-cost, low power, and high performance autonomous wireless monitoring system for civil assets such as large facilities, new construction, bridges, dams, commercial buildings, etc. The role of the system is to identify the onset, development, location and severity of structural vulnerability and damage. The proposed system represents an enabling infrastructure for addressing structural vulnerabilities specifically associated with homeland security. The system concept is based on dense networks of "intelligent" wireless sensing units. The fundamental properties of a wireless sensing unit include: (a) interfaces to multiple sensors for measuring structural and environmental data (such as acceleration, displacements, pressure, strain, material degradation, temperature, gas agents, biological agents, humidity, corrosion, etc.); (b) processing of sensor data with embedded algorithms for assessing damage and environmental conditions; (c) peer-to-peer wireless communications for information exchange among units(thus enabling joint "intelligent" processing coordination) and storage of data and processed information in servers for information fusion; (d) ultra low power operation; (e) cost-effectiveness and compact size through the use of low-cost small-size off-the-shelf components. An integral component of the overall system concept is a decision support environment for interpretation and dissemination of information to various decision makers.

Continental Divide? The attitudes of US and Canadian oncologists on the costs, cost-effectiveness, and health policies associated with new cancer drugs.

PubMed

Berry, Scott R; Bell, Chaim M; Ubel, Peter A; Evans, William K; Nadler, Eric; Strevel, Elizabeth L; Neumann, Peter J

2010-09-20

Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy. Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared. Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Econometric estimation of country-specific hospital costs.

PubMed

Adam, Taghreed; Evans, David B; Murray, Christopher JL

2003-02-26

Information on the unit cost of inpatient and outpatient care is an essential element for costing, budgeting and economic-evaluation exercises. Many countries lack reliable estimates, however. WHO has recently undertaken an extensive effort to collect and collate data on the unit cost of hospitals and health centres from as many countries as possible; so far, data have been assembled from 49 countries, for various years during the period 1973-2000. The database covers a total of 2173 country-years of observations. Large gaps remain, however, particularly for developing countries. Although the long-term solution is that all countries perform their own costing studies, the question arises whether it is possible to predict unit costs for different countries in a standardized way for short-term use. The purpose of the work described in this paper, a modelling exercise, was to use the data collected across countries to predict unit costs in countries for which data are not yet available, with the appropriate uncertainty intervals.The model presented here forms part of a series of models used to estimate unit costs for the WHO-CHOICE project. The methods and the results of the model, however, may be used to predict a number of different types of country-specific unit costs, depending on the purpose of the exercise. They may be used, for instance, to estimate the costs per bed-day at different capacity levels; the "hotel" component of cost per bed-day; or unit costs net of particular components such as drugs.In addition to reporting estimates for selected countries, the paper shows that unit costs of hospitals vary within countries, sometimes by an order of magnitude. Basing cost-effectiveness studies or budgeting exercises on the results of a study of a single facility, or even a small group of facilities, is likely to be misleading.

The prediction of engineering cost for green buildings based on information entropy

NASA Astrophysics Data System (ADS)

Liang, Guoqiang; Huang, Jinglian

2018-03-01

Green building is the developing trend in the world building industry. Additionally, construction costs are an essential consideration in building constructions. Therefore, it is necessary to investigate the problems of cost prediction in green building. On the basis of analyzing the cost of green building, this paper proposes the forecasting method of actual cost in green building based on information entropy and provides the forecasting working procedure. Using the probability density obtained from statistical data, such as labor costs, material costs, machinery costs, administration costs, profits, risk costs a unit project quotation and etc., situations can be predicted which lead to cost variations between budgeted cost and actual cost in constructions, through estimating the information entropy of budgeted cost and actual cost. The research results of this article have a practical significance in cost control of green building. Additionally, the method proposed in this article can be generalized and applied to a variety of other aspects in building management.

PCS: a pallet costing system for wood pallet manufacturers (version 1.0 for Windows®)

Treesearch

A. Jefferson, Jr. Palmer; Cynthia D. West; Bruce G. Hansen; Marshall S. White; Hal L. Mitchell

2002-01-01

The Pallet Costing System (PCS) is a computer-based, Microsoft Windows® application that computes the total and per-unit cost of manufacturing an order of wood pallets. Information about the manufacturing facility, along with the pallet-order requirements provided by the customer, is used in determining production cost. The major cost factors addressed by PCS...

LICENSING HYDROPOWER PROJECTS: Better Time and Cost Data Needed to Reach Informed Decisions About Process Reforms

DTIC Science & Technology

2001-05-01

GAO United States General Accounting Office Report to Congressional Requesters May 2001 LICENSING HYDROPOWER PROJECTS Better Time and Cost Data...Dates Covered (from... to) ("DD MON YYYY") Title and Subtitle LICENSING HYDROPOWER PROJECTS: Better Time and Cost Data Needed to Reach Informed...Organization Name(s) and Address(es) General Accounting Office, PO Box 37050, Washington, DC 20013 Performing Organization Number(s) GAO-01-499

United States Air Force 611th Civil Engineer Squadron, Elmendorf, AFB, Alaska. Final engineering evaluation/cost analysis, million gallon hill source area of the West Unit, Galena Airport, Alaska

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

NONE

1996-02-05

This decision document presents the selected removal action for the Million Gallon Hill source area of the Installation Restoration Program (IRP) site ST009, otherwise known as the West Unit at Galena Airport, Alaska. The information from the RI Report is summarized, along with an analysis of potential removal action alternatives in the Engineering Evaluation/Cost Analysis (EE/CA).

Implementing a comprehensive cost information system in rural health facilities: the case of Nouna health district, Burkina Faso.

PubMed

Flessa, Steffen; Kouyaté, Bocar

2006-09-01

To present first findings of a cost-of-illness (COI) information system implemented in Nouna health district, Burkina Faso. The entire project will include household and provider tangible COI, whereas this article concentrates on the development of a provider cost information system in rural first-line health facilities. Special forms and reports are prepared to routinely collect capital and recurrent costs of first-line facilities. Inventory lists are designed, and buildings and equipment are assessed by engineers. Total, fixed, variable and average costs are calculated for 15 rural health centres with five cost centres: general outpatient consultation, ambulatory nursing care, deliveries, immunization and other services (neonatal consultation, child care and family planning). In 2003, the average costs per service unit were 1.34 US$ for a general consultation, 0.51 US$ for ambulatory nursing care, 6.73 US$ per delivery, 3.64 US$ per vaccination and 1.11 US$ per service unit of other care. On average, a health centre consumes 29,900 US$ per year for a catchment population of 10,000 inhabitants. The major share of costs is fixed and does not depend on the workload of the health centre. Consequently, the costs of first-line facilities will hardly increase if the demand for health services rises. These findings can be used to improve the health financing in Nouna health district, Burkina Faso.

Financial Planning for Study in the United States. A Guide for Students from Other Countries. Revised Edition.

ERIC Educational Resources Information Center

College Entrance Examination Board, New York, NY.

A guide for foreign students who need information on the cost of higher education in the United States is presented. Responsibilities of foreign students in meeting these costs are addressed, along with types of financial help that may be available to them from colleges and other sources, applying for financial aid, and planning the financial…

Estimating costs of programme services and products using information provided in standard financial statements.

PubMed

Ellwein, L B; Thulasiraj, R D; Boulter, A R; Dhittal, S P

1998-01-01

The financial viability of programme services and product offerings requires that revenue exceeds expenses. Revenue includes payments for services and products as well as donor cash and in-kind contributions. Expenses reflect consumption of purchased or contributed time and materials and utilization (depreciation) of physical plant facilities and equipment. Standard financial reports contain this revenue and expense information, complemented when necessary by valuation and accounting of in-kind contributions. Since financial statements are prepared using consistent and accepted accounting practices, year-to-year and organization-to-organization comparisons can be made. The use of such financial information is illustrated in this article by determining the unit cost of cataract surgery in two hospitals in Nepal. The proportion of unit cost attributed to personnel, medical supplies, administrative materials, and depreciation varied significantly by institution. These variations are accounted for by examining differences in operational structure and capacity utilization.

Estimating costs of programme services and products using information provided in standard financial statements.

PubMed Central

Ellwein, L. B.; Thulasiraj, R. D.; Boulter, A. R.; Dhittal, S. P.

1998-01-01

The financial viability of programme services and product offerings requires that revenue exceeds expenses. Revenue includes payments for services and products as well as donor cash and in-kind contributions. Expenses reflect consumption of purchased or contributed time and materials and utilization (depreciation) of physical plant facilities and equipment. Standard financial reports contain this revenue and expense information, complemented when necessary by valuation and accounting of in-kind contributions. Since financial statements are prepared using consistent and accepted accounting practices, year-to-year and organization-to-organization comparisons can be made. The use of such financial information is illustrated in this article by determining the unit cost of cataract surgery in two hospitals in Nepal. The proportion of unit cost attributed to personnel, medical supplies, administrative materials, and depreciation varied significantly by institution. These variations are accounted for by examining differences in operational structure and capacity utilization. PMID:9868836

Implementation of a management information system for hospital use at the Policlinico Universitario A. Gemelli.

PubMed

Mobilia, G

1996-01-01

First, the experience with the implementation of HISs at the "Policlinico Gemelli", is reported. They were adopted since long for management support. In fact, they are playing an increasingly relevant role in health care facilities. Subsequently, operational applications are described with particular reference to the most recent ones, implemented within European projects with partial EEC financing. They are very useful to the medical and nursing personnel and for patient data management during treatment. Finally, the accounting system for cost centers, using, processing and integrating data of all used information systems, is described. It affords a low cost aggregation of all information about costs and services required for the management of four-hundred elementary operating units which constitute the structure. This system is representative of all managerial information of the "Policlinico" which is included in monthly reports, also described. They are sent to the Direction and managers of the organizational units. The system is a strategic tool of the utmost importance for rapid and effective management.

Medicare intensive care unit use: analysis of incidence, cost, and payment.

PubMed

Cooper, Liesl M; Linde-Zwirble, Walter T

2004-11-01

To determine the incidence, cost, and payment for intensive care unit services among Medicare beneficiaries. Retrospective observational database cohort study. All nonfederal hospitals with intensive care unit beds (n = 5003) paid through the inpatient prospective payment system (IPPS). We used all fiscal year 2000 Medicare IPPS hospitalizations with consistent payment information (n = 10,657,587). None. We examined the distribution of cost and payments overall, by hospital type, and by diagnosis related group. Intensive care was used in 2,353,208 cases (21.1%). The overall incidence was 59.8 cases per thousand beneficiaries in the aged (65+) population, increasing with age from 36.2 (65-69) to 91.6 (85+). Intensive care unit patients cost nearly three times floor patients (4,135 dollars vs. 5,571 dollars), with two thirds of costs associated with the intensive care unit portion of the stay, 2,278 dollars per intensive care unit day. However, intensive care unit cases were paid at a rate only twice floor cases (11,704 dollars vs. 5,835 dollars). Only 83% of costs were paid for intensive care unit patients, compared with 105% for floor patients, generating a 5.8 billion dollars loss to hospitals when intensive care unit care is required. There was a linear association between the percent intensive care unit in a diagnosis related group and the percent paid, with payment >90% of cost only in diagnosis related groups with >/=60% intensive care unit cases. We found that teaching hospitals were better paid than nonteaching hospitals (87% vs. 78% of costs, respectively), but this was only due to indirect medical education payments. Intensive care is common, expensive, and poorly paid in the Medicare population. Few diagnosis related groups have a large enough intensive care unit population to ensure adequate payment. Additional diagnosis related groups for conditions common to the intensive care unit would improve payment and enable incentives for efficiency.

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.

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.

10 CFR 600.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... appropriate and the output of programs or projects can be readily quantified, such quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established goals were not met, if appropriate. (3) Other pertinent information including, when appropriate, analysis and explanation of cost...

22 CFR 145.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... appropriate and the output of programs or projects can be readily quantified, such quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established goals were not met, if appropriate. (3) Other pertinent information including, when appropriate, analysis and explanation of cost...

34 CFR 74.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... programs or projects can be readily quantified, this quantitative data should be related to cost data for... information including, when appropriate, analysis, and explanation of cost overruns or high unit costs. (e... requirements of 5 CFR part 1320 when requesting performance data from recipients. (Approved by the Office of...

40 CFR 30.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... appropriate and the output of programs or projects can be readily quantified, such quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established goals were not met, if appropriate. (3) Other pertinent information including, when appropriate, analysis and explanation of cost...

The Costs of Employing Older Workers. An Information Paper Prepared for Use by the Special Committee on Aging, United States Senate.

ERIC Educational Resources Information Center

Morrison, Malcolm; Rappaport, Anna

Analysis of the costs of employing older workers indicates that some types of employment costs do vary by age and that overall compensation costs increase with age, largely because of increasing employee benefit costs. There is, however, no statistical evidence that direct salary costs increase by age on an economy-wide basis. The belief that…

Burn care delivery in a sub-saharan african unit: A cost analysis study.

PubMed

Gallaher, Jared R; Mjuweni, Stephen; Cairns, Bruce A; Charles, Anthony G

2015-07-01

There are significant resource challenges to burn surgical care delivery in low and middle-income countries at baseline and only a few burn cost analysis studies from sub-Saharan Africa have been performed. This is a retrospective database analysis of prospectively collected data from all patients recorded in the burn registry between June 2011 and August 2014 located at the Kamuzu Central Hospital Burn Unit in Lilongwe, Malawi. We utilized activity-based costing, a bottom-up cost analysis methodology with cost allocation that allows determination of unit cost or cost per service. 905 patients were admitted to the burn unit during the study period. The calculated total monthly burn expenditure for all cost centers was $11,622.66. Per day, the total unit cost was $387.42 with a mean daily per-patient cost of $24.26 (SD ± $6.44). Consequently, the mean cost per in-patient admission was $559.85 (SD ± $736.17). The mean daily cost per 1% total burn surface per patient at our center is $2.65 (SD ± $3.01). This burn care cost analysis study helps quantify the relative contribution of differing cost centers that comprise burn care delivery and hospital costs in a sub-Saharan African setting. Accurate and relevant cost information on hospital services at the patient level is therefore fundamental for policy makers, payers, and hospitals. Our study has demonstrated that comprehensive burn care is possible at a cost much lower than found in other burn centers in low or middle-income countries and can be sustained with moderate funding. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

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.

Terms, Trends, and Insights: PV Project Finance in the United States, 2017

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

Feldman, David J; Schwabe, Paul D

This brief is a compilation of data points and market insights that reflect the state of the project finance market for solar photovoltaic (PV) assets in the United States as of the third quarter of 2017. This information can generally be used as a simplified benchmark of the costs associated with securing financing for solar PV as well as the cost of the financing itself (i.e., the cost of capital). This work represents the second DOE sponsored effort to benchmark financing costs across the residential, commercial, and utility-scale PV markets, as part of its larger effort to benchmark the componentsmore » of PV system costs.« less

Price-Transparency and Cost Accounting

PubMed Central

Eakin, Cynthia; Fischer, Katrina

2015-01-01

Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. PMID:25862425

PV Project Finance in the United States, 2016

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

Feldman, David; Lowder, Travis; Schwabe, Paul

This brief is a compilation of data points and market insights that reflect the state of the project finance market for solar photovoltaic (PV) assets in the United States as of the third quarter of 2016. This information can generally be used as a simplified benchmark of the costs associated with securing financing for solar PV as well as the cost of the financing itself (i.e., the cost of capital). Three sources of capital are considered -- tax equity, sponsor equity, and debt -- across three segments of the PV marketplace.

Financial Performance of Specialized Cotton Farms. Agriculture Information Bulletin Number 538.

ERIC Educational Resources Information Center

Ahearn, Mary; And Others

This United States Department of Agriculture summary report focuses on the revenues, costs, and finances of specialized cotton farms in 1986. The report also provides general information on all farms producing cotton. The data on which the report is based are from the 1986 Farm Costs and Returns Survey. Some of the conclusions drawn from the study…

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.

An Advanced Microcosting System for Forecasting and Managing Radiology Expenses

PubMed Central

Arenson, Ronald; Viale, Richard; van der Voorde, Frans

1985-01-01

The new prospective payment system encourages hospital cost containment and necessitates understanding actual costs for radiology procedures. The automated microcosting system described here, utilizing data from the Radiology Information Management System, hospital expense reports, and payroll management reports, calculates an accurate unit cost for each procedure type. This data is very useful for cost control, enhancement of department efficiency, and planning.

Integration of photovoltaic units into electric utility grids: experiment information requirements and selected issues

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

Not Available

1980-09-01

A number of investigations, including those conducted by The Aerospace Corporation and other contractors, have led to the recognition of technical, economic, and institutional issues relating to the interface between solar electric technologies and electric utility systems. These issues derive from three attributes of solar electric power concepts, including (1) the variability and unpredictability of the solar resources, (2) the dispersed nature of those resources which suggests the feasible deployment of small dispersed power units, and (3) a high initial capital cost coupled with relatively low operating costs. It is imperative that these integration issues be pursued in parallel withmore » the development of each technology if the nation's electric utility systems are to effectively utilize these technologies in the near to intermediate term. Analyses of three of these issues are presented: utility information requirements, generation mix and production cost impacts, and rate structures in the context of photovoltaic units integrated into the utility system. (WHK)« less

The Cost of Distribution System Upgrades to Accommodate Increasing Penetrations of Distributed Photovoltaic Systems on Real Feeders in the United States

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

Horowitz, Kelsey A; Ding, Fei; Mather, Barry A

The increasing deployment of distributed photovoltaic systems (DPV) can impact operations at the distribution level and the transmission level of the electric grid. It is important to develop and implement forward-looking approaches for calculating distribution upgrade costs that can be used to inform system planning, market and tariff design, cost allocation, and other policymaking as penetration levels of DPV increase. Using a bottom-up approach that involves iterative hosting capacity analysis, this report calculates distribution upgrade costs as a function of DPV penetration on three real feeders - two in California and one in the Northeastern United States.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies-The example of viral load informed differentiated care.

PubMed

Revill, Paul; Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J

2018-01-01

The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter's value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented.

Using a Context-aware Medical Application to Address Information Needs for Extubation Decisions

PubMed Central

Zhu, Xinxin; Lord, William

2005-01-01

Information overload has been one of the causes of preventable medical errors [1] and escalating costs [2]. A context-aware application with embedded clinical knowledge is proposed to provide practitioners with the appropriate amount of information and content. We developed a prototype of a context-aware medical application to address clinicians’ information needs that arise in a data-intensive unit, the Cardio-Thoracic Intensive Care Unit (CTICU). A major clinical decision supported by the prototype, the extubation decision, is illustrated. PMID:16779455

Unit costs for house spraying and bednet impregnation with residual insecticides in Colombia: a management tool for the control of vector-borne disease.

PubMed

Kroeger, A; Ayala, C; Medina Lara, A

2002-06-01

A study of unit costs and cost components of two malaria-control strategies (house spraying and bednet impregnation with residual insecticides) was undertaken in 11 malaria-endemic states (departamentos) of Colombia, using data provided by control staff on self-administered questionnaires. The accuracy of the data was verified by personal visits, telephone conversations and complementary information from 10 other states. Allthe financial-cost components of the malaria-control operations carried out in the previous 6 months and the results of the control operations themselves (including the numbers of houses sprayed and numbers of bednets impregnated/day) were recorded. The information was stratified according to whether the target communities were 'near' or 'far away' from an operational base, the far-away communities being those that needed overnight stays by the control staff. The main variables analysed were unit costs/house treated, and annual cost/person protected. The results show that house spraying was generally more expensive for the health services than bednet impregnation. This is particularly the case in 'nearby' communities, where most of those at-risk live. In such communities, spraying one house was 7.2 times more expensive than impregnating one bednet. Even if only those sleeping under an impregnated net were assumed to be protected, the unit costs/person protected in a 'nearby' community were twice as high for house spraying than for bednet impregnation. In 'nearby' communities, where technicians could return to the operational base each evening, insecticides made up 80% of the total spraying costs and 42% of the costs of bednet impregnation. In 'far-away' communities, however, salaries and 'per diems' were the most important cost components, representing, respectively, 23% and 22% of the costs of spraying, and 34% plus 27% of the costs of impregnation. Insecticide wastage and non-use of discounts on insecticide prices (available through the national Ministry of Health) increased the overall costs considerably. The multiple uses of these cost calculations for district health managers are presented.

Model-Driven Energy Intelligence

DTIC Science & Technology

2015-03-01

building information model ( BIM ) for operations...estimate of the potential impact on energy performance at Fort Jackson. 15. SUBJECT TERMS Building Information Modeling ( BIM ), Energy, ECMs, monitoring...dimensional AHU Air Handling Unit API Application Programming Interface BIM building information model BLCC Building Life Cycle Cost

Variability in Costs across Hospital Wards. A Study of Chinese Hospitals

PubMed Central

Adam, Taghreed; Evans, David B.; Ying, Bian; Murray, Christopher J. L.

2014-01-01

Introduction Analysts estimating the costs or cost-effectiveness of health interventions requiring hospitalization often cut corners because they lack data and the costs of undertaking full step-down costing studies are high. They sometimes use the costs taken from a single hospital, sometimes use simple rules of thumb for allocating total hospital costs between general inpatient care and the outpatient department, and sometimes use the average cost of an inpatient bed-day instead of a ward-specific cost. Purpose In this paper we explore for the first time the extent and the causes of variation in ward-specific costs across hospitals, using data from China. We then use the resulting model to show how ward-specific costs for hospitals outside the data set could be estimated using information on the determinants identified in the paper. Methodology Ward-specific costs estimated using step-down costing methods from 41 hospitals in 12 provinces of China were used. We used seemingly unrelated regressions to identify the determinants of variability in the ratio of the costs of specific wards to that of the outpatient department, and explain how this can be used to generate ward-specific unit costs. Findings Ward-specific unit costs varied considerably across hospitals, ranging from 1 to 24 times the unit cost in the outpatient department — average unit costs are not a good proxy for costs at specialty wards in general. The most important sources of variability were the number of staff and the level of capacity utilization. Practice Implications More careful hospital costing studies are clearly needed. In the meantime, we have shown that in China it is possible to estimate ward-specific unit costs taking into account key determinants of variability in costs across wards. This might well be a better alternative than using simple rules of thumb or using estimates from a single study. PMID:24874566

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.

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...

Social and economic costs and health-related quality of life in stroke survivors in the Canary Islands, Spain

PubMed Central

2012-01-01

Background Cost-of-illness analysis is the main method of providing an overall vision of the economic impact of a disease. Such studies have been used to set priorities for healthcare policies and inform resource allocation. The aim of this study was to determine the economic burden and health-related quality of life (HRQOL) in the first, second and third years after surviving a stroke in the Canary Islands, Spain. Methods Cross-sectional, retrospective study of 448 patients with stroke based on ICD 9 discharge codes, who received outpatient care at five hospitals. The study was approved by the Research Ethics Committee of Nuestra Señora de la Candelaria University Hospital. Data on demographic characteristics, health resource utilization, informal care, labor productivity losses and HRQOL were collected from the hospital admissions databases and questionnaires completed by stroke patients or their caregivers. Labor productivity losses were calculated from physical units and converted into monetary units with a human capital-based method. HRQOL was measured with the EuroQol EQ-5D questionnaire. Healthcare costs, productivity losses and informal care costs were analyzed with log-normal, probit and ordered probit multivariate models. Results The average cost for each stroke survivor was €17 618 in the first, €14 453 in the second and €12 924 in the third year after the stroke; the reference year for unit prices was 2004. The largest expenditures in the first year were informal care and hospitalizations; in the second and third years the main costs were for informal care, productivity losses and medication. Mean EQ-5D index scores for stroke survivors were 0.50 for the first, 0.47 for the second and 0.46 for the third year, and mean EQ-5D visual analog scale scores were 56, 52 and 55, respectively. Conclusions The main strengths of this study lie in our bottom-up-approach to costing, and in the evaluation of stroke survivors from a broad perspective (societal costs) in the first, second and third years after surviving the stroke. This type of analysis is rare in the Spanish context. We conclude that stroke incurs considerable societal costs among survivors to three years and there is substantial deterioration in HRQOL. PMID:22970797

Cost Indexing and Unit Price Adjustments for Construction Materials

DOT National Transportation Integrated Search

2012-10-30

This project was focused on the assimilation of information regarding unit price adjustment clauses, or PACs, : that are offered for construction materials at the state Departments of Transportation (DOTs). It is intended to : provide the South Carol...

Economic evaluation of the DiAMOND randomized trial: cost and outcomes of 2 decision aids for mode of delivery among women with a previous cesarean section.

PubMed

Hollinghurst, Sandra; Emmett, Clare; Peters, Tim J; Watson, Helen; Fahey, Tom; Murphy, Deirdre J; Montgomery, Alan

2010-01-01

Maternal preferences should be considered in decisions about mode of delivery following a previous cesarean, but risks and benefits are unclear. Decision aids can help decision making, although few studies have assessed costs in conjunction with effectiveness. Economic evaluation of 2 decision aids for women with 1 previous cesarean. Cost-consequences analysis. Data sources were self-reported resource use and outcome and published national unit costs. The target population was women with 1 previous cesarean. The time horizon was 37 weeks' gestation and 6 weeks postnatal. The perspective was health care delivery system. The interventions were usual care, usual care plus an information program, and usual care plus a decision analysis program. The outcome measures were costs to the National Health Service (NHS) in the United Kingdom (UK), score on the Decisional Conflict Scale, and mode of delivery. RESULTS OF MAIN ANALYSIS: Cost of delivery represented 84% of the total cost; mode of delivery was the most important determinant of cost differences across the groups. Mean (SD) total cost per mother and baby: 2033 (677) for usual care, 2069 (738) for information program, and 2019 (741) for decision analysis program. Decision aids reduced decisional conflict. Women using the decision analysis program had fewest cesarean deliveries. Applying a cost premium to emergency cesareans over electives had little effect on group comparisons. Conclusions were unaffected. Disparity in timing of outcomes and costs, data completeness, and quality. Decision aids can reduce decisional conflict in women with a previous cesarean section when deciding on mode of delivery. The information program could be implemented at no extra cost to the NHS. The decision analysis program might reduce the rate of cesarean sections without any increase in costs.

Application of activity-based costing (ABC) for a Peruvian NGO healthcare provider.

PubMed

Waters, H; Abdallah, H; Santillán, D

2001-01-01

This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries.

Cochlear implants and medical tourism.

PubMed

McKinnon, Brian J; Bhatt, Nishant

2010-09-01

To compare the costs of medical tourism in cochlear implant surgery performed in India as compared to the United States. In addition, the cost savings of obtaining cochlear implant surgery in India were compare d to those of other surgical interventions obtained as a medical tourist. Searches were conducted on Medline and Google using the search terms: 'medical tourism', 'medical offshoring', 'medical outsourcing', 'cochlear implants' and 'cochlear implantation'. The information regarding cost of medical treatment was obtained from personal communication with individuals familiar with India's cochlear implantation medical tourism industry. The range of cost depended on length of stay as well as the device chosen. Generally the cost, inclusive of travel, surgery and device, was in the range of $21,000-30,000, as compared to a cost range of $40,000-$60,000 in the US. With the escalating cost of healthcare in the United States, it is not surprising that some patients would seek to obtain surgical care overseas at a fraction of the cost. Participants in medical tourism often have financial resources, but lack health insurance coverage. While cardiovascular and orthopedic surgery performed outside the United States in India at centers that cater to medical tourists are often performed at one-quarter to one-third of the cost that would have been paid in the United States, the cost differential for cochlear implants is not nearly as favorable.

Benchmarking U.S. Small Wind Costs with the Distributed Wind Taxonomy

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

Orrell, Alice C.; Poehlman, Eric A.

The objective of this report is to benchmark costs for small wind projects installed in the United States using a distributed wind taxonomy. Consequently, this report is a starting point to help expand the U.S. distributed wind market by informing potential areas for small wind cost-reduction opportunities and providing a benchmark to track future small wind cost-reduction progress.

Comparison of Patient Costs in Internal Medicine and Anaesthesiology Intensive Care Units in a Tertiary University Hospital.

PubMed

Kara, İskender; Yıldırım, Fatma; Başak, Dilek Yumuş; Küçük, Hamit; Türkoğlu, Melda; Aygencel, Gülbin; Katı, İsmail; Karabıyık, Lale

2015-06-01

The allocation of the Gross Domestic Product (GDP) to health is limited, therefore it has made a need for professional management of health business. Hospital managers as well as employees are required to have sufficient knowledge about the hospital costs. Hospital facilities like intensive care units that require specialization and advanced technology have an important part in costs. For this purpose, cost analysis studies should be done in the general health business and special units separately. In this study we aimed to compare the costs of anaesthesiology and internal medicine intensive care units (ICU) roughly. After approval of this study by Gazi University Faculty of Medicine Ethics Committee, the costs of 855 patients that were hospitalized, examined and treated for at least 24 hours in internal medicine and anaesthesiology ICUs between January 2012-August 2013 (20 months period) were taken and analyzed from chief staff of the Department of Information Technology, Gazi University Hospital. At the end of the study, we observed clear differences between internal medicine and anaesthesiology ICUs arising from transactions and patient characteristics of units. We stated that these differences should be considered by Social Security Institution (SSI) for the reimbursement of the services. Further, we revealed that SSI payments do not meet the intensive care expenditure.

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.

Hospital cost accounting and the new imperative.

PubMed

Sabin, P

1987-05-01

Government regulatory structures, prospective payment mechanisms, a more competitive environment, and attempts to link cost accounting principles to planning, budgeting, and fiscal control all have served as catalysts for hospitals to increase their reliance and emphasis on cost accounting. Current hospital accounting systems are relatively inexpensive to develop and maintain, and they fulfill the financial reporting requirements mandated by Medicare and other third-party payers. These systems, however, do not provide information on what specific service units cost, and managers must have this information to make optimal trade-offs between quality, availability, and cost of medical services. Most health care organizations have a predetermined charge for each type of service, but the charge may not accurately portray the cost of providing the service. Knowing true costs will enable managers to select the most cost-effective method of treating a patient; know the financial implications of adding tests or procedures; relate costs to established norms of care; establish ranges of acceptable costs in various diagnostic groups; negotiate more successfully with rate review organizations and health maintenance organizations; and vigorously market and advertise the services that most contribute to the organization's overall financial health. The goal of microcosting is to determine the full cost of providing specific service units. The microcosting process comprises three components: data collection, cost modeling, and cost analysis. Microcosting is used to determine full costs for 20 percent of the hospital's procedures that are responsible for generating 80 percent of the hospital's gross revenue. Full costs are established by adding labor costs, materials costs, equipment depreciation costs, departmental overhead costs, and corporate overhead costs.(ABSTRACT TRUNCATED AT 250 WORDS)

United States benefits of improved worldwide wheat crop information from a LANDSAT system overview

NASA Technical Reports Server (NTRS)

1976-01-01

The value of improvements in worldwide information on wheat crops provided by LANDSAT was measured in the context of world wheat markets. These benefits were based on exiting LANDSAT technical goals and assumed that information would be made available to the United States and other countries at the same time. The benefits to the United States of such public LANDSAT information on wheat crops were found to be 174 million dollars a year on the average. The benefits from improved wheat crop information compare favorably with the annual system's cost of about $62 million. A detailed empirical sample demonstration of the effect of improved information was developed. The history of wheat commodity prices for 1971-72 was reconstructed and the price changes from improved vs. historical information were compared.

Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

PubMed

Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

2015-01-01

Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. © The Author(s) 2015.

The burden of multiple sclerosis 2015: Methods of data collection, assessment and analysis of costs, quality of life and symptoms.

PubMed

Kobelt, Gisela; Eriksson, Jennifer; Phillips, Glenn; Berg, Jenny

2017-08-01

This article describes the methods used to perform this large European-wide burden-of-illness study on multiple sclerosis (MS) using individual patient data. The study collected all MS-related resource consumption, workforce participation, prevalent disease symptoms and health-related quality of life (HRQoL). Patients were recruited by national patient associations and, after informed consent, completed a specific questionnaire either on-line or on paper. Analyses were performed by country as well as for the study overall. Costs were estimated from the societal perspective, using publicly available unit costs and reported in national currencies and in EUR 2015 adjusted for purchasing power parity. The results are reported by disease severity groups according to self-assessed Expanded Disability Status Scale (EDSS) (mild, moderate, severe) and by EDSS point to highlight the development of costs as disability progresses. A total of 16,808 patients in 16 countries participated in the study: Austria, Belgium, Denmark, Czech Republic, France, Germany, Hungary, Italy, the Netherlands, Poland, Portugal, Russia, Spain, Sweden, Switzerland and the United Kingdom. This study, endorsed by the European Platform of MS Societies, provides up-to-date information on costs and expands the previously available information on HRQoL and symptoms.

The costs of treating curable sexually transmitted infections in low- and middle-income countries: a systematic review.

PubMed

Terris-Prestholt, Fern; Vyas, Seema; Kumaranayake, Lilani; Mayaud, Philippe; Watts, Charlotte

2006-10-01

Calls for increased investment in sexually transmitted infection (STI) treatment across the developing world have been made to address the high disease burden and the association with HIV transmission. The goals of this study were to systematically review evidence on the cost of treating curable STIs and to explore its key determinants. A search of published literature was conducted in PubMed and supplemented by reviews of gray literature. Studies were analyzed by broad focus. Regression analysis explored how intervention characteristics affect unit costs, accounting for differences in costing methods. Fifty-three primary studies were identified, of which 62% used empirical data, 35% presented economic costs, and 22% presented full costs. The median STI treatment cost was US dollars 17.80. Clinics serving symptomatic patients were consistently cheaper than outreach services, services using syndromic management protocols had lower costs, and unit costs decreased with scale. The compiled cost data provide an evidence base that can be used to help inform resource planning.

77 FR 59206 - U.S. Customs and Border Protection

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-26

... collection techniques or the use of other forms of information technology; and (e) the annual cost burden to... Schedule of the United States (HTSUS). This declaration includes information such as the quantity, value... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Agency Information Collection...

75 FR 40776 - Polyethylene Terephthalate Film, Sheet and Strip From the United Arab Emirates: Extension of Time...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-14

... Film, Sheet and Strip From the United Arab Emirates: Extension of Time Limit for Preliminary Results of... polyethylene terephthalate film, sheet and strip from the United Arab Emirates (UAE) for the period November 06... analysis of all information on the record, specifically considering the cost and affiliation issues in this...

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

ERIC Educational Resources Information Center

Shanks, Robb L., Comp.

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

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…

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.

Delivery Unit Costs for Antiretroviral Treatment and Prevention of Mother-to-Child-Transmission of HIV

PubMed Central

Galárraga, Omar; Wirtz, Veronika J.; Figueroa-Lara, Alejandro; Santa-Ana-Tellez, Yared; Coulibaly, Ibrahima; Viisainen, Kirsi; Medina-Lara, Antonieta; Korenromp, Eline L.

2013-01-01

Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding components included in the costing hampers standardization of unit cost measures. Evaluation of program-level unit costs would benefit from international guidance on standardized costing methods, and expenditure categories and definitions. Future work should help elucidate the sources for the large variations in delivery unit costs across settings with similar income and epidemiological characteristics. PMID:21671687

Cardiac rehabilitation costs.

PubMed

Moghei, Mahshid; Turk-Adawi, Karam; Isaranuwatchai, Wanrudee; Sarrafzadegan, Nizal; Oh, Paul; Chessex, Caroline; Grace, Sherry L

2017-10-01

Despite the clinical benefits of cardiac rehabilitation (CR) and its cost-effectiveness, it is not widely received. Arguably, capacity could be greatly increased if lower-cost models were implemented. The aims of this review were to describe: the costs associated with CR delivery, approaches to reduce these costs, and associated implications. Upon finalizing the PICO statement, information scientists were enlisted to develop the search strategy of MEDLINE, Embase, CDSR, Google Scholar and Scopus. Citations identified were considered for inclusion by the first author. Extracted cost data were summarized in tabular format and qualitatively synthesized. There is wide variability in the cost of CR delivery around the world, and patients pay out-of-pocket for some or all of services in 55% of countries. Supervised CR costs in high-income countries ranged from PPP$294 (Purchasing Power Parity; 2016 United States Dollars) in the United Kingdom to PPP$12,409 in Italy, and in middle-income countries ranged from PPP$146 in Venezuela to PPP$1095 in Brazil. Costs relate to facilities, personnel, and session dose. Delivering CR using information and communication technology (mean cost PPP$753/patient/program), lowering the dose and using lower-cost personnel and equipment are important strategies to consider in containing costs, however few explicitly low-cost models are available in the literature. More research is needed regarding the costs to deliver CR in community settings, the cost-effectiveness of CR in most countries, and the economic impact of return-to-work with CR participation. A low-cost model of CR should be standardized and tested for efficacy across multiple healthcare systems. Copyright © 2017 Elsevier B.V. All rights reserved.

45 CFR 2543.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... Whenever appropriate and the output of programs or projects can be readily quantified, such quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established goals were not met, if appropriate. (3) Other pertinent information including, when appropriate, analysis and...

Costs and financing of routine immunization: Approach and selected findings of a multi-country study (EPIC).

PubMed

Brenzel, Logan; Young, Darwin; Walker, Damian G

2015-05-07

Few detailed facility-based costing studies of routine immunization (RI) programs have been conducted in recent years, with planners, managers and donors relying on older information or data from planning tools. To fill gaps and improve quality of information, a multi-country study on costing and financing of routine immunization and new vaccines (EPIC) was conducted in Benin, Ghana, Honduras, Moldova, Uganda and Zambia. This paper provides the rationale for the launch of the EPIC study, as well as outlines methods used in a Common Approach on facility sampling, data collection, cost and financial flow estimation for both the routine program and new vaccine introduction. Costing relied on an ingredients-based approach from a government perspective. Estimating incremental economic costs of new vaccine introduction in contexts with excess capacity are highlighted. The use of more disaggregated System of Health Accounts (SHA) coding to evaluate financial flows is presented. The EPIC studies resulted in a sample of 319 primary health care facilities, with 65% of facilities in rural areas. The EPIC studies found wide variation in total and unit costs within each country, as well as between countries. Costs increased with level of scale and socio-economic status of the country. Governments are financing an increasing share of total RI financing. This study provides a wealth of high quality information on total and unit costs and financing for RI, and demonstrates the value of in-depth facility approaches. The paper discusses the lessons learned from using a standardized approach, as well as proposes further areas of methodology development. The paper discusses how results can be used for resource mobilization and allocation, improved efficiency of services at the country level, and to inform policies at the global level. Efforts at routinizing cost analysis to support sustainability efforts would be beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

United States Air Force 611th Civil Engineer Squadron, Elmendorf AFB, Alaska. Final engineering evaluation/cost analysis potential tce impact to the drinking water supply, Galena Airport, Alaska

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

NONE

1996-02-05

This decision document presents the selected removal action to address potential trichloroethene (TCE) impact to drinking water supply wells, located in the Installation Restoration Program (IRP) site ST009, otherwise known as the West Unit, at Galena Airport, Alaska. The information fron the RI Report is summarized, along with an analysis of potential removal action alternatives, in the Engineering Evaluation/Cost Analysis (EE/CA).

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.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care

PubMed Central

Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J.

2018-01-01

Background The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. Key issues for economic evaluation The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter’s value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. Implications The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented. PMID:29293611

An Inventory and Use Analysis of Information Systems on Small Farms in Pennsylvania

ERIC Educational Resources Information Center

Adams, Jean S.

2007-01-01

Across the United States, today's farm operators face continuing challenges from global competition, increasing production costs, changing technology, increased regulations, scarce resources, and lower profit margins. To face these challenges, farm operators need to gather and utilize information allowing them to make informed decisions. Several…

The injury profile and acute treatment costs of major trauma in older people in New South Wales.

PubMed

Curtis, Kate; Chan, Daniel Leonard; Lam, Mary Kit; Mitchell, Rebecca; King, Kate; Leonard, Liz; D'Amours, Scott; Black, Deborah

2014-12-01

To Describe injury profile and costs of older person trauma in New South Wales; quantify variations with peer group costs; and identify predictors of higher costs. Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥ 55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. Older person trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding. © 2013 ACOTA.

Improvement of General Electric’s Chilled Ammonia Process with the use of Membrane Technology

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

Muraskin, Dave; Dube, Sanjay; Baburao, Barath

General Electric Environmental Control Solutions (formerly Alstom Power Environmental Control Systems) set out to complete the Phase 1 award requirements for a Phase II renewal application for their project selected under DOE-FOA-0001190 “Small and Large Scale Pilots for Reducing the Cost of CO 2 Capture and Compression”. The project focus was to implement several improvement concepts utilizing membrane technology at the recipient’s Chilled Ammonia Process (CAP) CO 2 capture large-scale pilot plant. The goal was to lower the overall cost of technology. During the development of costs for the preliminary techno-economic assessment (TEA), it became clear that the capital andmore » operating costs of this concept were not economically attractive. All work related to a Phase II renewal application at that point was halted as GE made the decision not to submit a Phase II renewal application. Discussions with DOE resulted in a path towards useful information produced from the design and cost work already completed on the project. With the reverse osmosis (RO) unit providing most of the cost issues, GE would provide a sensitivity analysis of the RO unit with respect to project cost. This information would be included with the Techno-Economic Analysis along with the Technology Gap Analysis.« less

Cost of Information Handling in Hospitals

PubMed Central

Jydstrup, Ronald A.; Gross, Malvern J.

1966-01-01

Cost of information handling (noncomputerized) in hospitals was studied in detail from an industrial engineering point of view at Rochester General, Highland, and Geneva General hospitals. Activities were observed, personnel questioned, and time studies carried out. It was found that information handling comprises about one fourth of the hospitals' operating cost—a finding strongly recommending revision and streamlining of both forms and inefficient operations. In an Appendix to this study are presented 15 items that would improve information handling in one area of the hospital, nursing units, where this activity is greater than in any other in a hospital. PMID:5971636

Survey on Tuition Policy, Costs and Student Aid.

ERIC Educational Resources Information Center

State Higher Education Executive Officers Association.

A survey of the finance and executive officers of the statewide coordinating and governing boards in the United States and one Canadian province (Manitoba) gathered information on state policy regarding college costs, tuition, and student financial aid. The first part, completed by finance officers, asked specific questions about the…

Attaching unit costs to Australia's National Survey of Mental Health and Wellbeing.

PubMed

Mihalopoulos, Cathrine; Meadows, Graham; Stiller, Anna; Pirkis, Jane; Burgess, Philip

2005-06-01

In mental health, policy-makers and planners are increasingly being asked to set priorities. This means that health economists, health services researchers and clinical investigators are being called upon to work together to define and measure costs. Typically, these researchers take available service utilisation data and convert them to costs, using a range of assumptions. There are inefficiencies, as individual groups of researchers frequently repeat essentially similar exercises in achieving this end. There are clearly areas where shared or common investment in the development of statistical software syntax, analytical frameworks and other resources could maximise the use of data. This paper reports on an Australian project in which we calculated unit costs for mental health admissions and community encounters. In reporting on these calculations, our purpose is to make the data and the resources associated with them publicly available to researchers interested in conducting economic analyses, and allow them to copy, distribute and modify them, providing that all copies and modifications are available under the same terms and conditions (i.e., in accordance with the 'Copyleft' principle). Within this context, the objectives of the paper are to: (i) introduce the 'Copyleft' principle; (ii) provide an overview of the methodology we employed to derive the unit costs; (iii) present the unit costs themselves; and (iv) examine the total and mean costs for a range of single and comorbid conditions, as an example of the kind of question that the unit cost data can be used to address. We took relevant data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), and developed a set of unit costs for inpatient and community encounters. We then examined total and mean costs for a range of single and comorbid conditions. We present the unit costs for mental health admissions and mental health community contacts. Our example, which explored the association between comorbidity and total and mean costs, suggested that comorbidly occurring conditions cost more than conditions which occur on their own. Our unit costs, and the materials associated with them, have been published in a freely available form governed by a provision termed 'Copyleft'. They provide a valuable resource for researchers wanting to explore economic questions in mental health. Our unit costs provide an important resource to inform economic debate in mental health in Australia, particularly in the area of priority-setting. In the past, such debate has largely been based on opinion. Our unit costs provide the underpinning to strengthen the evidence-base of this debate. We would encourage other Australian researchers to make use of our unit costs in order to foster comparability across studies. We would also encourage Australian and international researchers to adopt the 'Copyleft' principle in equivalent circumstances. Furthermore, we suggest that the provision of 'Copyleft'-contingent funding to support the development of enabling resources for researchers should be considered in the planning of future large-scale collaborative survey work, both in Australia and overseas.

The Management Information Needs of the Activity Level Comptroller within the Marine Corps.

DTIC Science & Technology

1983-03-01

authority, cost accounting , and maintaining plant property account records and inventory. 14 . ., Sections that are usually maintained within accounting ...disbursing divisions are timekeeping, payroll, cost and reports, inventory account - ing, military pay records, public voucher, fiscal and savings bond...units incurring the expenses. PRIME was developed as a disciplined and mechanized way, to directly identify accountable cost separate from allocated

A Model for the Determination of the Costs of Special Education as Compared with That for General Education. Appendix: Part 2.

ERIC Educational Resources Information Center

Ernst and Ernst, Chicago, IL.

Part 2 of the appendix to "A Model for the Determination of the Costs of Special Education as Compared with That for General Education" contains information on using 10-minute units of service measure in Ernstville, a hypothetical school district conceived to illustrate operation of a proposed cost accounting system. (LH)

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

PubMed Central

Halpern, Neil A; Pastores, Stephen M.

2017-01-01

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

Adherence to infection control guidelines in surgery on MRSA positive patients : A cost analysis.

PubMed

Saegeman, V; Schuermans, A

2016-09-01

In surgical units, similar to other healthcare departments, guidelines are used to curb transmission of methicillin resistant Staphylococcus aureus (MRSA). The aim of this study was to calculate the extra costs for material and extra working hours for compliance to MRSA infection control guidelines in the operating rooms of a University Hospital. The study was based on observations of surgeries on MRSA positive patients. The average cost per surgery was calculated utilizing local information on unit costs. Robustness of the calculations was evaluated with a sensitivity analysis. The total extra costs of adherence to MRSA infection control guidelines averaged € 340.46 per surgical procedure (range € 207.76- € 473.15). A sensitivity analysis based on a standardized operating room hourly rate reached a cost of € 366.22. The extra costs of adherence to infection control guidelines are considerable. To reduce costs, the logistical planning of surgeries could be improved by for instance a dedicated room.

Braille in the United States: Its Production, Distribution, and Use.

ERIC Educational Resources Information Center

Goldish, Louis Harvey

The braille production system in the United States is described. Aspects treated are the following: the need for braille (the braille system), the market for braille (size and characteristics), sources of braille (producers and braille book source information), and present methods and costs of producing braille. Technological advances are…

77 FR 40324 - Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-09

... compromising RUS loan security, and to reduce the cost to borrowers, in terms of time, expenses and paperwork... make loans in the several United States and Territories of the United States for rural electrification... subordinating loans made by the national Rural Utilities Cooperative Finance Corporation, the Federal Financing...

Nuclear Power Plants. Revised.

ERIC Educational Resources Information Center

Lyerly, Ray L.; Mitchell, Walter, III

This publication is one of a series of information booklets for the general public published by the United States Atomic Energy Commission. Among the topics discussed are: Why Use Nuclear Power?; From Atoms to Electricity; Reactor Types; Typical Plant Design Features; The Cost of Nuclear Power; Plants in the United States; Developments in Foreign…

Economic analysis and assessment of syngas production using a modeling approach

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

Kim, Hakkwan; Parajuli, Prem B.; Yu, Fei

Economic analysis and modeling are essential and important issues for the development of current feedstock and process technology for bio-gasification. The objective of this study was to develop an economic model and apply to predict the unit cost of syngas production from a micro-scale bio-gasification facility. An economic model was programmed in C++ computer programming language and developed using a parametric cost approach, which included processes to calculate the total capital costs and the total operating costs. The model used measured economic data from the bio-gasification facility at Mississippi State University. The modeling results showed that the unit cost ofmore » syngas production was $1.217 for a 60 Nm-3 h-1 capacity bio-gasifier. The operating cost was the major part of the total production cost. The equipment purchase cost and the labor cost were the largest part of the total capital cost and the total operating cost, respectively. Sensitivity analysis indicated that labor costs rank the top as followed by equipment cost, loan life, feedstock cost, interest rate, utility cost, and waste treatment cost. The unit cost of syngas production increased with the increase of all parameters with exception of loan life. The annual cost regarding equipment, labor, feedstock, waste treatment, and utility cost showed a linear relationship with percent changes, while loan life and annual interest rate showed a non-linear relationship. This study provides the useful information for economic analysis and assessment of the syngas production using a modeling approach.« less

19 CFR 202.5 - Type of information to be developed at hearing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 3 2010-04-01 2010-04-01 false Type of information to be developed at hearing. 202.5 Section 202.5 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION NONADJUDICATIVE INVESTIGATIONS INVESTIGATIONS OF COSTS OF PRODUCTION § 202.5 Type of information to be developed at hearing...

19 CFR 202.5 - Type of information to be developed at hearing.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 3 2012-04-01 2012-04-01 false Type of information to be developed at hearing. 202.5 Section 202.5 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION NONADJUDICATIVE INVESTIGATIONS INVESTIGATIONS OF COSTS OF PRODUCTION § 202.5 Type of information to be developed at hearing...

19 CFR 202.5 - Type of information to be developed at hearing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 3 2011-04-01 2011-04-01 false Type of information to be developed at hearing. 202.5 Section 202.5 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION NONADJUDICATIVE INVESTIGATIONS INVESTIGATIONS OF COSTS OF PRODUCTION § 202.5 Type of information to be developed at hearing...

19 CFR 202.5 - Type of information to be developed at hearing.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 3 2014-04-01 2014-04-01 false Type of information to be developed at hearing. 202.5 Section 202.5 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION NONADJUDICATIVE INVESTIGATIONS INVESTIGATIONS OF COSTS OF PRODUCTION § 202.5 Type of information to be developed at hearing...

19 CFR 202.5 - Type of information to be developed at hearing.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 3 2013-04-01 2013-04-01 false Type of information to be developed at hearing. 202.5 Section 202.5 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION NONADJUDICATIVE INVESTIGATIONS INVESTIGATIONS OF COSTS OF PRODUCTION § 202.5 Type of information to be developed at hearing...

Health Information Exchange: The Determinants of Usage and the Impact on Utilization

ERIC Educational Resources Information Center

Vest, Joshua Ryan

2010-01-01

Health information exchange (HIE) is the process of electronically sharing patient-level information among different organizations with the objectives of quality and cost improvements. The adoption of HIE in the United States is not widespread, but numerous efforts at facilitating HIE exist and the incentives for electronic health record system…

Understanding the End User Perspective: A Multiple-Case Study of Successful Health Information Technology Implementation

ERIC Educational Resources Information Center

Behravesh, Bardia

2010-01-01

The United States continues to lag behind other countries in its adoption of health information technology. A failure to increase adoption will jeopardize the nation's ability to reduce medical errors, address the rapid growth of healthcare costs, and enact effective healthcare reform. Health information technology (HIT) implementation success…

Examining Health Information Technology Implementation Success Factors in Critical Access Hospitals

ERIC Educational Resources Information Center

Monkman, Blake D.

2016-01-01

As the role of information technology increases throughout the world, healthcare providers in the United States face industry and governmental pressures to implement health information technology (HIT) as a tool to improve healthcare costs, quality, and safety. The problem addressed in this study was the relatively low HIT implementation success…

78 FR 61378 - Agency Information Collection Activities: Small Vessel Reporting System

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-03

... respondents or record keepers from the collection of information (a total capital/ startup costs and... officer each time they enter the United States. In some cases, a participant may also be asked to report... information, listing of all persons on board, estimated dates and times of departure and return, and...

Expanding the generation and use of economic and financial data to improve HIV program planning and efficiency: a global perspective.

PubMed

Holmes, Charles B; Atun, Rifat; Avila, Carlos; Blandford, John M

2011-08-01

Cost information is needed at multiple levels of health care systems to inform the public health response to HIV. To date, most attention has been paid to identifying the cost drivers of providing antiretroviral treatment, and these data have driven interventions that have been successful in reducing drug and human resource costs. The need for further cost information, especially for less well-studied areas such as HIV prevention, is particularly acute given global budget constraints and ongoing efforts to extract the greatest possible value from money spent on the response. Cost information can be collected from multiple perspectives and levels of the health care system (site, program, and national levels), and it is critical to choose the appropriate methodology in order to generate the appropriate information for decision-making. Organizations such as United States President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and other organizations are working together to bridge the divide between the fields of economics and HIV program implementation by accelerating the collection of cost data and building further local demand and capacity for their use.

Cost of standard indoor ultra-low-volume space spraying as a method to control adult dengue vectors.

PubMed

Ditsuwan, Thanittha; Liabsuetrakul, Tippawan; Ditsuwan, Vallop; Thammapalo, Suwich

2012-06-01

To access the costs of standard indoor ultra-low-volume (SID-ULV) space spraying for controlling dengue vectors in Thailand. Resources related to SID-ULV space spraying as a method to control dengue vectors between July and December 2009 were identified, measured and valued taking a societal perspective into consideration. Information on costs was collected from direct observations, interviews and bookkeeping records. Uncertainty of unit costs was investigated using a bootstrap technique. Costs of SID-ULV were calculated from 18 new dengue cases that covered 1492 surrounding houses. The average coverage of the SID-ULV was 64.4%. In the first round of spraying, 53% of target houses were sprayed and 44.6% in the second round, of which 69.2% and 54.7% received entire indoor space spraying. Unit costs per case, per 10 houses and per 100 m(2) were USD 705 (95% Confidence Interval CI, 539-888), 180 (95% CI, 150-212) and USD 23 (95% CI, 17-30). The majority of SID-ULV unit cost per case was attributed to productivity loss (83.9%) and recurrent costs (15.2%). The unit cost of the SID-ULV per case and per house in rural was 2.8 and 1.6 times lower than municipal area. The estimated annual cost of SID-ULV space spraying from 2005 to 2009 using healthcare perspective ranged from USD 5.3 to 10.3 million. The majority of the cost of SID-ULV space spraying was attributed to productivity loss. Potential productivity loss influences the achievement of high coverage, so well-planned SID-ULV space spraying strategies are needed to reduce costs. © 2012 Blackwell Publishing Ltd.

Cost accounting models used for price-setting of health services: an international review.

PubMed

Raulinajtys-Grzybek, Monika

2014-12-01

The aim of the article was to present and compare cost accounting models which are used in the area of healthcare for pricing purposes in different countries. Cost information generated by hospitals is further used by regulatory bodies for setting or updating prices of public health services. The article presents a set of examples from different countries of the European Union, Australia and the United States and concentrates on DRG-based payment systems as they primarily use cost information for pricing. Differences between countries concern the methodology used, as well as the data collection process and the scope of the regulations on cost accounting. The article indicates that the accuracy of the calculation is only one of the factors that determine the choice of the cost accounting methodology. Important aspects are also the selection of the reference hospitals, precise and detailed regulations and the existence of complex healthcare information systems in hospitals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A Qualitative Study of Social Barriers to Digitizing Medical Records

ERIC Educational Resources Information Center

Belcher, Kenneth L., II

2012-01-01

The cost of the American healthcare system has escalated to the point that the United States spends more per patient than any other country. Based on the cost controls and increase in efficiency seen in other industries, many agree that information technology solutions should be adopted by the American healthcare industry. However, healthcare…

Factors affecting fire suppression costs as identified by incident management teams

Treesearch

Janie Canton-Thompson; Brooke Thompson; Krista Gebert; David Calkin; Geoff Donovan; Greg Jones

2006-01-01

This study uses qualitative sociological methodology to discover information and insights about the role of Incident Management Teams in wildland fire suppression costs. We interviewed 48 command and general staff members of Incident Management Teams throughout the United States. Interviewees were asked about team structure, functioning, and decision making as a...

Job Corps: Its Costs, Employment Outcomes, and Service to the Public. Briefing Report to the Chairman, Committee on Labor and Human Resources, United States Senate.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

This report evaluates the cost effectiveness of the Civilian Conservation Centers (CCCs) which are part of the Job Corps program but operated under inter-agency agreement by the Departments of Agriculture and the Interior. Data are from the program year beginning July 1, 1984. Information is presented on: (1) the costs, job placements, and…

Military Review. July-August 2011

DTIC Science & Technology

2011-08-01

IGHTING THE SO-CALLED “information war” against terrorists andinsurgents has cost the U.S. military nearly $1 billion in the past three years.1 But that...may not be the highest cost . Congressional questions about the spending for communication programs and news reports about questionable use of...strategic communications during the wars in Iraq and Afghanistan. In the end, these well-intended schemes might cost the United States its credibil­

Complications and Cost of Syndactyly Reconstruction in the United States: Analysis of the Pediatric Health Information System.

PubMed

Canizares, Maria F; Feldman, Lanna; Miller, Patricia E; Waters, Peter M; Bae, Donald S

2017-07-01

Syndactyly is one of the most common congenital differences of the upper extremity and offers an exceptional opportunity to evaluate value-based care in pediatric orthopedic surgery. We designed a study to characterize complications and cost associated to syndactyly surgery among US pediatric hospitals. A total of 2047 patients were identified for syndactyly surgery at 38 pediatric hospitals from 2009 to 2012 using the Pediatric Health Information System (PHIS) database. We examined costs as well as complication rates across hospitals stratified by patient and hospital variables. The postoperative complication rate was 1.9% (95% confidence interval [CI]: 1.3%-2.5%). Postoperative infection rate was 1.6% and surgical complication rate was 0.3%. Median adjusted standardized cost was $4112.5 (interquartile range: $2979-$6049). Patients with more than 1 diagnosis had 19 times higher risk of complications and were associated with 13% more hospital cost than those with syndactyly as single diagnosis ( P < .001). Finally, there was a wide variation in cost across hospitals; 8 (21%) yielded confidence limits above the benchmarked value. In the United States, it is important to recognize variations in practice of syndactyly surgery in hopes of developing quality improvement strategies in pediatric orthopedic surgery.

On-line searching: costly or cost effective? A marketing perspective.

PubMed

Dunn, R G; Boyle, H F

1984-05-01

The value of acquiring and using information is not well understood. Decisions to purchase information are made on the basis of the perceived need for the information, the anticipated benefit of using it, and the price. The current pricing of on-line information services, which emphasizes the connect hour as the unit of price, does not relate the price of a search to the value of a search, and the education programs of on-line vendors and database suppliers concentrate on the mechanics of information retrieval rather than on the application of information to the customer's problem. The on-line information industry needs to adopt a strong marketing orientation that focuses on the needs of customers rather than the needs of suppliers or vendors.

Methodological advances in unit cost calculation of psychiatric residential care in Spain.

PubMed

Moreno, Karen; Sanchez, Eduardo; Salvador-Carulla, Luis

2008-06-01

The care of the severe mentally ill who need intensive support for their daily living (dependent persons), accounts for an increasingly large proportion of public expenditure in many European countries. The main aim of this study was the design and implementation of solid methodology to calculate unit costs of different types of care. To date, methodologies used in Spain have produced inaccurate figures, suggesting few variations in patient consumption of the same service. An adaptation of the Activity-Based-Costing methodology was applied in Navarre, a region in the North of Spain, as a pilot project for the public mental health services. A unit cost per care process was obtained for all levels of care considered in each service during 2005. The European Service Mapping Schedule (ESMS) codes were used to classify the services for later comparisons. Finally, in order to avoid problems of asymmetric cost distribution, a simple Bayesian model was used. As an illustration, we report the results obtained for long-term residential care and note that there are important variations between unit costs when considering different levels of care. Considering three levels of care (Level 1-low, Level 2-medium and Level 3-intensive), the cost per bed in Level 3 was 10% higher than that of Level 2. The results obtained using the cost methodology described provide more useful information than those using conventional methods, although its implementation requires much time to compile the necessary information during the initial stages and the collaboration of staff and managers working in the services. However, in some services, if no important variations exist in patient care, another method would be advisable, although our system provides very useful information about patterns of care from a clinical point of view. Detailed work is required at the beginning of the implementation in order to avoid the calculation of distorted figures and to improve the levels of decision making within the Health Care Service. IMPLICATIONS FOR HEALTH CARE POLICY AND FORMULATIONS: As other European countries, Spain has adopted a new care system for the dependent population. To finance this new system, reliable figures must be calculated for each type of user in order to establish tariffs or public prices. This study provides a useful management tool to assist in decision making. The methodology should be implemented in other regions of Spain and even in other countries in order to compare our results and validate the cost system designed.

How much does a diabetes out-patient appointment actually cost? An argument for PLICS.

PubMed

Grant, Paul

2015-01-01

The national tariff system for clinical processes and procedures aims to put a discrete unit cost on clinical activity. Calculating such costs can be subject to a great deal of local variation and interpretation. Given the rising costs of diabetes the purpose of this paper is to ask the question what does a diabetes outpatient appointment in the UK NHS actually cost? This is important in a time of financial austerity and healthcare rationing because it can be difficult to decipher the attribution of costs within the acute hospital setting. Exploring this question, the author considers the present cost model and analyse in terms of the language of unit model cost; the basic tariff system and how it works in diabetes and looking at internal cost information the author attempts to unbundle the cost to provide a more accurate value for the cost object. One major finding is that costs and overheads are divided arbitrarily as opposed to being distributed on the basis of measured relative consumption. Alternative costing methods are appraised to demonstrate that a patient level episodic costing approach such as patient level information and costing system (PLICS) which incorporates aspects of activity-based costing (ABC) would be far more appropriate. Using time driven ABC (TDABC), a new patient appointment costs £162 for 30 minutes and a follow-up appointment costs £81 for 15 minutes. PLICS has the added benefit of greater financial and clinical transparency and this goes some way towards the holy grail of greater engagement with the doctors delivering clinical care. It would appear that there are different purposes of different costing systems. One can argue that a costing system is there to both contain costs and divide overheads and demonstrate activity. Depending on how data are interpreted costing information can be an agent of enlightenment and behavioural modification for healthcare professionals to show them their direct and indirect costs, their capacity and productivity. Clinicians and health service managers can see from this practical example how the distribution of costs and resources are unfair and can impede the delivery of a service. By using alternative costing methodologies such as ABC not only do the author gets a better reflection of the true cost of the finished consultant episode but is also able to engage clinicians in understanding how costs are generated.

RVU costing applications.

PubMed

Berlin, M F; Faber, B P; Berlin, L M; Budzynski, M R

1997-11-01

Relative value unit (RVU) cost accounting which uses the resource-based relative value scale (RBRVS), can be used to determine the cost to produce given services and determine appropriate physician fees. The calculations derived from RVU costing have additional applications, such as analyzing fee schedules, evaluating the profitability of third-party payer reimbursement, calculating a floor capitation rate, and allocating capitation payments within the group. The ability to produce this information can help group practice administrators determine ways to manage the cost of providing services, set more realistic fees, and negotiate more profitable contracts.

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.

Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: an analysis of direct healthcare neonatal intensive care unit costs and savings.

PubMed

Melnyk, Bernadette Mazurek; Feinstein, Nancy Fischbeck

2009-01-01

More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States $26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least $4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than $2 billion per year.

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

COMPARISON FRICTION: EXPERIMENTAL EVIDENCE FROM MEDICARE DRUG PLANS*

PubMed Central

Kling, Jeffrey R.; Mullainathan, Sendhil; Shafir, Eldar; Vermeulen, Lee; Wrobel, Marian V.

2011-01-01

Consumers need information to compare alternatives for markets to function efficiently. Recognizing this, public policies often pair competition with easy access to comparative information. The implicit assumption is that comparison friction—the wedge between the availability of comparative information and consumers’ use of it—is inconsequential because information is readily available and consumers will access this information and make effective choices. We examine the extent of comparison friction in the market for Medicare Part D prescription drug plans in the United States. In a randomized field experiment, an intervention group received a letter with personalized cost information. That information was readily available for free and widely advertised. However, this additional step—providing the information rather than having consumers actively access it—had an impact. Plan switching was 28 percent in the intervention group, versus 17 percent in the comparison group, and the intervention caused an average decline in predicted consumer cost of about $100 per year among letter recipients—roughly 5 percent of the cost in the comparison group. Our results suggest that comparison friction can be large even when the cost of acquiring information is small, and may be relevant for a wide range of public policies that incorporate consumer choice. PMID:22454838

A Study of the Relationship between User Attitudes and the Success of the MAJCOM and AFRCE Work Information Management System.

DTIC Science & Technology

1984-09-01

subsystems including labor reporting, Prime BEEF (Base Engineer Emergency Forces) composition, work order control, material control, cost accounting...AirComan IL ARCE BallsticLangey AB,24 Misl Supr)-FC Norton AF CA ( Estr Region) - AFRCE (United Kingdom) Ruislip AB UK UntdSae0i Fre nErp * Ramstein AB...Air Force personnel and minimize information burden on users, providers, and handlers, thereby reducing the costs, labor and intensiveness, and time

Costing improvement of remanufacturing crankshaft by integrating Mahalanobis-Taguchi System and Activity based Costing

NASA Astrophysics Data System (ADS)

Abu, M. Y.; Nor, E. E. Mohd; Rahman, M. S. Abd

2018-04-01

Integration between quality and costing system is very crucial in order to achieve an accurate product cost and profit. Current practice by most of remanufacturers, there are still lacking on optimization during the remanufacturing process which contributed to incorrect variables consideration to the costing system. Meanwhile, traditional costing accounting being practice has distortion in the cost unit which lead to inaccurate cost of product. The aim of this work is to identify the critical and non-critical variables during remanufacturing process using Mahalanobis-Taguchi System and simultaneously estimate the cost using Activity Based Costing method. The orthogonal array was applied to indicate the contribution of variables in the factorial effect graph and the critical variables were considered with overhead costs that are actually demanding the activities. This work improved the quality inspection together with costing system to produce an accurate profitability information. As a result, the cost per unit of remanufactured crankshaft of MAN engine model with 5 critical crankpins is MYR609.50 while Detroit engine model with 4 critical crankpins is MYR1254.80. The significant of output demonstrated through promoting green by reducing re-melting process of damaged parts to ensure consistent benefit of return cores.

2016 Offshore Wind Market Report

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

Musial, Walter; Beiter, Philipp; Schwabe, Paul

The 2016 Offshore Wind Technologies Market Report is intended to provide stakeholders with quantitative information about the offshore wind market, technology, and cost trends in the United States and worldwide.

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.

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.

Usefulness of a Regional Health Care Information System in primary care: a case study.

PubMed

Maass, Marianne C; Asikainen, Paula; Mäenpää, Tiina; Wanne, Olli; Suominen, Tarja

2008-08-01

The goal of this paper is to describe some benefits and possible cost consequences of computer based access to specialised health care information. A before-after activity analysis regarding 20 diabetic patients' clinical appointments was performed in a Health Centre in Satakunta region in Finland. Cost data, an interview, time-and-motion studies, and flow charts based on modelling were applied. Access to up-to-date diagnostic information reduced redundant clinical re-appointments, repeated tests, and mail orders for missing data. Timely access to diagnostic information brought about several benefits regarding workflow, patient care, and disease management. These benefits resulted in theoretical net cost savings. The study results indicated that Regional Information Systems may be useful tools to support performance and improve efficiency. However, further studies are required in order to verify how the monetary savings would impact the performance of Health Care Units.

Hidden Costs of the Campus Security Force.

ERIC Educational Resources Information Center

Temple, Charles M.

1981-01-01

Information on the security operations of public four-year colleges and universities is examined, and the case of the University of Tennessee, Chattanooga (UTC), which saved $66,000 a year from the security unit's operational budget, is noted. Of 561 questionnaires sent to public institutions regarding the general operation of security units,…

A Film Unit Designed Especially For Developing Countries.

ERIC Educational Resources Information Center

Woods, John L.

An Agency for International Development (AID) project established an educational film production unit in Malawi. The project was designed to deliver extension services and information from the Ministry of Agriculture to rural farmers and had to: 1) produce films which meet the needs of villagers; 2) keep costs to an absolute minimum; and 3) fully…

Controlling Costs. Managing Resources Module. Operational Management Programme. Second Edition.

ERIC Educational Resources Information Center

Hayter, Roy

This self-study unit focuses on managing resources--materials, equipment, personnel, money, energy, time, and information. The material is designed primarily for those in a supervisory or junior management position working within their company's policies and systems. The unit may be of value to the small business proprietor, as an introduction to…

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.

Making the case for a clinical information system: the chief information officer view.

PubMed

Cotter, Carole M

2007-03-01

Adequate decision support for clinicians and other caregivers requires accessible and reliable patient information. Powerful societal and economic forces are moving us toward an integrated, patient-centered health care information system that will allow caregivers to exchange up-to-date patient health information quickly and easily. These forces include patient safety, potential health care cost savings, empowerment of consumers (and their subsequent demands for quality), new federal policies, and growing regional health care initiatives. Underspending on health care information technologies has gone on for many years; and the creation and implementation of a comprehensive clinical information system will entail many difficulties, particularly in regard to patients' privacy and control of their information, standardization of electronic health records, cost of adopting information technology, unbalanced financial incentives, and the varying levels of preparation across caregivers. There will also be potential effects on the physician-patient relationship. Ultimately, an integrated system will require a concerted transformation of the health care industry that is akin to what the banking industry has accomplished with electronic automation. Critical care units provide a good starting point for how information system technologies can be used and electronic patient information collected, although the robust systems designed for intensive care units are not always used to their potential.

Price and quality transparency: how effective for health care reform?

PubMed

Nyman, John A; Li, Chia-Hsuan W

2009-07-01

Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed.

7 CFR 636.19 - Access to operating unit.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636.19 Access to... information necessary to evaluate the habitat development performance specified in the cost-share agreements...

7 CFR 636.19 - Access to operating unit.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636.19 Access to... information necessary to evaluate the habitat development performance specified in the cost-share agreements...

7 CFR 636.19 - Access to operating unit.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636.19 Access to... information necessary to evaluate the habitat development performance specified in the cost-share agreements...

7 CFR 636.19 - Access to operating unit.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636.19 Access to... information necessary to evaluate the habitat development performance specified in the cost-share agreements...

A cost description of an adult cystic fibrosis unit and cost analyses of different categories of patients.

PubMed Central

Robson, M; Abbott, J; Webb, K; Dodd, M; Walsworth-Bell, J

1992-01-01

BACKGROUND: There is little information on the costs of running an adult cystic fibrosis centre. The aim of this study was to provide detailed costs to assist funding and planning for these patients. METHODS: The cost of a regional adult cystic fibrosis centre serving 119 cystic fibrosis patients, categorised according to four treatment regimens, was determined. District health authority, family health service authority, and voluntary resources used from April 1989 to March 1990 were determined, with appropriate bases for allocation of costs and patient based costs from local information. RESULTS: The total annual cost of treating the 119 patients was 980,646 pounds, with an average cost 8241 pounds per patient. An outpatient reviewed at three monthly intervals cost 2792 pounds a year; an outpatient receiving intravenous antibiotics cost 8606 pounds; an inpatient receiving intravenous antibiotics cost 13,501 pounds; and a patient needing a high level of care cost 19,955 pounds. Medication accounted for 57% (561,395 pounds) of the total cost. CONCLUSIONS: This analysis has helped us to secure funding for patients with cystic fibrosis and it facilitates the prediction of future requirements. The study also indicates the limitations of using average patient costs and difficulties as a result of the poorly structured British National Health Service accounting and information systems. PMID:1440461

Inordinate Fondness: The Feds and the Internet.

ERIC Educational Resources Information Center

Morehead, Joe

1997-01-01

Examines the move to make U. S. government information available solely in an electronic format. Discusses inability of general purpose search engines to access the information; shift of cost to the consumer; the online version of the "Monthly Catalog of United States Government Publications"; federal statistics; Agency Web sites; and a…

77 FR 13326 - Carpenter Technology Corporation and Latrobe Specialty Metals, Inc.; Analysis of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

... established sales and marketing network in the United States that will allow it to be immediately competitive... making sure that your comment does not include any sensitive personal information, like anyone's Social... information such as costs, sales statistics, inventories, formulas, patterns, devices, manufacturing processes...

76 FR 70451 - Agency Information Collection Activities; Proposed Collection; Comment Request; Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

... commodities to keep records that substantiate ``cents off,'' ``introductory offer,'' and/or ``economy size... United States, 2010, U.S. Department of Labor, U.S. Bureau of Labor Statistics (May 2011) (``BLS National... information such as costs, sales statistics, inventories, formulas, patterns devices, manufacturing processes...

Using cost-effectiveness analysis to support research and development portfolio prioritization for product innovations in measles vaccination.

PubMed

Garrison, Louis P; Bauch, Chris T; Bresnahan, Brian W; Hazlet, Tom K; Kadiyala, Srikanth; Veenstra, David L

2011-07-01

Several potential measles vaccine innovations are in development to address the shortcomings of the current vaccine. Funders need to prioritize their scarce research and development resources. This article demonstrates the usefulness of cost-effectiveness analysis to support these decisions. This study had 4 major components: (1) identifying potential innovations, (2) developing transmission models to assess mortality and morbidity impacts, (3) estimating the unit cost impacts, and (4) assessing aggregate cost-effectiveness in United Nations Children's Fund countries through 2049. Four promising technologies were evaluated: aerosol delivery, needle-free injection, inhalable dry powder, and early administration DNA vaccine. They are projected to have a small absolute impact in terms of reducing the number of measles cases in most scenarios because of already improving vaccine coverage. Three are projected to reduce unit cost per dose by $0.024 to $0.170 and would improve overall cost-effectiveness. Each will require additional investments to reach the market. Over the next 40 years, the aggregate cost savings could be substantial, ranging from $98.4 million to $689.4 million. Cost-effectiveness analysis can help to inform research and development portfolio prioritization decisions. Three new measles vaccination technologies under development hold promise to be cost-saving from a global perspective over the long-term, even after considering additional investment costs. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

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.

Establishing Common Cost Measures to Evaluate the Economic Value of Patient Navigation Programs

PubMed Central

Whitley, Elizabeth; Valverde, Patricia; Wells, Kristen; Williams, Loretta; Teschner, Taylor; Shih, Ya-Chen Tina

2011-01-01

Background Patient navigation is an intervention aimed at reducing barriers to healthcare for underserved populations as a means to reduce cancer health disparities. Despite the proliferation of patient navigation programs across the United States, information related to the economic impact and sustainability of these programs is lacking. Method Following a review of the relevant literature, the Health Services Research (HSR) cost workgroup of the American Cancer Society National Patient Navigator Leadership Summit met to examine cost data relevant to assessing the economic impact of patient navigation and to propose common cost metrics. Results Recognizing that resources available for data collection, management and analysis vary, five categories of core and optional cost measures were identified related to patient navigator programs, including, program costs, human capital costs, direct medical costs, direct non-medical costs and indirect costs. Conclusion(s) Information demonstrating economic as well as clinical value is necessary to make decisions about sustainability of patient navigation programs. Adoption of these common cost metrics are recommended to promote understanding of the economic impact of patient navigation and comparability across diverse patient navigation programs. PMID:21780096

INL Director Discusses the Future for Nuclear Energy in the United States

ScienceCinema

Grossenbacher, John

2018-01-15

Idaho National Laboratory's Director John Grossenbacher explains that the United States should develop its energy policies based on an assessment of the current events at Japan's Fukushima nuclear reactors and the costs and benefits of providing electricity through various energy sources. For more information about INL's nuclear energy research, visit http://www.facebook.com/idahonationallaboratory.

Performance indicators and decision making for outsourcing public health laboratory services.

PubMed

Santos, Maria Angelica Borges dos; Moraes, Ricardo Montes de; Passos, Sonia Regina Lambert

2012-06-01

To develop performance indicators for outsourcing clinical laboratory services, based on information systems and public administrative records. In the municipality of Rio de Janeiro, Southern Brazil, the public health laboratory network comprised 33 laboratories with automated equipment (but no integrated information system), 90 primary care units (where sample collection was performed) and 983 employees. Information records were obtained from the administrative records of the Budget Information System for Public Health and the Outpatient and Hospital Information System of the Unified Health System. Performance indicators (production, productivity, usage and costs) were generated from data collected routinely from 2006 to 2008. The variations in production, costs and unit prices for tests were analyzed by Laspeyres and Paasche indices, which specifically measure laboratory activity, and by the Consumer Price Index from the Brazilian Institute of Geography and Statistics. A total of 10,359,111 tests were performed in 2008 (10.6% increase over 2006), and the test/employee ratio grew by 8.6%. The costs of supplies, wages and providers increased by 2.3%, 45.4% and 18.3%, respectively. The laboratory tests per visit and hospitalizations increased by 10% and 20%, respectively. The direct costs totaled R$ 63.2 million in 2008, representing an increase of 22.2% in current values during the period analyzed. The direct costs deflated by the Brazilian National Consumer Price Index (9.5% for the period) showed an 11.6% increase in production volumes. The activity-specific volume index, which considers changes in the mix of tests, showed increases of 18.5% in the test price and 3.1% in the production volume. The performance indicators, particularly the specific indices for volume and price of activity, constitute a baseline of performance potential for monitoring private laboratories and contractors. The economic performance indicators demonstrated the need for network information system integration prior to an outsourcing decision.

Health Economics Information in Wound Care: The Elephant in the Room

PubMed Central

Carter, Marissa Janine

2013-01-01

Objective To describe the role of health economics (HE) in wound care in relation to coverage and reimbursement. Approach Narrative description of key concepts with supporting references. Results The process of approval or clearance of wound care products within the U.S. regulatory framework often causes lack of high level of evidence regarding clinical outcomes. There is also a paucity of HE information and great reluctance to use such information (when it is available) by insurers and Centers for Medicare and Medicaid, as well as other health-care agencies. Cost-effectiveness (CE) studies are the most common type of HE study in wound care, and the most common outcomes are incremental CE ratios (ICERs). Interpretation of ICERs requires considerable judgment when results are not obvious and is hampered by lack of contemporary and useful benchmarks. While many lessons have been learned in applying CE to coverage and reimbursement decisions in other western countries—including transparency of decision-making and involvement of patients—there is still a major aversion to using CE in the United States Applying CE to basic wound care and advanced therapeutics has the potential to decrease the costs of wound healing considerably. Innovation and Conclusions Many CE approaches, including modeling, provide sufficiently detailed information that decision-makers can make informed decisions about wound care products in regard to coverage and reimbursement. The reluctance to use CE information in the United States, however, is likely to contribute heavily to the ever-increasing costs in wound care. PMID:24527322

Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital.

PubMed

Wani, Mohammad Ashraf; Tabish, S A; Jan, Farooq A; Khan, Nazir A; Wafai, Z A; Pandita, K K

2013-01-01

Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.

PubMed

Ruiz-Ramos, Jesus; Frasquet, Juan; Romá, Eva; Poveda-Andres, Jose Luis; Salavert-Leti, Miguel; Castellanos, Alvaro; Ramirez, Paula

2017-06-01

To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

Community-directed treatment with ivermectin in two Nigerian communities: an analysis of first year start-up processes, costs and consequences.

PubMed

Onwujekwe, Obinna; Chima, Reginald; Shu, Elvis; Okonkwo, Paul

2002-10-01

To determine the start-up processes, costs and consequences of community-directed treatment with ivermectin (CDTI) in two onchocerciasis endemic rural towns of Southeast Nigeria; namely Achi and Nike. The other objectives were to discover the community-financing mechanisms, local ivermectin distribution strategies and communities' organisational capacity to handle the programme. Structured questionnaires, informal interviews, observations, discussions with community members at general village assemblies and community outreach lectures were used at different stages of the study. The towns had the organisational capacity to implement the programme. Coverage with ivermectin was between 31-73% in Achi (mean = 58.6%), and 36.6-72% in Nike (mean = 61.95%). The unit financial costs were $0.17 in Nike and $0.13 in Achi, but the unit aggregate cost was $0.37 in Nike and $0.39 in Achi. When research costs were removed, the unit aggregate cost was $0.22 in Achi and $0.20 in Nike. Provider's financial costs and communities' non-financial costs were the biggest contributors to the aggregate cost. The cost would decrease in subsequent years since the research cost and parts of the mobilisation and training costs would not be incurred after the first year. Governments and sponsors of CDTI should find means of continuously strengthening the programme and providing technical support to the communities. As both CDTI and communities are dynamic entities, continuous health education campaigns are needed to keep reminding the people of the benefit of long-term ivermectin distribution, together with the need for community ownership of the programme.

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

The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications.

PubMed

Schroeder, Liz; Patel, Nishma; Keeler, Michelle; Rocca-Ihenacho, Lucia; Macfarlane, Alison J

2017-02-01

to compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital. micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes. the Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, both run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007-2010. maternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre. Of these, 167 women started their intrapartum care at the Birth Centre and 166 started care at the Royal London Hospital. women who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who planned for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units. the study showed that intrapartum throughput in the Birth Centre could be considered cost-minimising when compared to hospital. Modelling the financial viability of midwifery units at a local level is important because it can inform the appropriate provision of these services. This finding from this study contribute a local perspective and thus further weight to the evidence from the Birthplace Programme in support of freestanding midwifery unit care for women without obstetric complications. Copyright © 2016. Published by Elsevier Ltd.

The Ring of Gyges: Anonymity and Technological Advance’s Effect on the Deterrence of Nonstate Actors in 2035

DTIC Science & Technology

2012-10-01

Technical Information Center, 1972), 723–24. A case in point is the Manhattan Project undertaken by the United States to produce the first atomic weapon. A...capital and operations costs from 1942 through 1945. Costs adjusted using a base year of 1944 (the year of highest Manhattan Project expenditures). 39

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.

What do we get for our money? Cost-effectiveness of adding contingency management.

PubMed

Sindelar, Jody; Elbel, Brian; Petry, Nancy M

2007-02-01

To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse. Cost-effectiveness analyses based on resource utilization, unit costs and outcomes from a previous CM efficacy trial. Two community-based treatment centers. Patients (n = 120) enrolled in out-patient treatment for cocaine abuse. Random assignment to one of three 12-week treatment conditions: standard treatment (STD) alone or two variants of STD combined with prize based CM. In CM, drawing for prizes was available to those submitting drug-free urine samples and completing goal-related activities. There were two levels of pay-out (referred to as $80 versus $240) based on the potential value of prizes won. Costs per participant associated with counseling utilization, urine and breathalyzer testing, and operation of the prize-drawing procedure were derived from a survey conducted at 16 clinics that had participated in CM studies. The three measures of effectiveness were: (1) longest duration of consecutive abstinence; (2) percentage completing treatment; and (3) percentage of samples drug-free. The higher magnitude CM produced outcomes at a lower per unit cost than did the lower magnitude prize CM treatment. This was the case for all three outcome measures examined and held across various assumptions in the sensitivity analysis. Cost-effectiveness analyses can inform policy decisions regarding selection of one treatment model over another. Decisions on adoption of new evidence-based treatments would be aided by more information on society's willingness to pay for incremental gains in effectiveness.

Interpreting Financial Results. Financial Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

ERIC Educational Resources Information Center

Adamson, Jan; And Others

One of a series of three self-instructional units, these materials are aimed at helping British hotel and catering managers improve profits and/or reduce costs in their areas of responsibility. Following an introduction and a paragraph on how to use the unit, section 1 covers how to use management information. The section includes these trainee…

Reimbursement for critical care services in India

PubMed Central

Jayaram, Raja; Ramakrishnan, Nagarajan

2013-01-01

There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India. PMID:23833469

Advanced Crash Survivable Flight Data Recorder And Accident Information Retrieval System (AIRS).

DTIC Science & Technology

1981-08-01

Costs ................................. 151 Portable Ground Unit (PGU) ............................... 151 Maintenance Readout Unit ( MRU ...95 31 NARROW-BAND CONDUCTED EMISSIONS ON THE AIRS 24 VDC POWER RETURN (CE04 TESI ) ......................... 96 32 BROAD-BAND...Shunt) N/A Any Any Change Change MRU (Shunt) N/A Any Any ...... _Change Change PGU (Shunt) N/A --- Any Any Change Change 15 .. . . .i A, TABLE 4

Impact of trucking network flow on preferred biorefinery locations in the southern United States

Treesearch

Timothy M. Young; Lee D. Han; James H. Perdue; Stephanie R. Hargrove; Frank M. Guess; Xia Huang; Chung-Hao Chen

2017-01-01

The impact of the trucking transportation network flow was modeled for the southern United States. The study addresses a gap in existing research by applying a Bayesian logistic regression and Geographic Information System (GIS) geospatial analysis to predict biorefinery site locations. A one-way trucking cost assuming a 128.8 km (80-mile) haul distance was estimated...

Costs for Hospital Stays in the United States, 2011

MedlinePlus

... detailed description of HCUP, more information on the design of the Nationwide Inpatient Sample (NIS), and methods ... Nationwide Inpatient Sample (NIS) Variances, 2001. HCUP Methods Series Report #2003-2. Online. June 2005 (revised June ...

The direct cost of epilepsy in the United States: A systematic review of estimates.

PubMed

Begley, Charles E; Durgin, Tracy L

2015-09-01

To develop estimates of the direct cost of epilepsy in the United States for the general epilepsy population and sub-populations by systematically comparing similarities and differences in types of estimates and estimation methods from recently published studies. Papers published since 1995 were identified by systematic literature search. Information on types of estimates, study designs, data sources, types of epilepsy, and estimation methods was extracted from each study. Annual per person cost estimates from methodologically similar studies were identified, converted to 2013 U.S. dollars, and compared. From 4,104 publications discovered in the literature search, 21 were selected for review. Three were added that were published after the search. Eighteen were identified that reported estimates of average annual direct costs for the general epilepsy population in the United States. For general epilepsy populations (comprising all clinically defined subgroups), total direct healthcare costs per person ranged from $10,192 to $47,862 and epilepsy-specific costs ranged from $1,022 to $19,749. Four recent studies using claims data from large general populations yielded relatively similar epilepsy-specific annual cost estimates ranging from $8,412 to $11,354. Although more difficult to compare, studies examining direct cost differences for epilepsy sub-populations indicated a consistent pattern of markedly higher costs for those with uncontrolled or refractory epilepsy, and for those with comorbidities. This systematic review found that various approaches have been used to estimate the direct costs of epilepsy in the United States. However, recent studies using large claims databases and similar methods allow estimation of the direct cost burden of epilepsy for the general disease population, and show that it is greater for some patient subgroups. Additional research is needed to further understand the broader economic burden of epilepsy and how it varies across subpopulations. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

An Extra Dimension to Decision-Making in Animals: The Three-way Trade-off between Speed, Effort per-Unit-Time and Accuracy

PubMed Central

de Froment, Adrian J.; Rubenstein, Daniel I.; Levin, Simon A.

2014-01-01

The standard view in biology is that all animals, from bumblebees to human beings, face a trade-off between speed and accuracy as they search for resources and mates, and attempt to avoid predators. For example, the more time a forager spends out of cover gathering information about potential food sources the more likely it is to make accurate decisions about which sources are most rewarding. However, when the cost of time spent out of cover rises (e.g. in the presence of a predator) the optimal strategy is for the forager to spend less time gathering information and to accept a corresponding decline in the accuracy of its decisions. We suggest that this familiar picture is missing a crucial dimension: the amount of effort an animal expends on gathering information in each unit of time. This is important because an animal that can respond to changing time costs by modulating its level of effort per-unit-time does not have to accept the same decrease in accuracy that an animal limited to a simple speed-accuracy trade-off must bear in the same situation. Instead, it can direct additional effort towards (i) reducing the frequency of perceptual errors in the samples it gathers or (ii) increasing the number of samples it gathers per-unit-time. Both of these have the effect of allowing it to gather more accurate information within a given period of time. We use a modified version of a canonical model of decision-making (the sequential probability ratio test) to show that this ability to substitute effort for time confers a fitness advantage in the face of changing time costs. We predict that the ability to modulate effort levels will therefore be widespread in nature, and we lay out testable predictions that could be used to detect adaptive modulation of effort levels in laboratory and field studies. Our understanding of decision-making in all species, including our own, will be improved by this more ecologically-complete picture of the three-way tradeoff between time, effort per-unit-time and accuracy. PMID:25522281

An extra dimension to decision-making in animals: the three-way trade-off between speed, effort per-unit-time and accuracy.

PubMed

de Froment, Adrian J; Rubenstein, Daniel I; Levin, Simon A

2014-12-01

The standard view in biology is that all animals, from bumblebees to human beings, face a trade-off between speed and accuracy as they search for resources and mates, and attempt to avoid predators. For example, the more time a forager spends out of cover gathering information about potential food sources the more likely it is to make accurate decisions about which sources are most rewarding. However, when the cost of time spent out of cover rises (e.g. in the presence of a predator) the optimal strategy is for the forager to spend less time gathering information and to accept a corresponding decline in the accuracy of its decisions. We suggest that this familiar picture is missing a crucial dimension: the amount of effort an animal expends on gathering information in each unit of time. This is important because an animal that can respond to changing time costs by modulating its level of effort per-unit-time does not have to accept the same decrease in accuracy that an animal limited to a simple speed-accuracy trade-off must bear in the same situation. Instead, it can direct additional effort towards (i) reducing the frequency of perceptual errors in the samples it gathers or (ii) increasing the number of samples it gathers per-unit-time. Both of these have the effect of allowing it to gather more accurate information within a given period of time. We use a modified version of a canonical model of decision-making (the sequential probability ratio test) to show that this ability to substitute effort for time confers a fitness advantage in the face of changing time costs. We predict that the ability to modulate effort levels will therefore be widespread in nature, and we lay out testable predictions that could be used to detect adaptive modulation of effort levels in laboratory and field studies. Our understanding of decision-making in all species, including our own, will be improved by this more ecologically-complete picture of the three-way tradeoff between time, effort per-unit-time and accuracy.

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.

End-of-Life Care in the Intensive Care Unit

PubMed Central

Engelberg, Ruth A.; Bensink, Mark E.; Ramsey, Scott D.

2012-01-01

The incidence and costs of critical illness are increasing in the United States at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. More than 25% of healthcare costs are spent in the last year of life, and approximately 20% of deaths occur in the intensive care unit (ICU). Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs. PMID:22859524

Marketization in Long-Term Care: A Cross-Country Comparison of Large For-Profit Nursing Home Chains.

PubMed

Harrington, Charlene; Jacobsen, Frode F; Panos, Justin; Pollock, Allyson; Sutaria, Shailen; Szebehely, Marta

2017-01-01

This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability.

Marketization in Long-Term Care: A Cross-Country Comparison of Large For-Profit Nursing Home Chains

PubMed Central

Harrington, Charlene; Jacobsen, Frode F; Panos, Justin; Pollock, Allyson; Sutaria, Shailen; Szebehely, Marta

2017-01-01

This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability. PMID:28634428

Excerpta Medica abstracting journals: a case study of costs to medical school libraries.

PubMed Central

La Rocco, A; Feng, C

1977-01-01

A cost comparison study was made of Excerpta Medica's abstracting journals, based upon actual costs to a library. Unit costs were determined for six sections of EM as compared with six corresponding abstract journals. On average, EM sections were found to be 138% more costly than corresponding abstract journals. The effects of splitting of EM journal titles were also analyzed. This practice increases the price of a total subscription to EM and makes comprehensive information retrieval more difficult. A survey of medical school librarians as users of EM points to dissatisfaction with its increasing price, particularly when it results from title splitting. PMID:843653

Unit Cost of Medical Services at Different Hospitals in India

PubMed Central

Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

2013-01-01

Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes. PMID:23936088

Cost of umbilical cord blood units released for transplantation.

PubMed

Sirchia, G; Rebulla, P; Tibaldi, S; Lecchi, L

1999-06-01

A large number of institutions have started programs banking umbilical cord blood (UCB) for allogeneic unrelated-donor and related-donor transplantation. However, limited information is available on the financial issues surrounding these activities. The aim of this study was to determine the fee per UCB unit released for transplantation that would allow cost recovery after 10 years. Three organizational models were considered suitable to provide units for five UCB transplants per 1 million population per year, a figure that would translate into an annual need for 280 units in Italy. Models A, B, and C included, respectively, seven networked banks, each with an inventory of 1,500 units; two networked banks, each with an inventory of 5,000 units; and one bank with an inventory of 10,000 units. It was estimated that it would take 3 years to develop the cryopreserved inventory and that approximately 3 percent of the inventory could be released and replaced each year during the 7-year interval between the fourth and tenth years of activity. The data on the costs of labor, reagents and diagnostics, disposables, depreciation and maintenance, laboratory tests, and overhead, as well as the operational data used in the analysis were collected at the Milano Cord Blood Bank in 1996. Fees of US $15,061, $12,666, and $11,602 per unit released during the fourth through the tenth years of activity allow full cost recovery (principle and interest) under Models A, B, and C, respectively. Although UCB procurement costs compare favorably with those of other hematopoietic cell sources, these results and the current fee of US $15,300 used in some institutions show that UCB is an expensive resource. Therefore, judicious planning of banking programs with high quality standards is necessary to prevent economic losses. The advantages of lower fees associated with the centralized banking approach of Model C should be balanced with the more flexible collection offered by Model A.

[Data sources, the data used, and the modality for collection].

PubMed

Mercier, G; Costa, N; Dutot, C; Riche, V-P

2018-03-01

The hospital costing process implies access to various sources of data. Whether a micro-costing or a gross-costing approach is used, the choice of the methodology is based on a compromise between the cost of data collection, data accuracy, and data transferability. This work describes the data sources available in France and the access modalities that are used, as well as the main advantages and shortcomings of: (1) the local unit costs, (2) the hospital analytical accounting, (3) the Angers database, (4) the National Health Cost Studies, (5) the INTER CHR/U databases, (6) the Program for Medicalizing Information Systems, and (7) the public health insurance databases. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

The Cost of Accumulating Evidence in Perceptual Decision Making

PubMed Central

Drugowitsch, Jan; Moreno-Bote, Rubén; Churchland, Anne K.; Shadlen, Michael N.; Pouget, Alexandre

2012-01-01

Decision making often involves the accumulation of information over time, but acquiring information typically comes at a cost. Little is known about the cost incurred by animals and humans for acquiring additional information from sensory variables, due, for instance, to attentional efforts. Through a novel integration of diffusion models and dynamic programming, we were able to estimate the cost of making additional observations per unit of time from two monkeys and six humans in a reaction time random dot motion discrimination task. Surprisingly, we find that, the cost is neither zero nor constant over time, but for the animals and humans features a brief period in which it is constant but increases thereafter. In addition, we show that our theory accurately matches the observed reaction time distributions for each stimulus condition, the time-dependent choice accuracy both conditional on stimulus strength and independent of it, and choice accuracy and mean reaction times as a function of stimulus strength. The theory also correctly predicts that urgency signals in the brain should be independent of the difficulty, or stimulus strength, at each trial. PMID:22423085

15 CFR 2007.1 - Information required of interested parties in submitting requests for modifications in the last...

Code of Federal Regulations, 2011 CFR

2011-01-01

... duty-free treatment under the GSP have on competition and the business of the interest on whose behalf..., total quantity, value and trends in exports; (8) Information on exports to the United States in terms of... beneficiary countries and trends in their production and promotional activities; (9) Analysis of cost...

15 CFR 2007.1 - Information required of interested parties in submitting requests for modifications in the last...

Code of Federal Regulations, 2010 CFR

2010-01-01

... duty-free treatment under the GSP have on competition and the business of the interest on whose behalf..., total quantity, value and trends in exports; (8) Information on exports to the United States in terms of... beneficiary countries and trends in their production and promotional activities; (9) Analysis of cost...

[Unit cost variation in a social security company in Querétaro, México].

PubMed

Villarreal-Ríos, Enrique; Campos-Esparza, Maribel; Garza-Elizondo, María E; Martínez-González, Lidia; Núñez-Rocha, Georgina M; Romero-Islas, Nestor R

2006-01-01

Comparing unit cost variation between departments and reasons for consultation in outpatient health services provided by a social security company from Querétaro, Mexico. A study of costs (in US dollars) was carried out in outpatient health service units during 2004. Fixed unit costs were estimated per department and adjusted for one year's productivity. Material, physical and consumer resources were included. Weighting was assigned to resources invested in each department. Unit cost was estimated by using the micro cost technique; medicaments, materials used during treatment and reagents were considered to be consumer items. Unit cost resulted from adding fixed unit cost to the variable unit cost corresponding to the reason for consulting. Units costs were then compared between the medical units. Unit cost per month for diabetic treatment varied from 34.8 US dollars, 32,2 US dollars to US 34 US dollars, pap smear screening test costs were 7,2 US dollars, 8,7 US dollars and 7,3 US dollars and dental treatment 27 US dollars, 33 US dollars, 6 and 28,7 US dollars. Unit cost variation was more important in the emergency room and the dental service.

Airport Capacity Investment Handbook

DOT National Transportation Integrated Search

1978-12-01

This handbook provides a methodology for estimating the benefits and costs of capacity-related investments in airports in the United States. The procedures are laid out in a series of worksheets. The user provides certain basic information such as ex...

C-A4-01: Computerized Clinical Decision Support During Drug Ordering for Long-term Care Residents With Renal Insufficiency

PubMed Central

Field, Terry S; Rochon, Paula; Lee, Monica; Gavendo, Linda; Baril, Joann L; Gurwitz, Jerry H

2010-01-01

Objective: To determine whether a computerized clinical decision support system (CDSS) providing patient specific recommendations in real- time improves the quality of prescribing for long-term care residents with renal insufficiency. Design: A randomized trial within the long-stay units of a large long-term care facility. Randomization was within blocks by unit type. Alerts related to medication prescribing for residents with renal insufficiency were displayed to prescribers in the intervention units and hidden but tracked in control units. Measurement: The proportions of final drug orders that were appropriate were compared between intervention and control units within alert categories: recommended medication doses; recommended administration frequencies; recommendations to avoid the drug; 4) warnings of missing information. Results: The rates of alerts were nearly equal in the intervention and control units: 2.5 per 1000 resident days in the intervention units and 2.4 in the control units. The proportions of dose alerts for which the final drug orders were appropriate were similar between the intervention and control units (relative risk 0.95, 95% confidence interval 0.83, 1.1). For the remaining alert categories significantly higher proportions of final drug orders were appropriate in the intervention units: relative risk 2.4 for maximum frequency (1.4, 4.4); 2.6 for drugs that should be avoided (1.4, 5.0); and 1.8 for alerts to acquire missing information (1.1, 3.4). Overall, final drug orders were appropriate significantly more often than a relative risk 1.2 (1.0, 1.4). By tracking personnel time and expenditures, we estimated the cost of developing the CDSS as $48,668.57. Drug costs saved during the 12 months of the trial are estimated at $2,137. Conclusion: Clinical decision support for physicians prescribing medications for long-term care residents with renal insufficiency can improve the quality of prescribing decisions. However, patient well-being and quality of care rather than the business case related to cost savings are likely to be the key drivers for adoption of this HIT application.

Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective.

PubMed

Hatcher, Peter; Shaikh, Shiraz; Fazli, Hassan; Zaidi, Shehla; Riaz, Atif

2014-11-13

There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services. This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs. The unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$ 18.78, normal delivery US$ 84.61, newborn care US$ 16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$ 45.50, Normal Delivery US$ 148.43, assisted delivery US$ 167.43, C-section US$ 183.34, Newborn Care US$ 41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies. The unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis using standard treatment guideline (STG) based service costing frameworks should be applied across a number of health facilities to calculate the cost of services and guide development of evidence based resource envelopes and performance based contracting.

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

Update on Electronic Dental Record and Clinical Computing Adoption Among Dental Practices in the United States

PubMed Central

Schroeder, Dixie; Schwei, Kelsey; Chyou, Po-Huang

2017-01-01

This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low. PMID:29229631

Estimating the costs for the treatment of abortion complications in two public referral hospitals: a cross-sectional study in Ouagadougou, Burkina Faso.

PubMed

Ilboudo, Patrick G C; Greco, Giulia; Sundby, Johanne; Torsvik, Gaute

2016-10-07

Treatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals scarce resources to treat induced abortion complications may affect hospitals' capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications including incomplete abortion, hemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost saving of providing safe abortion care services. The distribution of abortion-related complications was assessed through a review of postabortion care-registers combined with interviews with key informants in maternity wards and in hospital facilities. Two structured questionnaires were used for data collection following the perspective of the hospital. The first questionnaire collected information on the units and the unit costs of drugs and medical supplies used in the treatment of each complication. The second questionnaire gathered information on salaries and overhead expenses. All data were entered in a spreadsheet designed for studying abortion, and analyses were performed on Excel 2007. Across six types of abortion complications, the mean cost per patient was USD45.86. The total cost to these two public referral hospital facilities for treating the complications of abortion was USD22,472.53 in 2010 equivalent to USD24,466.21 in 2015. Provision of safe abortion care services to women who suffered from complications of unsafe induced abortion and who received care in these public hospitals would only have cost USD2,694, giving potential savings of more than USD19,778.53 in that year. The treatment of the complications of abortion consumes a significant proportion (up to USD22,472.53) of the two public hospitals resources in Burkina Faso. Safe abortion care services may represent a cost beneficial alternative, as it may have saved USD19,778.53 in 2010.

Getting the Right Staff. Personnel Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

ERIC Educational Resources Information Center

Goddard, Tessa; Murray, Jennifer

This self-instructional unit for supervisors and managers in the British hotel and catering industry contains information on all the important stages in the process of recruiting staff. The document begins with an introduction and advice on how to use the unit. Five sections cover the following topics: (1) the cost of employment; (2) planning for…

Estimating the cost of informal caregiving for elderly patients with cancer.

PubMed

Hayman, J A; Langa, K M; Kabeto, M U; Katz, S J; DeMonner, S M; Chernew, M E; Slavin, M B; Fendrick, A M

2001-07-01

As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients. To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT). Of the 7,443 subjects surveyed, 6,422 (86%) reported NC, 718 (10%) reported CNT, and 303 (4%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26%, it was 34% for those reporting CT (P <.05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P <.05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally. Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly.

78 FR 21950 - Bosley, Inc., a Corporation, and Aderans America Holdings, Inc., a Corporation, and Aderans Co...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-12

... information such as costs, sales statistics, inventories, formulas, patterns, devices, manufacturing processes... recognition. Bosley is the largest such manager in the United States. For at least four years, the chief...

Assessment of Non-EGU NOx Emission Controls, Cost of Controls, and Time for Compliance Final TSD

EPA Pesticide Factsheets

The purpose of this Technical Support Document (TSD) is to discuss the currently available information on emissions and control measures for sources of NOX other than electric generating units (EGUs).

45 CFR 154.215 - Submission of disclosure to CMS for rate increases subject to review.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Trend projections related to utilization, and service or unit cost: (3) Any claims assumptions related... provide the requested information to CMS within 10 business days following its receipt of the request. (i...

Cost of Purchased Versus Produced Plasma from Donor Recruitment Through Transfusion.

PubMed

Prioli, Katherine M; Pizzi, Laura T; Karp, Julie Katz; Galanis, Taki; Herman, Jay H

2016-10-01

Plasma is used to treat acquired coagulopathy or thrombotic thrombocytopenic purpura, or to reverse warfarin effect. Scant data are available, however, about its costs. To estimate total costs of plasma from production through administration, from the perspective of a US hospital blood donor center (BDC). Six sequential decision analytic models were constructed and informed by primary and secondary data on time, tasks, personnel, and supplies for donation, processing, and administration. Expected values of the models were summed to yield the BDC's total cost of producing, preparing, and transfusing plasma. Costs ($US 2015) are reported for a typical patient using three units of plasma. Models assume plasma was obtained from whole blood donation and transfused in an inpatient setting. Univariate sensitivity analyses were performed to test the impact of changing inputs for personnel costs and adverse event (AE) rates and costs. BDC production cost of plasma was $91.24/patient ($30.41/unit), a $30.16/patient savings versus purchased plasma. Administration and monitoring costs totaled $194.64/patient. Sensitivity analyses indicated that modifying BDC personnel costs during donation and processing has little impact on total plasma costs. However, the probability and cost of transfusion-associated circulatory overload (TACO) have a significant impact on costs. Plasma produced by our BDC may be less costly than purchased plasma. Though plasma processes have multiple tasks involving staff time, these are not the largest cost driver. Major plasma-related AEs are uncommon, but are the biggest driver of total plasma costs.

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.

A short-stay unit for thyroidectomy patients increases discharge efficiency.

PubMed

Vrabec, Sara; Oltmann, Sarah C; Clark, Nicholas; Chen, Herbert; Sippel, Rebecca S

2013-09-01

Patients traditionally recover overnight on a general surgery ward after a thyroidectomy; however, these units often lack the efficiency and focus for rapid discharge, which is the goal of a short-stay (SS) unit. Using an SS unit for thyroidectomy patients, who are often discharged in <24 h, may reduce the duration of hospital stay and subsequently decrease associated costs and increase hospital bed and resource availability. A retrospective review of 400 patients undergoing thyroidectomy at a single academic hospital. We analyzed postoperative discharge information and hospital cost data. Adult patients who stayed a single night in the hospital were included. We compared patients staying on a designated SS unit versus a general surgery (GS) ward. A total of 223 patients were admitted to SS, and 177 to GS. Trends of admission location were blocked based on time period, with most patients per time period going to the same location. Discharge times were significantly quicker for patients admitted to SS (P < 0.001). A total of 70% of SS patients were discharged before noon, versus 40% of GS patients (P < 0.001). Many variances were identified to account for these differences. Direct costs were significantly lower with SS, owing to savings in pharmacy, recovery room, and nursing expenses (all P < 0.01). A designated short-stay hospital unit is an effective model for increasing the efficiency of discharge for thyroidectomy patients compared with those admitted to a general surgery ward. It also serves to increase bed availability, which decreases hospital cost and may improve patient flow. Copyright © 2013 Elsevier Inc. All rights reserved.

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.

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

The distribution of common construction materials at risk to acid deposition in the United States

NASA Astrophysics Data System (ADS)

Lipfert, Frederick W.; Daum, Mary L.

Information on the geographic distribution of various types of exposed materials is required to estimate the economic costs of damage to construction materials from acid deposition. This paper focuses on the identification, evaluation and interpretation of data describing the distributions of exterior construction materials, primarily in the United States. This information could provide guidance on how data needed for future economic assessments might be acquired in the most cost-effective ways. Materials distribution surveys from 16 cities in the U.S. and Canada and five related databases from government agencies and trade organizations were examined. Data on residential buildings are more commonly available than on nonresidential buildings; little geographically resolved information on distributions of materials in infrastructure was found. Survey results generally agree with the appropriate ancillary databases, but the usefulness of the databases is often limited by their coarse spatial resolution. Information on those materials which are most sensitive to acid deposition is especially scarce. Since a comprehensive error analysis has never been performed on the data required for an economic assessment, it is not possible to specify the corresponding detailed requirements for data on the distributions of materials.

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.

2015 Cost of Wind Energy Review

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

Mone, Christopher; Hand, Maureen; Bolinger, Mark

This report uses representative commercial projects to estimate the levelized cost of energy (LCOE) for both land-based and offshore wind plants in the United States for 2015. Scheduled to be published on an annual basis, the analysis relies on both market and modeled data to maintain an up-to-date understanding of wind generation cost trends and drivers. It is intended to provide insight into current component-level costs and a basis for understanding variability in the LCOE across the industry. Data and tools developed by the National Renewable Energy Laboratory (NREL) are used in this analysis to inform wind technology cost projections,more » goals, and improvement opportunities.« less

2014 Cost of Wind Energy Review

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

Mone, Christopher; Stehly, Tyler; Maples, Ben

2015-10-01

This report uses representative commercial projects to estimate the levelized cost of energy (LCOE) for both land-based and offshore wind plants in the United States for 2014. Scheduled to be published on an annual basis, the analysis relies on both market and modeled data to maintain an up-to-date understanding of wind generation cost trends and drivers. It is intended to provide insight into current component-level costs and a basis for understanding variability in the LCOE across the industry. Data and tools developed by the National Renewable Energy Laboratory (NREL) are used in this analysis to inform wind technology cost projections,more » goals, and improvement opportunities.« less

Using cost-analyses to inform health professions education - The economic cost of pre-clinical failure.

PubMed

Foo, Jonathan; Ilic, Dragan; Rivers, George; Evans, Darrell J R; Walsh, Kieran; Haines, Terry P; Paynter, Sophie; Morgan, Prue; Maloney, Stephen

2017-12-07

Student failure creates additional economic costs. Knowing the cost of failure helps to frame its economic burden relative to other educational issues, providing an evidence-base to guide priority setting and allocation of resources. The Ingredients Method is a cost-analysis approach which has been previously applied to health professions education research. In this study, the Ingredients Method is introduced, and applied to a case study, investigating the cost of pre-clinical student failure. The four step Ingredients Method was introduced and applied: (1) identify and specify resource items, (2) measure volume of resources in natural units, (3) assign monetary prices to resource items, and (4) analyze and report costs. Calculations were based on a physiotherapy program at an Australian university. The cost of failure was £5991 per failing student, distributed across students (70%), the government (21%), and the university (8%). If the cost of failure and attrition is distributed among the remaining continuing cohort, the cost per continuing student educated increases from £9923 to £11,391 per semester. The economics of health professions education is complex. Researchers should consider both accuracy and feasibility in their costing approach, toward the goal of better informing cost-conscious decision-making.

White House Conference on Library and Information Services. Hearing before the Subcommittee on Education, Arts and Humanities of the Committee on Labor and Human Resources. United States Senate, One Hundredth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

Held to authorize a White House Conference on Library and Information Services (WHCLIST) in 1989, this hearing focused on library services for literacy, productivity, and democracy as well as on the conference structure and costs. Statements and supporting information provided by the following individuals and institutions were presented: (1)…

19 CFR 10.3013 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Colombia Trade Promotion... value. “Adjusted value” means the value determined in accordancewith Articles 1 through 8, Article 15... revenues, expenses, costs, assets, and liabilities, the disclosure of information, and the preparation of...

Teaching about Transportation.

ERIC Educational Resources Information Center

Paine, Carolyn; Arnold, Anne Jurmu

1983-01-01

A teaching unit on transportation compares the costs of various modes of transportation--private automobile, bus, and bicycle--in terms of energy efficiency and air pollution. Class projects on transportation are suggested, along with sources of further information and a reading list for children. (PP)

UnitedHealthcare experience illustrates how payers can enable patient engagement.

PubMed

Sandy, Lewis G; Tuckson, Reed V; Stevens, Simon L

2013-08-01

Patient engagement is crucial to better outcomes and a high-performing health system, but efforts to support it often focus narrowly on the role of physicians and other care providers. Such efforts miss payers' unique capabilities to help patients achieve better health. Using the experience of UnitedHealthcare, a large national payer, this article demonstrates how health plans can analyze and present information to both patients and providers to help close gaps in care; share detailed quality and cost information to inform patients' choice of providers; and offer treatment decision support and value-based benefit designs to help guide choices of diagnostic tests and therapies. As an employer, UnitedHealth Group has used these strategies along with an "earn-back" program that provides positive financial incentives through reduced premiums to employees who adopt healthful habits. UnitedHealth's experience provides lessons for other payers and for Medicare and Medicaid, which have had minimal involvement with demand-side strategies and could benefit from efforts to promote activated beneficiaries.

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.

An assessment of seismic monitoring in the United States; requirement for an Advanced National Seismic System

USGS Publications Warehouse

,

1999-01-01

This report assesses the status, needs, and associated costs of seismic monitoring in the United States. It sets down the requirement for an effective, national seismic monitoring strategy and an advanced system linking national, regional, and urban monitoring networks. Modernized seismic monitoring can provide alerts of imminent strong earthquake shaking; rapid assessment of distribution and severity of earthquake shaking (for use in emergency response); warnings of a possible tsunami from an offshore earthquake; warnings of volcanic eruptions; information for correctly characterizing earthquake hazards and for improving building codes; and data on response of buildings and structures during earthquakes, for safe, cost-effective design, engineering, and construction practices in earthquake-prone regions.

Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System.

PubMed

Pinto, Márcia; Entringer, Aline Piovezan; Steffen, Ricardo; Trajman, Anete

2015-01-01

We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil.

Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

PubMed Central

Pinto, Márcia; Entringer, Aline Piovezan; Steffen, Ricardo; Trajman, Anete

2015-01-01

ABSTRACT We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil. PMID:26785963

Laboratory manager's financial handbook. Cost accounting: the road map to financial success.

PubMed

Travers, E M

1996-01-01

Cost accounting is the most basic element of the laboratory's financial management structure. Historically, cost accounting in the nonmedical world referred to accumulating and assigning costs to units of production and departments, primarily for inventory valuation and income determination. In the health industry, microcost accounting is distinguishable from macrocost (management/internal) accounting and serves multiple purposes. Microcost accounting pertains to gathering and providing information for decision making. The range of decisions include managing recurring operations, making nonrecurring strategic decisions, and formulating major organizational policies. Macrocost accounting fulfills the legal requirements of reporting to stockholders, auditors, governmental agencies, and other external parties.

A cost management model for hospital food and nutrition in a public hospital.

PubMed

Neriz, Liliana; Núñez, Alicia; Ramis, Francisco

2014-11-13

In Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization. This paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit. The results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital. This is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study.

PubMed

Saronga, Happiness P; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell A; Savadogo, Germain; Tonchev, Pencho; Dong, Hengjin; Sauerborn, Rainer; Loukanova, Svetla

2014-02-28

Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described. The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency. Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives.

Utility of functioning in predicting costs of care for patients with mood and anxiety disorders: a prospective cohort study

PubMed Central

Cieza, Alarcos; Baldwin, David S.

2017-01-01

Development of payment systems for mental health services has been hindered by limited evidence for the utility of diagnosis or symptoms in predicting costs of care. We investigated the utility of functioning information in predicting costs for patients with mood and anxiety disorders. This was a prospective cohort study involving 102 adult patients attending a tertiary referral specialist clinic for mood and anxiety disorders. The main outcome was total costs, calculated by applying unit costs to healthcare use data. After adjusting for covariates, a significant total costs association was yielded for functioning (eβ=1.02; 95% confidence interval: 1.01–1.03), but not depressive symptom severity or anxiety symptom severity. When we accounted for the correlations between the main independent variables by constructing an abridged functioning metric, a significant total costs association was again yielded for functioning (eβ=1.04; 95% confidence interval: 1.01–1.09), but not symptom severity. The utility of functioning in predicting costs for patients with mood and anxiety disorders was supported. Functioning information could be useful within mental health payment systems. PMID:28383309

Healthcare technology: physician collaboration in reducing the surgical cost.

PubMed

Olson, Steven A; Obremskey, William T; Bozic, Kevin J

2013-06-01

The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

45 CFR 602.20 - Standards for financial management systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 602.20 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... subgrant. Financial information must be related to performance or productivity data, including the... agreement. If unit cost data are required, estimates based on available documentation will be accepted...

45 CFR 602.20 - Standards for financial management systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Section 602.20 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... subgrant. Financial information must be related to performance or productivity data, including the... agreement. If unit cost data are required, estimates based on available documentation will be accepted...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

Fiscal Year 2000 Unit Cost Report for the Illinois Public Community Colleges.

ERIC Educational Resources Information Center

Illinois Community Coll. Board, Springfield.

This report shows net instructional unit costs from fiscal year 1995 through fiscal year 2000. The five sections are: (1) Comparison of Fiscal Year 2000 Net Instructional Unit Cost with Previous Years; (2) Net Instructional Unit Cost in Illinois Public Community Colleges Since Fiscal Year 1995; (3) Fiscal Year 2000 Net Instructional Unit Cost,…

Costs of occupational injury and illness across industries.

PubMed

Leigh, J Paul; Waehrer, Geetha; Miller, Ted R; Keenan, Craig

2004-06-01

This study has ranked industries using estimated total costs and costs per worker. This incidence study of nationwide data was carried out in 1993. The main outcome measure was total cost for medical care, lost productivity, and pain and suffering for the entire United States (US). The analysis was conducted using fatal and nonfatal injury and illness data recorded in large data sets from the US Bureau of Labor Statistics. Cost data were derived from workers' compensation records, estimates of lost wages, and jury awards. Current-value calculations were used to express all costs in 1993 in US dollars. The following industries were at the top of the list for average cost (cost per worker): taxicabs, bituminous coal and lignite mining, logging, crushed stone, oil field services, water transportation services, sand and gravel, and trucking. Industries high on the total-cost list were trucking, eating and drinking places, hospitals, grocery stores, nursing homes, motor vehicles, and department stores. Industries at the bottom of the cost-per-worker list included legal services, security brokers, mortgage bankers, security exchanges, and labor union offices. Detailed methodology was developed for ranking industries by total cost and cost per worker. Ranking by total costs provided information on total burden of hazards, and ranking by cost per worker provided information on risk. Industries that ranked high on both lists deserve increased research and regulatory attention.

Lignocellulosic feedstock resource assessment

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

Rooney, T.

This report provides overall state and national information on the quantity, availability, and costs of current and potential feedstocks for ethanol production in the United States. It characterizes end uses and physical characteristics of feedstocks, and presents relevant information that affects the economic and technical feasibility of ethanol production from these feedstocks. The data can help researchers focus ethanol conversion research efforts on feedstocks that are compatible with the resource base.

Information Technology and People with Disabilities: The Current State of Federal Accessibility. Presented by The Attorney General to The President of the United States.

ERIC Educational Resources Information Center

Department of Justice, Washington, DC. Civil Rights Div.

This report responds to requirements of Section 508 of the Rehabilitation Act, as amended in 1998, concerning the accessibility of federal electronic and information technology to individuals with disabilities. It contains the results of the first executive branch-wide Section 508 evaluation and recommends specific inexpensive, cost-effective, and…

A comparison of salary-wage and hourly-wage acute care nursing units: a pilot study.

PubMed

Hickey, Rosa G; Buchko, Barbara L; Coe, Paula F; Woods, Anne B

2015-05-01

This pilot study examined differences in RN perception of the professional practice environment and financial indicators between salary-wage and hourly-wage compensation models. There is a dearth of current information regarding use of salary-wage models for compensation for direct care nurses. A descriptive, comparative design was used to examine the Revised Professional Practice Environment Scale (RPPE) and financial indicators of nurses in a nonprofit healthcare system over a 6-month period. Mean scores on the RPPE were significantly lower for hourly-wage RNs, and the hourly-wage model resulted in a 1.2% additional cost for overtime hours compared with the fixed cost of the salary-wage model. Nurses in an hourly-wage unit reported a significantly lower perception of the clinical practice environment than did their peers in a salary-wage unit, indicating that professional practice perceptions in a salary-wage unit may provide a more effective professional practice environment. Financial analysis resulted in a budget-neutral impact.

A Microcosting Study of Establishing a Baby Café® in Texas.

PubMed

Delgado, Rigoberto I; Gill, Sara L

2018-02-01

This article focuses on the costs of opening and running a Baby Café. A Baby Café is an intervention that focuses on providing peer-to-peer support for breastfeeding mothers. Research aim: This study aimed to estimate the costs of establishing and running a Baby Café. The authors used a microcosting approach to identifying costs using the case of a Baby Café located in San Antonio, Texas, and modeled after other existing cafés in the United States. They also used extensive literature review and conducted an informal interview with a manager of an existing Baby Café in the United States to validate our cost data. The cost analysis was done from the provider perspective. Costs of starting a Baby Café were $36,000, whereas annual operating costs totaled $47,000. Total discounted costs for a 5-year period amounted to $250,000, resulting in a cost per Baby Café session of $521 and cost per mother of $104. Varying the number of sessions per week and number of mothers attending each session, the discounted cost per Baby Café session ranged between $460 and $740 and the cost per mother varied between $65 and $246. These findings can be used by policy makers and organizations to evaluate local resource requirements for starting a Baby Café. Further research is needed to evaluate the effectiveness of this intervention against other breastfeeding promoting initiatives.

Comparison of anticancer drug coverage decisions in the United States and United Kingdom: does the evidence support the rhetoric?

PubMed

Mason, Anne; Drummond, Michael; Ramsey, Scott; Campbell, Jonathan; Raisch, Dennis

2010-07-10

In contrast to the United States, several European countries have health technology assessment programs for drugs, many of which assess cost effectiveness. Coverage decisions that consider cost effectiveness may lead to restrictions in access. For a purposive sample of five decision-making bodies, we analyzed US and United Kingdom coverage decisions on all anticancer drugs approved by the US Food and Drug Administration (FDA) from 2004 to 2008. Data sources for the timing and outcome of licensing and coverage decisions included published and unpublished documentation, Web sites, and personal communication. The FDA approved 59 anticancer drugs over the study period, of which 46 were also approved by the European Medicines Agency. In the United States, 100% of drugs were covered, mostly without restriction. However, the United Kingdom bodies made positive coverage decisions for less than half of licensed drugs (National Institute for Health and Clinical Excellence [NICE]: 39%; Scottish Medicines Consortium [SMC]: 43%). Whereas the Centers for Medicare and Medicaid Services (CMS) and the Department of Veterans Affairs (VA) covered all 59 drugs from the FDA license date, delays were evident for some Regence Group decisions that were informed by cost effectiveness (median, 0 days; semi-interquartile range [SIQR], 122 days; n = 22). Relative to the European Medicines Agency license date, median time to coverage was 783 days (SIQR, 170 days) for NICE and 231 days (SIQR, 129 days) for the SMC. Anticancer drug coverage decisions that consider cost effectiveness are associated with greater restrictions and slower time to coverage. However, this approach may represent an explicit alternative to rationing achieved through the use of patient copayments.

A new approach to the design of information systems for foodservice management in health care facilities.

PubMed

Matthews, M E; Norback, J P

1984-06-01

An organizational framework for integrating foodservice data into an information system for management decision making is presented. The framework involves the application to foodservice of principles developed by the disciplines of managerial economics and accounting, mathematics, computer science, and information systems. The first step is to conceptualize a foodservice system from an input-output perspective, in which inputs are units of resources available to managers and outputs are servings of menu items. Next, methods of full cost accounting, from the management accounting literature, are suggested as a mechanism for developing and assigning costs of using resources within a foodservice operation. Then matrix multiplication is used to illustrate types of information that matrix data structures could make available for management planning and control when combined with a conversational mode of computer programming.

An Analysis of Unit Costs at a Consolidated Supply Depot

DTIC Science & Technology

1990-12-01

Not-For-Profit Setting,"The Accounting Review,July 1990. Horngren , C. T., Cost Accountinq:A Managerial Emphasis,3rd ed, Prentice-Hall Inc.,1972...sector has used concepts of unit costs for 4 decades. Any managerial or cost accounting text discusses in some length unit costs . For Defense contractors...the Cost Accounting Standards Board (CASB) provides guidance for contract costs . Unit costs include direct, indirect, and general and administrative

Onchocerciasis control in Nigeria: will households be able to afford community-directed treatment with ivermectin?

PubMed

Onwujekwe, O; Shu, E; Onwuameze, O; Ndum, C; Okonkwo, P

2001-12-21

To determine the level of affordability of community-directed treatment with ivermectin (CDTI) to households living in two onchocerciasis endemic Nigerian communities namely Toro in the north and Nike in the south. The proportion of the cost of treating people with ivermectin will deplete in average monthly/projected annual household expenditure on food and health care, and on average monthly and projected annual household income were respectively calculated and used to determine the level of affordability of CDTI. Questionnaires administered to heads of households or their representatives were used to collect information on the household expenditures and income. The suggested unit CDTI cost of $0.20 was used. However, as a test of sensitivity, we also used the unit cost of $0.056 which some community based distributors are charging per treatment. Using $0.20 as the unit treatment cost, this will consume less than 0.05% of average annual household income in both communities. It will equally deplete 0.05% of combined annual household expenditures on food and health care in both communities. However, using $0.056 as the unit treatment cost, then 0.02% of average annual household expenditure on health care, 0.01% average annual expenditure on combined health care and food, and 0.01% of average annual household income will be depleted. The households living in both communities may be able to afford CDTI schemes. However, the final decision on levels of affordability lies with the households. They will decide whether they can afford to trade-off some household income for ivermectin distribution.

Economics of immunization information systems in the United States: assessing costs and efficiency.

PubMed

Bartlett, Diana L; Molinari, Noelle-Angelique M; Ortega-Sanchez, Ismael R; Urquhart, Gary A

2006-08-22

One of the United States' national health objectives for 2010 is that 95% of children aged <6 years participate in fully operational population-based immunization information systems (IIS). Despite important progress, child participation in most IIS has increased slowly, in part due to limited economic knowledge about IIS operations. Should IIS need further improvement, characterizing costs and identifying factors that affect IIS efficiency become crucial. Data were collected from a national sampling frame of the 56 states/cities that received federal immunization grants under U.S. Public Health Service Act 317b and completed the federal 1999 Immunization Registry Annual Report. The sampling frame was stratified by IIS functional status, children's enrollment in the IIS, and whether the IIS had been developed as an independent system or was integrated into a larger system. These sites self-reported IIS developmental and operational program costs for calendar years 1998-2002 using a standardized data collection tool and underwent on-site interviews to verify reported data with information from the state/city financial management system and other financial records. A parametric cost-per-patient-record (CPR) model was estimated. The model assessed the impact of labor and non-labor resources used in development and operations tasks, as well as the impact of information technology, local providers' participation and compliance with federal IIS performance standards (e.g., ensuring the confidentiality and security of information, ensure timely vaccination data at the time of patient encounter, and produce official immunization records). Given the number of records minimizing CPR, the additional amount of resources needed to meet national health goals for the year 2010 was also calculated. Estimated CPR was as high as $10.30 and as low as $0.09 in operating IIS. About 20% of IIS had between 2.9 to 3.2 million records and showed CPR estimates of $0.09. Overall, CPR was highly sensitive to local providers' participation. To achieve the 2010 goals, additional aggregated costs were estimated to be $75.6 million nationwide. Efficiently increasing the number of records in IIS would require additional resources and careful consideration of various strategies to minimize CPR, such as boosting providers' participation.

Cost-Benefit Analysis of Telemedicine Systems/Units in Greek Remote Areas.

PubMed

Kouskoukis, Marios-Nikolaos; Botsaris, Charalambos

2017-06-01

Telemedicine units and information technology systems provide special healthcare services to remote populations using telecommunication technology, in order to reduce or even remove the usual and typical face-to-face contact between doctor and patient. This innovative approach to medical care delivery has been expanding for several years and currently covers various medical specialties. To facilitate installation of telemedicine systems/units in Greek remote areas, this article presents results of a cost-benefit analysis for two Greek islands, Patmos and Leros, using specific economic criteria. Net present value (NPV), internal rate of return (IRR), and payback period were calculated, in order to monetize the economic benefits and the costs savings, estimate the depreciation of each project, and highlight the social benefits. Costs were reduced (through saved air medical transportations) by €19,005 for Patmos and €78,225 for Leros each year. NPV and IRR were positive; NPV was €29,608 for Patmos and €293,245 for Leros, and IRR was 21.5% for Patmos and 140.5% for Leros. Each project depreciated faster than the 5-year life-cycle period, and specifically in 3.13 years for Patmos and in 0.70 years for Leros. The establishment of telemedicine systems/units in Patmos and Leros was evaluated and assessed positively, with large savings, economical and social, gained by reducing or even removing the face-to-face contact between doctor and patient. Telemedicine systems/units seem to be a promising solution, especially in Greece, where the problem of primary healthcare services in remote/inaccessible areas is of great concern.

Longitudinal costs of caring for people with Alzheimer's disease.

PubMed

Gillespie, Paddy; O'Shea, Eamon; Cullinan, John; Buchanan, Jacqui; Bobula, Joel; Lacey, Loretto; Gallagher, Damien; Mhaolain, Aine Ni; Lawlor, Brian

2015-05-01

There has been an increasing interest in the relationship between severity of disease and costs in the care of people with dementia. Much of the current evidence is based on cross-sectional data, suggesting the need to examine trends over time for this important and growing cohort of the population. This paper estimates resource use and costs of care based on longitudinal data for 72 people with dementia in Ireland. Data were collected from the Enhancing Care in Alzheimer's Disease (ECAD) study at two time points: baseline and follow-up, two years later. Patients' dependence on others was measured using the Dependence Scale (DS), while patient function was measured using the Disability Assessment for Dementia (DAD) scale. Univariate and multivariate analysis were used to explore the effects of a range of variables on formal and informal care costs. Total costs of formal and informal care over six months rose from €9,266 (Standard Deviation (SD): 12,947) per patient at baseline to €21,266 (SD: 26,883) at follow-up, two years later. This constituted a statistically significant (p = 0.0014) increase in costs over time, driven primarily by an increase in estimated informal care costs. In the multivariate analysis, a one-point increase in the DS score, that is a one-unit increase in patient's dependence on others, was associated with a 19% increase in total costs (p = 0.0610). Higher levels of dependence in people with Alzheimer's disease are significantly associated with increased costs of informal care as the disease progresses. Formal care services did not respond to increased dependence in people with dementia, leaving it to families to fill the caring gap, mainly through increased supervision with the progress of disease.

Advanced Neonatal Medicine in China: A National Baseline Database.

PubMed

Liao, Xiang-Peng; Chipenda-Dansokho, Selma; Lewin, Antoine; Abdelouahab, Nadia; Wei, Shu-Qin

2017-01-01

Previous surveys of neonatal medicine in China have not collected comprehensive information on workforce, investment, health care practice, and disease expenditure. The goal of the present study was to develop a national database of neonatal care units and compare present outcomes data in conjunction with health care practices and costs. We summarized the above components by extracting data from the databases of the national key clinical subspecialty proposals issued by national health authority in China, as well as publicly accessible databases. Sixty-one newborn clinical units from provincial or ministerial hospitals at the highest level within local areas in mainland China, were included for the study. Data were gathered for three consecutive years (2008-2010) in 28 of 31 provincial districts in mainland China. Of the 61 newborn units in 2010, there were 4,948 beds (median = 62 [IQR 43-110]), 1,369 physicians (median = 22 [IQR 15-29]), 3,443 nurses (median = 52 [IQR 33-81]), and 170,159 inpatient discharges (median = 2,612 [IQR 1,436-3,804]). During 2008-2010, the median yearly investment for a single newborn unit was US$344,700 (IQR 166,100-585,800), median length of hospital stay for overall inpatient newborns 9.5 (IQR 8.2-10.8) days, median inpatient antimicrobial drug use rate 68.7% (IQR 49.8-87.0), and median nosocomial infection rate 3.2% (IQR1.7-5.4). For the common newborn diseases of pneumonia, sepsis, respiratory distress syndrome, and very low birth weight (<1,500 grams) infants, their lengths of hospital stay, daily costs, hospital costs, ratios of hospital cost to per-capita disposable income, and ratios of hospital cost to per-capita health expenditure, were all significantly different across regions (North China, Northeast China, East China, South Central China, Southwest China, and Northwest China). The survival rate of extremely low birth weight (ELBW) infants (Birth weight <1,000 grams) was 76.0% during 2008-2010 in the five hospitals where each unit had more than 20 admissions of ELBW infants in 2010; and the median hospital cost for a single hospital stay in ELBW infants was US$8,613 (IQR 8,153-9,216), which was 3.0 times (IQR 2.0-3.2) the average per-capita disposable income, or 63 times (IQR 40.3-72.1) the average per-capita health expenditure of local urban residents in 2011. Our national database provides baseline data on the status of advanced neonatal medicine in China, gathering valuable information for quality improvement, decision making, longitudinal studies and horizontal comparisons.

Program Manager: Journal of the Defense Systems Management College. Volume 19, Number 4, July-August 1990

DTIC Science & Technology

1990-08-01

officials making process, innovation, integ- would be focused on customer were committed, as well as the Con- rity, and accountability. satisrceion...staff in the Department of The bill contains the following - Research and Information at the Defensetion which has as its goal to make S ms Managmnt Cov...Cost/Quantity Dynamics There is a necessary relationship 7 between unit costs and quantities procured, and the budget changes made. This relationship

Copying Machine Improvement

NASA Technical Reports Server (NTRS)

1981-01-01

Manufacturer of the Model 2210 copying machine was looking for a plastic valve bushing material that could be produced by a low-cost injection molding process to replace the unsuitable valve bushing they were using. NERAC conducted a computer search of the NASA database and was able to supply Nashua Corporation with several technical reports in their area of interest. Information aided the company's development of a urethane valve bushing which solved the problem and created a dramatic reduction in unit cost.

Economics of One Health: Costs and benefits of integrated West Nile virus surveillance in Emilia-Romagna.

PubMed

Paternoster, Giulia; Babo Martins, Sara; Mattivi, Andrea; Cagarelli, Roberto; Angelini, Paola; Bellini, Romeo; Santi, Annalisa; Galletti, Giorgio; Pupella, Simonetta; Marano, Giuseppe; Copello, Francesco; Rushton, Jonathan; Stärk, Katharina D C; Tamba, Marco

2017-01-01

Since 2013 in Emilia-Romagna, Italy, surveillance information generated in the public health and in the animal health sectors has been shared and used to guide public health interventions to mitigate the risk of West Nile virus (WNV) transmission via blood transfusion. The objective of the current study was to identify and estimate the costs and benefits associated with this One Health surveillance approach, and to compare it to an approach that does not integrate animal health information in blood donations safety policy (uni-sectoral scenario). Costs of human, animal, and entomological surveillance, sharing of information, and triggered interventions were estimated. Benefits were quantified as the averted costs of potential human cases of WNV neuroinvasive disease associated to infected blood transfusion. In the 2009-2015 period, the One Health approach was estimated to represent a cost saving of €160,921 compared to the uni-sectoral scenario. Blood donation screening was the main cost for both scenarios. The One Health approach further allowed savings of €1.21 million in terms of avoided tests on blood units. Benefits of the One Health approach due to short-term costs of hospitalization and compensation for transfusion-associated disease potentially avoided, were estimated to range from €0 to €2.98 million according to the probability of developing WNV neuroinvasive disease after receiving an infected blood transfusion.

Effectiveness and cost of two stair-climbing interventions-less is more.

PubMed

Olander, Ellinor K; Eves, Frank F

2011-01-01

The current study compared two interventions for promotion of stair climbing in the workplace, an information-based intervention at a health information day and an environmental intervention (point-of-choice prompts), for their effectiveness in changing stair climbing and cost per employee. Interrupted time-series design. Four buildings on a university campus. Employees at a university in the United Kingdom. Two stair-climbing interventions were compared: (1) a stand providing information on stair climbing at a health information day and (2) point-of-choice prompts (posters). Observers recorded employees' gender and method of ascent (n = 4279). The cost of the two interventions was calculated. Logistic regression. There was no significant difference between baseline (47.9% stair climbing) and the Workplace Wellbeing Day (48.8% stair climbing), whereas the prompts increased stair climbing (52.6% stair climbing). The health information day and point-of-choice prompts cost $773.96 and $31.38, respectively. The stand at the health information day was more expensive than the point-of-choice prompts and was inferior in promoting stair climbing. It is likely that the stand was unable to encourage stair climbing because only 3.2% of targeted employees visited the stand. In contrast, the point-of-choice prompts were potentially visible to all employees using the buildings and hence better for disseminating the stair climbing message to the target audience.

19 CFR 10.913 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Peru Trade Promotion Agreement.... “Adjusted value” means the value determined in accordance with Articles 1 through 8, Article 15, and the... revenues, expenses, costs, assets, and liabilities, the disclosure of information, and the preparation of...

19 CFR 10.913 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Peru Trade Promotion Agreement.... “Adjusted value” means the value determined in accordance with Articles 1 through 8, Article 15, and the... revenues, expenses, costs, assets, and liabilities, the disclosure of information, and the preparation of...

Digitization of Microfilm: A Scottish Perspective.

ERIC Educational Resources Information Center

Lauder, John

1995-01-01

Discusses the Scottish Newspapers Microfilming Unit's interest in conversion of microfilm to digital technology. Concerns include cost, potential market, reliability of digital technology as a preservation medium, and the necessity to have both microfilm and digital formats for preservation. Solicits feedback and information from colleagues on the…

Disease management positively affects patient quality of life.

PubMed

Walker, David R; Landis, Darryl L; Stern, Patricia M; Vance, Richard P

2003-04-01

Health care costs are spiraling upward. The population of the United States is aging, and many baby boomers will develop multiple chronic health conditions. Disease management is one method for reducing costs associated with chronic health conditions. Although these programs have been proven effective in improving patient health, detailed information about their effect on patient quality of life has been scarce. This article provides preliminary evidence that disease management programs for coronary artery disease, chronic obstructive pulmonary disease, diabetes, and heart failure lead to improved quality of life, which correlates with a healthier, more satisfied, and less costly patient.

Social Acceptance of Wind Energy: Managing and Evaluating Its Market Impacts (Presentation)

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

Baring-Gould, I.

2012-06-01

As with any industrial-scale technology, wind power has impacts. As wind technology deployment becomes more widespread, a defined opposition will form as a result of fear of change and competing energy technologies. As the easy-to-deploy sites are developed, the costs of developing at sites with deployment barriers will increase, therefore increasing the total cost of power. This presentation provides an overview of wind development stakeholders and related stakeholder engagement questions, Energy Department activities that provide wind project deployment information, and the quantification of deployment barriers and costs in the continental United States.

Central electrical utility power for a satellite ring city in low earth orbit space

NASA Technical Reports Server (NTRS)

Myers, Ira T.; Faymon, Karl A.; Patton, A. D.

1989-01-01

Information is given in viewgraph form on central electrical power for a satellite ring city, defined as a group of large free flyers of 10 to 20 units with perhaps 100 people in each unit, and organized in a circle so that power can be fed from a central location. The free flyers would be located at 300 to 700 miles in altitude, and spaced about a kilometer apart. Potential activities of a ring city are listed as well as the electrical power needs. Information is given on costs and individual and centralized solar arrays and nuclear reactor systems.

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

Addressing the risk of bacterial contamination in platelets: a hospital economic perspective.

PubMed

Li, Justin W; Brecher, Mark E; Jacobson, Jessica L; Harm, Sarah K; Chen, Dorothy; El-Gamil, Audrey; Dobson, Al; Mintz, Paul D

2017-10-01

Bacterially contaminated platelets (PLTs) remain a serious risk. The Food and Drug Administration has issued draft guidance recommending hospitals implement secondary testing or transfuse PLTs that have been treated with pathogen reduction technology (PRT). The cost implications of these approaches are not well understood. We modeled incurred costs when hospitals acquire, process, and transfuse PLTs that are PRT treated with INTERCEPT (Cerus Corp.) or secondary tested with the PLT PGD Test (Verax Biomedical). Hospitals will spend $221.27 (30.0%) more per PRT-treated apheresis PLT unit administered compared to a Zika-tested apheresis PLT unit that is irradiated and PGD tested in hospital. This difference is reflected in PRT PLT units having: 1) a higher hospital purchase price ($100.00 additional charge compared to an untreated PLT); 2) lower therapeutic effectiveness than untreated PLTs among hematologic-oncologic patients, which contributes to additional transfusions ($96.05); or 3) fewer PLT storage days, which contributes to higher outdating cost from expired PLTs ($67.87). Only a small portion of the incremental costs for PRT-treated PLTs are offset by costs that may be avoided, including primary bacterial culture, secondary bacterial testing ($26.65), hospital irradiation ($8.50), Zika testing ($4.47), and other costs ($3.03). The significantly higher cost of PRT-treated PLTs over PGD-tested PLTs should interest stakeholders. For hospitals that outdate PLTs, savings associated with expiration extension to 7 days by adding PGD testing will likely be substantially greater than the cost of implementing PGD-testing. Our findings might usefully inform a hospital's decision to select a particular blood safety approach. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

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.

Information technology for the treatment of diabetes: improving outcomes and controlling costs.

PubMed

Wyne, Kathleen

2008-03-01

Diabetes in particular presents an ideal opportunity for the incorporation of information technology (IT) in the provision of care. The disease is highly prevalent in managed care populations, is frequently associated with comorbid conditions, and requires multiple medications in its management. Furthermore, effective diabetes care involves the monitoring of several measures of disease control, such as hemoglobin A1c (A1c) and lipid levels, by several different levels of providers, such as physicians, nurse practitioners, physician assistants, pharmacists, and dieticians. All of these factors combined make diabetes an opportune disease state for a case study of the implementation of health information technology (HIT) in managed care. To review practical applications of HIT for improving the delivery of care in diabetes management. Between 1990 and 2002, the incidence of type 2 diabetes increased by 61% in the United States. The total costs associated with diabetes have been increasing since the late 1970s as well, with a more dramatic rise over the last 10 years. In fact, the total cost of diabetes in the United States will approach $200 billion per year by the year 2020. In order to improve diabetes management efforts nation wide, the goal of glucose lowering therapy has been recommended to lower the hemoglobin A1c (A1c) to < 7% and keep it below that level long term. Other measures beyond A1c levels have also been identified as being important components to effective diabetes management and incorporated into national treatment recommendations, providing an ideal opportunity for the incorporation of HIT interventions. These interventions have been aimed at 3 different groups of stakeholders in managed care: payers, providers, and patients. While uncontrolled diabetes remains a major concern in managed care from both a health and a cost perspective, implementation of information technology enabled diabetes management (ITDM) has demonstrated significant potential for improving processes of care, preventing the development of diabetic complications, and generating cost savings. ITDM improves the synthesis of information, the delivery of knowledge, and the efficiency of communication, allowing for coordination of care across delivery teams. Of the existing technologies targeting providers, patients, and payers, provider centered interventions, such as diabetes registries currently show the most potential for benefit in improving outcomes and reducing costs.

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

An extensible, low-cost drifter control unit

NASA Astrophysics Data System (ADS)

Giudici, Andrea; Torsvik, Tomas; Soomere, Tarmo

2017-04-01

We introduce an extensible, low-cost drifter control unit, which is developed for use with surface drifters that are deployed in inland water bodies or near-coast regions. The control unit is custom-built on top of a small footprint micro controller. It makes use of a GPS receiver for position tracking, a GSM radio for data transmission, and two sensor buses to handle analog and digital data measured by an array of external sensors. A cloud-based data collection platform receives and stores the data transmitted over GPRS from the drifter. The control unit was found to perform satisfactorily in operational testing, providing data at sub-Hz frequency for position and temperature during extended time. Test deployments revealed some issues related to power consumption spikes. Even though the unit is fully functional in the present form and shows, on average, low energy consumption , battery packs with relatively large maximum output power are required to ensure its operation within prolonged periods of time. We expect that a further development of the power supply unit together with a careful de-synchronization scheme of sensors' operation would smooth those peaks without any loss of the quality of recorded information.

Integrated health system for chronic disease management: lessons learned from France.

PubMed

Stuart, Mary; Weinrich, Michael

2004-02-01

Rated number one in overall health system performance by the World Health Organization, the French spend less than half the amount on annual health care per capita that the United States spends. One contributing factor may be the attention given to chronic care. Since the mid-1900s, the French have developed regional community-based specialty systems for patients with chronic respiratory insufficiency or failure. COPD is the major cause of respiratory failure, the fourth leading cause of death in the United States, and its prevalence is increasing. Despite the clinical success of home mechanical ventilation and the potential for cost savings, providing such services in the United States remains a challenge. Lessons from France can inform the development of cost-effective chronic care models in the United States In this article, we review the French experience in the context of the United States Supreme Court's Olmstead decision, mandating that people in "more restrictive settings" such as nursing homes be offered community-based supports. We suggest that regional demonstration projects for patients with chronic respiratory failure or insufficiency can provide an important step in the development of effective chronic care systems in the United States

Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach

PubMed Central

2013-01-01

Background There is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services. Methods The study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider’s perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis. Results The average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery. Conclusion The high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to make appropriate decisions regarding the allocation and sustainability of health care resources. PMID:23890185

A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan.

PubMed

Yagi, Mitsuru; Ames, Christopher P; Keefe, Malla; Hosogane, Naobumi; Smith, Justin S; Shaffrey, Christopher I; Schwab, Frank; Lafage, Virginie; Shay Bess, R; Matsumoto, Morio; Watanabe, Kota

2018-03-01

Information about the cost-effectiveness of surgical procedures for adult spinal deformity (ASD) is critical for providing appropriate treatments for these patients. The purposes of this study were to compare the direct cost and cost-effectiveness of surgery for ASD in the United States (US) and Japan (JP). Retrospective analysis of 76 US and 76 JP patients receiving surgery for ASD with ≥2-year follow-up was identified. Data analysis included preoperative and postoperative demographic, radiographic, health-related quality of life (HRQOL), and direct cost for surgery. An incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY). The cost/QALY was calculated from the 2-year cost and HRQOL data. JP exhibited worse baseline spinopelvic alignment than the US (pelvic incidence and lumbar lordosis: 35.4° vs 22.7°, p < 0.01). The US had more three-column osteotomies (50 vs 16%), and shorter hospital stay (7.9 vs 22.7 days) (p < 0.05). The US demonstrated worse postoperative ODI (41.3 vs. 33.9%) and greater revision surgery rate (40 vs 10%) (p < 0.05). Due to the high initial cost and revision frequency, the US had greater total cost ($92,133 vs. $49,647) and cost/QALY ($511,840 vs. $225,668) at 2-year follow-up (p < 0.05). Retrospective analysis comparing the direct costs and cost-effectiveness of ASD surgery in the US vs JP demonstrated that the total direct costs and cost/QALY were substantially higher in the US than JP. Variations in patient cohort, healthcare costs, revision frequencies, and HRQOL improvement influenced the cost/QALY differential between these countries.

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.

Cost-Effectiveness Analysis: a proposal of new reporting standards in statistical analysis

PubMed Central

Bang, Heejung; Zhao, Hongwei

2014-01-01

Cost-effectiveness analysis (CEA) is a method for evaluating the outcomes and costs of competing strategies designed to improve health, and has been applied to a variety of different scientific fields. Yet, there are inherent complexities in cost estimation and CEA from statistical perspectives (e.g., skewness, bi-dimensionality, and censoring). The incremental cost-effectiveness ratio that represents the additional cost per one unit of outcome gained by a new strategy has served as the most widely accepted methodology in the CEA. In this article, we call for expanded perspectives and reporting standards reflecting a more comprehensive analysis that can elucidate different aspects of available data. Specifically, we propose that mean and median-based incremental cost-effectiveness ratios and average cost-effectiveness ratios be reported together, along with relevant summary and inferential statistics as complementary measures for informed decision making. PMID:24605979

Universal Health Insurance Coverage in Massachusetts Did Not Change the Trajectory of Arthroplasty Use or Costs.

PubMed

Kurtz, Steven M; Lau, Edmund; Ong, Kevin L; Katz, Jeffrey N; Bozic, Kevin J

2016-05-01

The state of Massachusetts enacted universal health insurance in 2006. However it is unknown whether the increased access to care resulted in changes to surgical use or costs. We asked the following related research questions: compared with the United States as a whole, how did the (1) number of cases (as a percentage of the overall population, to account for changes in the overall population during the time surveyed), (2) payer mix, and (3) inpatient costs for arthroplasty change in Massachusetts after introduction of health insurance reform? We analyzed the use and cost of primary THAs and TKAs in Massachusetts using the State Inpatient Database (SID) between 2002 and 2011 compared with the Nationwide Inpatient Sample (NIS) during the same years. The SID captures 100% of inpatient procedures in Massachusetts, while the NIS is a nationally representative database of inpatient procedures for the United States. The SID and NIS are publicly available data sources from the Agency for Healthcare Research and Quality, and include information regarding procedure volumes, payer mixes, and costs. Inpatient costs were defined similarly in both databases by using hospital charges and an average cost-to-charge ratio that is unique for each hospital. The incidence of arthroplasties was calculated by dividing the procedure volume by the relevant population (either for Massachusetts or the entire country) based on public data from the United States Census bureau. The incidence of THAs and TKAs performed in Massachusetts increased steadily throughout the study period, and paralleled a similar increase in the United States as a whole. In Massachusetts, the incidence of THAs increased by 59% between 2002 and 2011, and the incidence of TKAs likewise increased by 80%. The trends for the incidence in total joint arthroplasties were similar to those for Massachusetts for the United States as a whole. The period of health insurance reform in Massachusetts was associated with a greater proportion of patients covered by Medicaid, Commonwealth Care, or Health Safety Net for THAs and TKAs. By 2011, universal health insurance in Massachusetts covered 2.45% of primary THAs and 2.77% of primary TKAs. Coverage for Medicaid in Massachusetts increased from 3.23% and 3.04% of THAs and TKAs in 2002 to 4.06% and 4.34% respectively in 2011. On average, Medicaid coverage was greater for TKAs in Massachusetts than across the United States during the study period. The introduction of health insurance reform had a minimal effect on the cost of total joint arthroplasties in Massachusetts. Although the costs of total joint arthroplasties in the United States were higher than those in Massachusetts, this difference narrowed substantially from 2002 to 2011, with the Massachusetts cost trending upward and the overall United States cost trending downward. Despite extending insurance coverage to the entire state of Massachusetts, there was little change in actual utilization trends for joint replacement. The enactment of universal health insurance coverage in Massachusetts appears to have been a nonevent insofar as the use and cost of total hip and knee surgeries is concerned in the state. Factors other than health insurance reform appear to be driving the growth in demand for arthroplasties in Massachusetts and are likely to do so as well in the United States under the Affordable Care Act of 2010.

Information logistics: A production-line approach to information services

NASA Technical Reports Server (NTRS)

Adams, Dennis; Lee, Chee-Seng

1991-01-01

Logistics can be defined as the process of strategically managing the acquisition, movement, and storage of materials, parts, and finished inventory (and the related information flow) through the organization and its marketing channels in a cost effective manner. It is concerned with delivering the right product to the right customer in the right place at the right time. The logistics function is composed of inventory management, facilities management, communications unitization, transportation, materials management, and production scheduling. The relationship between logistics and information systems is clear. Systems such as Electronic Data Interchange (EDI), Point of Sale (POS) systems, and Just in Time (JIT) inventory management systems are important elements in the management of product development and delivery. With improved access to market demand figures, logisticians can decrease inventory sizes and better service customer demand. However, without accurate, timely information, little, if any, of this would be feasible in today's global markets. Information systems specialists can learn from logisticians. In a manner similar to logistics management, information logistics is concerned with the delivery of the right data, to the ring customer, at the right time. As such, information systems are integral components of the information logistics system charged with providing customers with accurate, timely, cost-effective, and useful information. Information logistics is a management style and is composed of elements similar to those associated with the traditional logistics activity: inventory management (data resource management), facilities management (distributed, centralized and decentralized information systems), communications (participative design and joint application development methodologies), unitization (input/output system design, i.e., packaging or formatting of the information), transportations (voice, data, image, and video communication systems), materials management (data acquisition, e.g., EDI, POS, external data bases, data entry) and production scheduling (job, staff, and project scheduling).

Cost Benefit Analysis of Boat Lifts

DTIC Science & Technology

2014-09-01

boats in the high tempo operations scenario, and combined information for all lifts. Crystal Ball ran the model and estimated this total impact...the Department of Homeland Security in the interest of information exchange. The United States Government assumes no liability for its contents or...and recovery of the craft were considered and a total of three were tested. These models included: Hydro Hoist, SunStream, and Jet Dock. The study

34 CFR 74.21 - Standards for financial management systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Standards for financial management systems. 74.21... Requirements Financial and Program Management § 74.21 Standards for financial management systems. (a) Recipients shall relate financial data to performance data and develop unit cost information whenever...

75 FR 72845 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-26

... contract for future functional equivalence analyses of the GEPS 3 product. \\1\\ Notice of United States... analysis of the formulas, and certification of the Governors' vote; and Attachment 4--an application for... costing information and volume commitments, do not alter the contracts' functional equivalency. Id. at 3-4...

Towards marine seismological Network: real time small aperture seismic array

NASA Astrophysics Data System (ADS)

Ilinskiy, Dmitry

2017-04-01

Most powerful and dangerous seismic events are generated in underwater subduction zones. Existing seismological networks are based on land seismological stations. Increased demands for accuracy of location, magnitude, rupture process of coming earthquakes and at the same time reduction of data processing time require information from seabed seismic stations located near the earthquake generation area. Marine stations provide important contribution for clarification of the tectonic settings in most active subduction zones of the world. Early warning system for subduction zone area is based on marine seabed array which located near the area of most hazardous seismic zone in the region. Fast track processing for location of the earthquake hypocenter and energy takes place in buoy surface unit. Information about detected and located earthquake reaches the onshore seismological center earlier than the first break waves from the same earthquake will reach the nearest onshore seismological station. Implementation of small aperture array is based on existed and shown a good proven performance and costs effective solutions such as weather moored buoy and self-pop up autonomous seabed seismic nodes. Permanent seabed system for real-time operation has to be installed in deep sea waters far from the coast. Seabed array consists of several self-popup seismological stations which continuously acquire the data, detect the events of certain energy class and send detected event parameters to the surface buoy via acoustic link. Surface buoy unit determine the earthquake location by receiving the event parameters from seabed units and send such information in semi-real time to the onshore seismological center via narrow band satellite link. Upon the request from the cost the system could send wave form of events of certain energy class, bottom seismic station battery status and other environmental parameters. When the battery life of particular seabed unit is close to became empty, the seabed unit is switching into sleep mode and send that information to surface buoy and father to the onshore data center. Then seabed unit can wait for the vessel of opportunity for recovery of seabed unit to sea surface and replacing seabed station to another one with fresh batteries. All collected permanent seismic data by seabed unit could than downloaded for father processing and analysis. In our presentation we will demonstrate the several working prototypes of proposed system such as real time cable broad band seismological station and real time buoy seabed seismological station.

VAR and generalized impulse response analysis of manufacturing unit labor costs

NASA Astrophysics Data System (ADS)

Ewing, Bradley T.; Thompson, Mark A.

2008-04-01

This paper examines the relationship among manufacturing unit labor costs in the United States, United Kingdom, and Canada. The analysis is conducted within the context of an economic system utilizing the recently developed method of generalized impulse response analysis to simulate the responses of the cost series to disturbances. The results indicate that, while unit labor costs do not share a common stochastic trend, there are significant responses in the unit labor costs of each country to shocks in the costs of other countries that are not captured by standard interpretation of the multiple-equation model results. The findings indicate the presence of significant linkages among unit labor costs in the countries studied. The results are consistent with the economic environment of manufacturing operations being characterized by a competitive, integrated marketplace.

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.

Reviewing the evidence to inform the population of cost-effectiveness models within health technology assessments.

PubMed

Kaltenthaler, Eva; Tappenden, Paul; Paisley, Suzy

2013-01-01

Health technology assessments (HTAs) typically require the development of a cost-effectiveness model, which necessitates the identification, selection, and use of other types of information beyond clinical effectiveness evidence to populate the model parameters. The reviewing activity associated with model development should be transparent and reproducible but can result in a tension between being both timely and systematic. Little procedural guidance exists in this area. The purpose of this article was to provide guidance, informed by focus groups, on what might constitute a systematic and transparent approach to reviewing information to populate model parameters. A focus group series was held with HTA experts in the United Kingdom including systematic reviewers, information specialists, and health economic modelers to explore these issues. Framework analysis was used to analyze the qualitative data elicited during focus groups. Suggestions included the use of rapid reviewing methods and the need to consider the trade-off between relevance and quality. The need for transparency in the reporting of review methods was emphasized. It was suggested that additional attention should be given to the reporting of parameters deemed to be more important to the model or where the preferred decision regarding the choice of evidence is equivocal. These recommendations form part of a Technical Support Document produced for the National Institute for Health and Clinical Excellence Decision Support Unit in the United Kingdom. It is intended that these recommendations will help to ensure a more systematic, transparent, and reproducible process for the review of model parameters within HTA. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Parallel multi-join query optimization algorithm for distributed sensor network in the internet of things

NASA Astrophysics Data System (ADS)

Zheng, Yan

2015-03-01

Internet of things (IoT), focusing on providing users with information exchange and intelligent control, attracts a lot of attention of researchers from all over the world since the beginning of this century. IoT is consisted of large scale of sensor nodes and data processing units, and the most important features of IoT can be illustrated as energy confinement, efficient communication and high redundancy. With the sensor nodes increment, the communication efficiency and the available communication band width become bottle necks. Many research work is based on the instance which the number of joins is less. However, it is not proper to the increasing multi-join query in whole internet of things. To improve the communication efficiency between parallel units in the distributed sensor network, this paper proposed parallel query optimization algorithm based on distribution attributes cost graph. The storage information relations and the network communication cost are considered in this algorithm, and an optimized information changing rule is established. The experimental result shows that the algorithm has good performance, and it would effectively use the resource of each node in the distributed sensor network. Therefore, executive efficiency of multi-join query between different nodes could be improved.

Effect of breast milk on hospital costs and length of stay among very low-birth-weight infants in the NICU.

PubMed

Parker, Leslie A; Krueger, Charlene; Sullivan, Sandra; Kelechi, Teresa; Mueller, Martina

2012-08-01

Care of the very low-birth-weight (VLBW) infant is associated with prolonged hospitalization and increased hospital costs. Specific complications of prematurity, including necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and feeding intolerance, contribute to increased cost and length of hospitalization in this population. The provision of breast milk to VLBW infants has been associated with decreased incidence of NEC and LOS as well as fewer days required to achieve full enteral feedings. The purpose of this study was to determine the impact of breast milk on length of hospitalization and hospital costs among VLBW infants in the neonatal intensive care unit (NICU). A total of 80 infants weighing less than 1500 g, born prior to 32 weeks' gestation and who remained in the home hospital until discharge. This descriptive comparative study examined cost of hospitalization and length of stay between 2 groups of VLBW premature infants fed either exclusively formula (n = 40) or at least 50% breast milk (n = 40) during their hospitalization. A retrospective chart review was used to collect information concerning patient demographics, discharge information, and nutritional variables. Information regarding hospital costs was obtained from the hospital's patient accounting office. Independent t tests were used to compare demographic data, length of hospitalization, and cost of care between the 2 groups. No statistically significant differences in length of stay or cost of care were found between infants fed at least 50% breast milk and those who were exclusively formula fed. Descriptive data concerning length of stay and cost of care for VLBW infants and those infants weighing less than 1000 g are presented. This article presents a descriptive comparative study on the effect of providing at least 50% breast milk feedings compared with formula feeding on days to discharge and cost of hospitalization in VLBW infants in the NICU. It also provides information concerning cost of care and length of stay in VLBW and infants weighing less than 1000 g.

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20-29 in Zimbabwe.

PubMed

Kripke, Katharine; Hatzold, Karin; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Gold, Elizabeth; Ahanda, Kim Seifert; Kruse-Levy, Natalie; Njeuhmeli, Emmanuel

2016-01-01

Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20-29 was examined. Zimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10-19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20-29 with a corresponding increase in unit cost for these age groups. When circumcision coverage among men ages 20-29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario. Although increased investment in recruiting VMMC clients ages 20-29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group.

Cost of hospital care for older adults with heart failure: medical, pharmaceutical, and nursing costs.

PubMed

Titler, Marita G; Jensen, Gwenneth A; Dochterman, Joanne McCloskey; Xie, Xian-Jin; Kanak, Mary; Reed, David; Shever, Leah L

2008-04-01

To determine the impact of patient characteristics, clinical conditions, hospital unit characteristics, and health care interventions on hospital cost of patients with heart failure. Data for this study were part of a larger study that used electronic clinical data repositories from an 843-bed, academic medical center in the Midwest. This retrospective, exploratory study used existing administrative and clinical data from 1,435 hospitalizations of 1,075 patients 60 years of age or older. A cost model was tested using generalized estimating equations (GEE) analysis. Electronic databases used in this study were the medical record abstract, the financial data repository, the pharmacy repository; and the Nursing Information System repository. Data repositories were merged at the patient level into a relational database and housed on an SQL server. The model accounted for 88 percent of the variability in hospital costs for heart failure patients 60 years of age and older. The majority of variables that were associated with hospital cost were provider interventions. Each medical procedure increased cost by $623, each unique medication increased cost by $179, and the addition of each nursing intervention increased cost by $289. One medication and several nursing interventions were associated with lower cost. Nurse staffing below the average and residing on 2-4 units increased hospital cost. The model and data analysis techniques used here provide an innovative and useful methodology to describe and quantify significant health care processes and their impact on cost per hospitalization. The findings indicate the importance of conducting research using existing clinical data in health care.

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.

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.

What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa?

PubMed

Pooran, Anil; Pieterson, Elize; Davids, Malika; Theron, Grant; Dheda, Keertan

2013-01-01

Drug-resistant tuberculosis (DR-TB) is undermining TB control in South Africa. However, there are hardly any data about the cost of treating DR-TB in high burden settings despite such information being quintessential for the rational planning and allocation of resources by policy-makers, and to inform future cost-effectiveness analyses. We analysed the comparative 2011 United States dollar ($) cost of diagnosis and treatment of drug sensitive TB (DS-TB), MDR-TB and XDR-TB, based on National South African TB guidelines, from the perspective of the National TB Program using published clinical outcome data. Assuming adherence to national DR-TB management guidelines, the per patient cost of XDR-TB was $26,392, four times greater than MDR-TB ($6772), and 103 times greater than drug-sensitive TB ($257). Despite DR-TB comprising only 2.2% of the case burden, it consumed ~32% of the total estimated 2011 national TB budget of US $218 million. 45% and 25% of the DR-TB costs were attributed to anti-TB drugs and hospitalization, respectively. XDR-TB consumed 28% of the total DR-TB diagnosis and treatment costs. Laboratory testing and anti-TB drugs comprised the majority (71%) of MDR-TB costs while hospitalization and anti-TB drug costs comprised the majority (92%) of XDR-TB costs. A decentralized XDR-TB treatment programme could potentially reduce costs by $6930 (26%) per case and reduce the total amount spent on DR-TB by ~7%. Although DR-TB forms a very small proportion of the total case burden it consumes a disproportionate and substantial amount of South Africa's total annual TB budget. These data inform rational resource allocation and selection of management strategies for DR-TB in high burden settings.

A comparison between probability and information measures of uncertainty in a simulated soil map and the economic value of imperfect soil information.

NASA Astrophysics Data System (ADS)

Lark, R. Murray

2014-05-01

Conventionally the uncertainty of a conventional soil map has been expressed in terms of the mean purity of its map units: the probability that the soil profile class examined at a site would be found to correspond to the eponymous class of the simple map unit that is delineated there (Burrough et al, 1971). This measure of uncertainty has an intuitive meaning and is used for quality control in soil survey contracts (Western, 1978). However, it may be of limited value to the manager or policy maker who wants to decide whether the map provides a basis for decision making, and whether the cost of producing a better map would be justified. In this study I extend a published analysis of the economic implications of uncertainty in a soil map (Giasson et al., 2000). A decision analysis was developed to assess the economic value of imperfect soil map information for agricultural land use planning. Random error matrices for the soil map units were then generated, subject to constraints which ensure consistency with fixed frequencies of the different soil classes. For each error matrix the mean map unit purity was computed, and the value of the implied imperfect soil information was computed by the decision analysis. An alternative measure of the uncertainty in a soil map was considered. This is the mean soil map information which is the difference between the information content of a soil observation, at a random location in the region, and the information content of a soil observation given that the map unit is known. I examined the relationship between the value of imperfect soil information and the purity and information measures of map uncertainty. In both cases there was considerable variation in the economic value of possible maps with fixed values of the uncertainty measure. However, the correlation was somewhat stronger with the information measure, and there was a clear upper bound on the value of an imperfect soil map when the mean information takes some particular value. This suggests that the information measure may be a useful one for general communication of the value of soil and similar thematic data. Burrough, P.A., Beckett, P.H.T., Jarvis, M.G., 1971. The relation between cost and utility in soil survey. J. Soil Sci. 22, 359-394. Giasson, E., van Es, C, van Wambeke, A., Bryant, R.B. 2000. Assessing the economic value of soil information using decision analysis techniques. Soil Science 165, 971-978 Western, S., 1978. Soil survey contracts and quality control. Oxford Univ. Press, Oxford.

Direct cost of monitoring conventional hemodialysis conducted by nursing professionals.

PubMed

Lima, Antônio Fernandes Costa

2017-04-01

to analyze the mean direct cost of conventional hemodialysis monitored by nursing professionals in three public teaching and research hospitals in the state of São Paulo, Brazil. this was a quantitative, explorative and descriptive investigation, based on a multiple case study approach. The mean direct cost was calculated by multiplying (clocked) time spent per procedure by the unit cost of direct labor. Values were calculated in Brazilian real (BRL). Hospital C presented the highest mean direct cost (BRL 184.52), 5.23 times greater than the value for Hospital A (BRL 35.29) and 3.91 times greater than Hospital B (BRL 47.22). the costing method used in this study can be reproduced at other dialysis centers to inform strategies aimed at efficient allocation of necessary human resources to successfully monitor conventional hemodialysis.

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.

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.

SIMYAR: a cable-yarding simulation model.

Treesearch

R.J. McGaughey; R.H. Twito

1987-01-01

A skyline-logging simulation model designed to help planners evaluate potential yarding options and alternative harvest plans is presented. The model, called SIMYAR, uses information about the timber stand, yarding equipment, and unit geometry to estimate yarding co stand productivity for a particular operation. The costs of felling, bucking, loading, and hauling are...

The Achiever. Volume 6, Number 8, November-December 2007

ERIC Educational Resources Information Center

Ashby, Nicole, Ed.

2007-01-01

"The Achiever" is a monthly publication for parents and community leaders. Each issue contains news and information about school improvement in the United States. Highlights of this issue include: (1) President Signs College Cost Reduction Act; (2) Galvanizing the Community: Charter Schools Provides Greater Choice to Colorado Latinos…

Estimating herbaceous biomass of grassland vegetation using the reference unit method

Treesearch

Eric D. Boyda; Jack L. Butler; Lan Xu

2015-01-01

Aboveground net primary production provides valuable information on wildlife habitat, fire fuel loads, and forage availability. Aboveground net primary production in herbaceous plant communities is typically measured by clipping aboveground biomass. However, the high costs associated with physically harvesting plant biomass may prevent collecting sufficient...

Building Successful Partnerships in Health Literacy

ERIC Educational Resources Information Center

McIntyre, Sue; Dale, Helen; Gabler, Carol

2010-01-01

Health literacy, the ability to obtain and understand information and services to make good health decisions, has received much attention recently. Literacy is a stronger predictor of health status than age, income, race, ethnicity, employment status, or educational level. Inadequate health literacy costs the United States an estimated $100-$236…

12 CFR 1402.22 - Fees to be charged.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION RELEASING INFORMATION Fees for Provision of...) (i.e., basic pay plus 16 percent of that rate) of the employee(s) making the search. (c) Computer... the cost of operating the central processing unit for that portion of operating time that is directly...

12 CFR 1402.22 - Fees to be charged.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION RELEASING INFORMATION Fees for Provision of...) (i.e., basic pay plus 16 percent of that rate) of the employee(s) making the search. (c) Computer... the cost of operating the central processing unit for that portion of operating time that is directly...

12 CFR 1402.22 - Fees to be charged.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION RELEASING INFORMATION Fees for Provision of...) (i.e., basic pay plus 16 percent of that rate) of the employee(s) making the search. (c) Computer... the cost of operating the central processing unit for that portion of operating time that is directly...

12 CFR 1402.22 - Fees to be charged.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION RELEASING INFORMATION Fees for Provision of...) (i.e., basic pay plus 16 percent of that rate) of the employee(s) making the search. (c) Computer... the cost of operating the central processing unit for that portion of operating time that is directly...

12 CFR 1402.22 - Fees to be charged.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION RELEASING INFORMATION Fees for Provision of...) (i.e., basic pay plus 16 percent of that rate) of the employee(s) making the search. (c) Computer... the cost of operating the central processing unit for that portion of operating time that is directly...

The Decision To Recruit Online: A Descriptive Study.

ERIC Educational Resources Information Center

Galanaki, Eleanna

2002-01-01

Responses from 34 of 99 United Kingdom information technology companies explored effects of cost effectiveness, response rate and quality, company image, targeting, time and effort, and overload. The effectiveness of online recruiting depends largely on its implementation and the quality of the recruitment process as a whole. (Contains 38…

Purchasing Energy. Managing School Facilities, Guide 5.

ERIC Educational Resources Information Center

Isbell, Paul

This booklet examines the purchasing choices which will be available with the introduction of full competition for all electricity and gas supplies in the United Kingdom, giving schools the chance to make significant savings on energy costs. The guide offers detailed purchasing information on such topics as tariff structures, contract energy…

NREL Achieves Solar-Electric Record

Science.gov Websites

Solar-Electric Record New Technology Could Spur Growth in Photovoltaic Panels For more information 2000, the photovoltaic industry increased production by 29 percent in the United States and 39 percent worldwide. In recent months the rising cost of fuels and the California power crisis have spurred an even

The (Paper)Work of Medicine: Understanding International Medical Costs

PubMed Central

Cutler, David M.; Ly, Dan P.

2015-01-01

Americans like to believe that their healthcare system is the best in the world, but the information they receive about the healthcare systems of other countries is limited. This is unfortunate because experiences abroad—both good and bad—can provide important lessons for the United States. PMID:21595323

Manufacturing Economics of Plant-Made Biologics: Case Studies in Therapeutic and Industrial Enzymes

PubMed Central

Tusé, Daniel; McDonald, Karen A.

2014-01-01

Production of recombinant biologics in plants has received considerable attention as an alternative platform to traditional microbial and animal cell culture. Industrially relevant features of plant systems include proper eukaryotic protein processing, inherent safety due to lack of adventitious agents, more facile scalability, faster production (transient systems), and potentially lower costs. Lower manufacturing cost has been widely claimed as an intuitive feature of the platform by the plant-made biologics community, even though cost information resides within a few private companies and studies accurately documenting such an advantage have been lacking. We present two technoeconomic case studies representing plant-made enzymes for diverse applications: human butyrylcholinesterase produced indoors for use as a medical countermeasure and cellulases produced in the field for the conversion of cellulosic biomass into ethanol as a fuel extender. Production economics were modeled based on results reported with the latest-generation expression technologies on Nicotiana host plants. We evaluated process unit operations and calculated bulk active and per-dose or per-unit costs using SuperPro Designer modeling software. Our analyses indicate that substantial cost advantages over alternative platforms can be achieved with plant systems, but these advantages are molecule/product-specific and depend on the relative cost-efficiencies of alternative sources of the same product. PMID:24977145

Manufacturing economics of plant-made biologics: case studies in therapeutic and industrial enzymes.

PubMed

Tusé, Daniel; Tu, Tiffany; McDonald, Karen A

2014-01-01

Production of recombinant biologics in plants has received considerable attention as an alternative platform to traditional microbial and animal cell culture. Industrially relevant features of plant systems include proper eukaryotic protein processing, inherent safety due to lack of adventitious agents, more facile scalability, faster production (transient systems), and potentially lower costs. Lower manufacturing cost has been widely claimed as an intuitive feature of the platform by the plant-made biologics community, even though cost information resides within a few private companies and studies accurately documenting such an advantage have been lacking. We present two technoeconomic case studies representing plant-made enzymes for diverse applications: human butyrylcholinesterase produced indoors for use as a medical countermeasure and cellulases produced in the field for the conversion of cellulosic biomass into ethanol as a fuel extender. Production economics were modeled based on results reported with the latest-generation expression technologies on Nicotiana host plants. We evaluated process unit operations and calculated bulk active and per-dose or per-unit costs using SuperPro Designer modeling software. Our analyses indicate that substantial cost advantages over alternative platforms can be achieved with plant systems, but these advantages are molecule/product-specific and depend on the relative cost-efficiencies of alternative sources of the same product.

Cost-effectiveness thresholds: pros and cons.

PubMed

Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

2016-12-01

Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

Direct and indirect costs incurred by Australian living kidney donors.

PubMed

Barnieh, Lianne; Kanellis, John; McDonald, Stephen; Arnold, Jennifer; Sontrop, Jessica M; Cuerden, Meaghan; Klarenbach, Scott; Garg, Amit X; Boudville, Neil

2017-12-07

To describe the direct and indirect costs incurred by Australian living kidney donors. We studied 55 living kidney donors from 3 centres in Perth, Australia and 1 centre in Melbourne, Australia (2010-2014); 49 donors provided information on expenses incurred during the donor evaluation period and up to 3 months after donation. We used a micro-costing approach to measure and value the units of resources consumed. Expenses were grouped as direct costs (ground and air travel, accommodation, and prescription medications) and indirect costs (lost wages and lost productivity). We standardized costs to the year 2016 in Australian dollars. The most common direct costs were for ground travel (100%), parking (76%), and post-donation pain medications or antibiotics (73%). The highest direct costs were for air travel (median $1,986 [3 donors]) and ground travel (median $459 [49 donors]). Donors also reported lost wages (median $9,891 [37 donors]). The inability to perform household activities or care for dependants were reported by 32 (65%) and 23 (47%) donors. Total direct costs averaged $1,682 per donor (median $806 among 49 donors). Total indirect costs averaged $7,249 per donor (median $7,273 among 49 donors). Total direct and indirect costs averaged $8,932 per donor (median $7,963 among 49 donors). Many Australian living kidney donors incur substantial costs during the donation process. Our findings inform the continued development of policies and programs designed to minimize costs incurred by living kidney donors. This article is protected by copyright. All rights reserved.

The cost of severe haemophilia in Europe: the CHESS study.

PubMed

O'Hara, Jamie; Hughes, David; Camp, Charlotte; Burke, Tom; Carroll, Liz; Diego, Daniel-Anibal Garcia

2017-05-31

Severe haemophilia is associated with major psychological and economic burden for patients, caregivers, and the wider health care system. This burden has been quantified and documented for a number of European countries in recent years. However, few studies have taken a standardised methodology across multiple countries simultaneously, and sought to amalgamate all three levels of burden for severe disease. The overall aim of the 'Cost of Haemophilia in Europe: a Socioeconomic Survey' (CHESS) study was to capture the annualised economic and psychosocial burden of severe haemophilia in five European countries. A cross-section of haemophilia specialists (surveyed between January and April 2015) provided demographic and clinical information and 12-month ambulatory and secondary care activity for patients via an online survey. In turn, patients provided corresponding direct and indirect non-medical cost information, including work loss and out-of-pocket expenses, as well as information on quality of life and adherence. The direct and indirect costs for the patient sample were calculated and extrapolated to population level. Clinical reports for a total of 1,285 patients were received. Five hundred and fifty-two patients (43% of the sample) provided information on indirect costs and health-related quality of life via the PSC. The total annual cost of severe haemophilia across the five countries for 2014 was estimated at EUR 1.4 billion, or just under EUR 200,000 per patient. The highest per-patient costs were in Germany (mean EUR 319,024) and the lowest were in the United Kingdom (mean EUR 129,365), with a study average of EUR 199,541. As expected, consumption of clotting factor replacement therapy represented the vast majority of costs (up to 99%). Indirect costs are driven by patient and caregiver work loss. The results of the CHESS study reflect previous research findings suggesting that costs of factor replacement therapy account for the vast majority of the cost burden in severe haemophilia. However, the importance of the indirect impact of haemophilia on the patient and family should not be overlooked. The CHESS study highlights the benefits of observational study methodologies in capturing a 'snapshot' of information for patients with rare diseases.

Multidose Botulinum Toxin A for Intralaryngeal Injection: A Cost Analysis.

PubMed

Gilbert, Mark R; Young, VyVy N; Smith, Libby J; Rosen, Clark A

2018-01-04

Botulinum toxin A (BtxA) injection is the mainstay treatment for laryngeal dystonias. BtxA product labeling states that reconstituted toxin should be used within 4 hours on a single patient despite several studies that have demonstrated multidose BtxA to be safe and effective. Many insurance carriers mandate the use of an outside pharmacy which necessitates a single-use approach. This study compares the cost savings of multidose BtxA for laryngeal dystonia compared to single-use. This is a retrospective review and projected cost savings analysis. Records and billing information were reviewed for patients receiving BtxA for intralaryngeal injection at a single laryngology division in 2015. Inclusion criteria included CPT 64617 or J0585; exclusion criteria included CPT 64616. The price of BtxA 100 unit vial for calculation was $670. A total of 142 patients were seen for intralaryngeal BtxA injection resulting in 337 visits over 1 year. The average BtxA dose per visit was 2.86 units with an average of 3.06 procedure visits per year. The calculated cost of BtxA treatment using a single vial approach was found to be $2,050 per patient per year. If billed instead for $7/unit with 5 units wastage charge per visit, the yearly per patient charge is $168. Single vial-use of BtxA injection thus represents a 1,118% price increase versus multidose use. When estimated for yearly prevalence of spasmodic dysphonia, multidose BtxA use would save almost $100 million annually. Multidose botulinum toxin A application utilizing per unit billing is significantly less expensive than per single-use vial billing and would save the health-care system significant amount of money without any sacrifice in safety or effectiveness. Copyright © 2018. Published by Elsevier Inc.

Vehicle Lightweighting: 40% and 45% Weight Savings Analysis: Technical Cost Modeling for Vehicle Lightweighting

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

Mascarin, Anthony; Hannibal, Ted; Raghunathan, Anand

2015-04-01

The U.S. Department of Energy’s Vehicle Technologies Office, Materials area commissioned a study to model and assess manufacturing economics of alternative design and production strategies for a series of lightweight vehicle concepts. The strategic targets were a 40% and a 45% mass reduction relative to a standard North American midsize passenger sedan at an effective cost of $3.42 per pound (lb) saved. The baseline vehicle was an average of several available vehicles in this class. Mass and cost breakdowns from several sources were used, including original equipment manufacturers’ (OEMs’) input through U.S. Department of Energy’s Vehicle Technologies Office programs andmore » public presentations, A2Mac1 LLC’s teardown information, Lotus Engineering Limited and FEV, Inc. breakdowns in their respective lightweighting studies, and IBIS Associates, Inc.’s decades of experience in automotive lightweighting and materials substitution analyses. Information on lightweighting strategies in this analysis came from these same sources and the ongoing U.S. Department of Energy-funded Vehma International of America, Inc. /Ford Motor Company Multi-Material Lightweight Prototype Vehicle Demonstration Project, the Aluminum Association Transportation Group, and many United States Council for Automotive Research’s/United States Automotive Materials Partnership LLC lightweight materials programs.« less

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.

Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England.

PubMed

Shetty, S; Kennea, N; Desai, P; Giuliani, S; Richards, J

2016-01-01

Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units after surgical repair of common congenital anomalies. There are few if any publications reporting the activity performed by units undertaking neonatal surgery. Such activity is important for contracting arrangements, commissioning specialist services and counselling parents. The aim of this study was to describe postnatal LOS for infants admitted to a single tertiary referral neonatal unit with congenital malformations requiring surgery. Methods Data on nine conditions were collected prospectively for babies on the neonatal unit over a five-year period (2006-2011). For those transferred back to their local unit following surgery, the local unit was contacted to determine the total LOS. Only those babies who had surgery during their first admission to our unit and who survived to discharge were included in the study. Cost estimates were based on the tariffs agreed for neonatal care between our trust and the London specialised commissioning group in 2011-2012. Results The median LOS for the conditions studied was: gastroschisis 35 days (range: 19-154 days), oesophageal atresia 33 days (range: 9-133 days), congenital diaphragmatic hernia 28 days (range: 7-99 days), intestinal atresia 24 days (range: 6-168 days), Hirschsprung's disease 21 days (range: 15-36 days), sacrococcygeal teratoma 17 days (range: 12-55 days), myelomeningocoele 15.5 days (range: 8-24 days), anorectal malformation 15 days (range: 6-90 days) and exomphalos 12 days (range: 3-228 days). The total neonatal bed day costs for the median LOS ranged from £8,701 (myelomeningocoele) to £23,874 (gastroschisis). The cost of surgery was not included. Conclusions There is wide variation in LOS for the same conditions in a single neonatal unit. This can be explained by different types and severity within the same congenital anomalies, different surgeons and other clinical confounders (eg sepsis, surgical complications, associated anomalies). These data will enable us to give more detailed information to families following prenatal or postnatal diagnosis. They also allow more detailed planning of resource allocation for neonatal admissions.

Design of capacity incentive and energy compensation for demand response programs

NASA Astrophysics Data System (ADS)

Liu, Zhoubin; Cui, Wenqi; Shen, Ran; Hu, Yishuang; Wu, Hui; Ye, Chengjin

2018-02-01

Variability and Uncertainties caused by renewable energy sources have called for large amount of balancing services. Demand side resources (DSRs) can be a good alternative of traditional generating units to provide balancing service. In the areas where the electricity market has not been fully established, e.g., China, DSRs can help balance the power system with incentive-based demand response programs. However, there is a lack of information about the interruption cost of consumers in these areas, making it hard to determine the rational amount of capacity incentive and energy compensation for the participants of demand response programs. This paper proposes an algorithm to calculate the amount of capacity incentive and energy compensation for demand response programs when there lacks the information about interruption cost. Available statistical information of interruption cost in referenced areas is selected as the referenced data. Interruption cost of the targeted area is converted from the referenced area by product per electricity consumption. On this basis, capacity incentive and energy compensation are obtained to minimize the payment to consumers. Moreover, the loss of consumers is guaranteed to be covered by the revenue they earned from load serving entities.

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.

A microcosting study of immunogenicity and tumour necrosis factor alpha inhibitor drug level tests for therapeutic drug monitoring in clinical practice.

PubMed

Jani, Meghna; Gavan, Sean; Chinoy, Hector; Dixon, William G; Harrison, Beverley; Moran, Andrew; Barton, Anne; Payne, Katherine

2016-12-01

To identify and quantify resource required and associated costs for implementing TNF-α inhibitor (TNFi) drug level and anti-drug antibody (ADAb) tests in UK rheumatology practice. A microcosting study, assuming the UK National Health Service perspective, identified the direct medical costs associated with providing TNFi drug level and ADAb testing in clinical practice. Resource use and costs per patient were identified via four stages: identification of a patient pathway with resource implications; estimation of the resources required; identification of the cost per unit of resource (2015 prices); and calculation of the total costs per patient. Univariate and multiway sensitivity analyses were performed using the variation in resource use and unit costs. Total costs for TNFi drug level and concurrent ADAb testing, assessed using ELISAs on trough serum levels, were £152.52/patient (range: £147.68-159.24) if 40 patient samples were tested simultaneously. For the base-case analysis, the pre-testing phase incurred the highest costs, which included booking an additional appointment to acquire trough blood samples. The additional appointment was the key driver of costs per patient (67% of the total cost), and labour accounted for 10% and consumables 23% of the total costs. Performing ELISAs once per patient (rather than in duplicate) reduced the total costs to £133.78/patient. This microcosting study is the first assessing the cost of TNFi drug level and ADAb testing. The results could be used in subsequent cost-effectiveness analyses of TNFi pharmacological tests to target treatments and inform future policy recommendations. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Cost of Surgery for Symptomatic Spinal Metastases in the United Kingdom.

PubMed

Turner, Isobel; Minhas, Zulfiqar; Kennedy, Joanne; Morris, Stephen; Crockard, Alan; Choi, David

2015-11-01

Spinal metastases represent a significant health and economic burden. The average cost of surgical management varies between institutions and countries, partially a result of differences in health care system billing. This study assessed hospital costs from a single institute in the United Kingdom National Healthcare Service and identified patient factors associated with these costs. This prospective study recruited patients with confirmed symptomatic spinal metastases who presented for surgical treatment. The primary outcome was cost of inpatient treatment collected using the Patient Level Costing and Information System; preoperative details collected included patient demographics, primary tumor type, Tomita and Tokuhashi scores, pain level, EuroQol 5 dimension score, Frankel, Karnofsky, and American Society of Anesthesiologists' physical status classification system scores, and operative details. Costs were analyzed for 74 patients. The mean cost of treatment (standard deviation, SD) per patient was £ 16,885 (£ 10,687); which was mainly comprised of operating theater (25% of the total) and ward costs (27%). Better health status at presentation significantly increased total and ward costs (Frankel score P = 0.006, and EuroQol 5 dimension index P = 0.014 respectively); male sex also increased total and ward costs (P < 0.01 and P = 0.06). Operation cost showed a trend to increased costs with less impairment on American Society of Anesthesiologists' physical status classification system scores. The cost of surgical management of spinal metastases is associated with several factors but is greater in patients presenting with better health status, probably because of their suitability for larger operations, whereas those with poor health status undergo smaller, palliative operations, resulting in shorter inpatient postoperative recovery. Copyright © 2015 Elsevier Inc. All rights reserved.

International strategic minerals inventory summary report; lithium

USGS Publications Warehouse

Anstett, T.F.; Krauss, U.H.; Ober, J.A.; Schmidt, H.W.

1990-01-01

Major world resources of lithium are described in this summary report of information in the International Strategic Minerals Inventory (ISMI). ISMI is a cooperative data-collection effort of earth-science and mineral-resource agencies in Australia, Canada, the Federal Republic of Germany, the Republic of South Africa, the United Kingdom, and the United States of America. Part I of this report presents an overview of the resources and potential supply of lithium on the basis of inventory information; Part II contains tables of some of the geologic information and mineral-resource information and production data collected by ISMI participants. In terms of lithium-resource availability, present economically viable resources are more than sufficient to meet likely demand in the foreseeable future. In times of excess capacity such as currently exist, some pegmatite operations cannot compete with brine operations, which are less costly. A further production shift from pegmatites to brines will result in the concentration of supply in a few countries such as Chile and the United States. This shift would lead to the dependence of industrialized countries on deliveries from these sources.

Library Services Funding Assessment

NASA Technical Reports Server (NTRS)

Lorig, Jonathan A.

2004-01-01

The Glenn Technical Library is a science and engineering library that primarily supports research activities at the Glenn Research Center, and provides selected services to researchers at all of the NASA research centers. Resources available in the library include books, journals, CD-ROMs, and access to various online sources, as well as live reference and inter-library loan services. The collection contains over 77,000 books, 800,000 research reports, and print or online access to over 1,400 journals. Currently the library operates within the Logistics and Technical Information Division, and is funded as an open-access resource within the GRC. Some of the research units at the GRC have recently requested that the library convert to a "pay-for-services" model, in which individual research units could fund only those journal subscriptions for which they have a specific need. Under this model, the library would always maintain a certain minimum level of pooled-expense services, including the ready reference and book collections, and inter-library loan services. Theoretically the "pay-for-services" model would encourage efficient financial allocation, and minimize the extent to which paid journal subscriptions go unused. However, this model also could potentially negate the benefits of group purchases for journal subscriptions and access. All of the major journal publishers offer package subscriptions that compare favorably in cost with the sum of individual subscription costs for a similar selection of titles. Furthermore, some of these subscription packages are "consortium" purchases that are funded collectively by the libraries at multiple NASA research centers; such consortia1 memberships would be difficult for the library to pay, if enough GRC research units were to withdraw their pooled contributions. cost of collectively-funded journal access with the cost of individual subscriptions. My primary task this summer is to create the cost dataset framework, and collect as much of the relevant data as possible. Hopefully this dataset will permit the research units at the GRC, and library administration as well, to make informed decisions about future library funding. Prior to the creation of the actual dataset, I established a comprehensive list of the library s print and online journal subscriptions. This list will be useful outside the context of the cost analysis project, as an addition to the library website. The cost analysis dataset s primary fields are: journal name, vendor, publisher, ISSN (International Standard Serial Number, to uniquely identify the titles), stand-alone price, and indication as to the presence of the journal in current GRC Technical Library consortium membership subscriptions. The dataset will hopefully facilitate comparisons between the stand-alone journal prices and the cost of shared journal subscriptions for groups of titles.

Natural Hazards - A National Threat

USGS Publications Warehouse

Geological Survey, U.S.

2007-01-01

The USGS Role in Reducing Disaster Losses -- In the United States each year, natural hazards cause hundreds of deaths and cost billions of dollars in disaster aid, disruption of commerce, and destruction of homes and critical infrastructure. Although the number of lives lost to natural hazards each year generally has declined, the economic cost of major disaster response and recovery continues to rise. Each decade, property damage from natural hazards events doubles or triples. The United States is second only to Japan in economic damages resulting from natural disasters. A major goal of the U.S. Geological Survey (USGS) is to reduce the vulnerability of the people and areas most at risk from natural hazards. Working with partners throughout all sectors of society, the USGS provides information, products, and knowledge to help build more resilient communities.

Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.

PubMed

Hasty, Robert T; Garbalosa, Ryan C; Barbato, Vincenzo A; Valdes, Pedro J; Powers, David W; Hernandez, Emmanuel; John, Jones S; Suciu, Gabriel; Qureshi, Farheen; Popa-Radu, Matei; San Jose, Sergio; Drexler, Nathaniel; Patankar, Rohan; Paz, Jose R; King, Christopher W; Gerber, Hilary N; Valladares, Michael G; Somji, Alyaz A

2014-05-01

Since its launch in 2001, Wikipedia has become the most popular general reference site on the Internet and a popular source of health care information. To evaluate the accuracy of this resource, the authors compared Wikipedia articles on the most costly medical conditions with standard, evidence-based, peer-reviewed sources. The top 10 most costly conditions in terms of public and private expenditure in the United States were identified, and a Wikipedia article corresponding to each topic was chosen. In a blinded process, 2 randomly assigned investigators independently reviewed each article and identified all assertions (ie, implication or statement of fact) made in it. The reviewer then conducted a literature search to determine whether each assertion was supported by evidence. The assertions found by each reviewer were compared and analyzed to determine whether assertions made by Wikipedia for these conditions were supported by peer-reviewed sources. For commonly identified assertions, there was statistically significant discordance between 9 of the 10 selected Wikipedia articles (coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, back pain, and hyperlipidemia) and their corresponding peer-reviewed sources (P<.05) and for all assertions made by Wikipedia for these medical conditions (P<.05 for all 9). Most Wikipedia articles representing the 10 most costly medical conditions in the United States contain many errors when checked against standard peer-reviewed sources. Caution should be used when using Wikipedia to answer questions regarding patient care.

Socio-economic and Engineering Assessments of Renewable Energy Cost Reduction Potential

NASA Astrophysics Data System (ADS)

Seel, Joachim

This dissertation combines three perspectives on the potential of cost reductions of renewable energy--a relevant topic, as high energy costs have traditionally been cited as major reason to vindicate developments of fossil fuel and nuclear power plants, and to justify financial support mechanisms and special incentives for renewable energy generators. First, I highlight the role of market and policy drivers in an international comparison of upfront capital expenses of residential photovoltaic systems in Germany and the United States that result in price differences of a factor of two and suggest cost reduction opportunities. In a second article I examine engineering approaches and siting considerations of large-scale photovoltaic projects in the United States that enable substantial system performance increases and allow thus for lower energy costs on a levelized basis. Finally, I investigate future cost reduction options of wind energy, ranging from capital expenses, operating expenses, and performance over a project's lifetime to financing costs. The assessment shows both substantial further cost decline potential for mature technologies like land-based turbines, nascent technologies like fixed-bottom offshore turbines, and experimental technologies like floating offshore turbines. The following paragraphs summarize each analysis: International upfront capital cost comparison of residential solar systems: Residential photovoltaic (PV) systems were twice as expensive in the United States as in Germany in 2012. This price discrepancy stems primarily from differences in non-hardware or "soft" costs between the two countries, of which only 35% be explained by differences in cumulative market size and associated learning. A survey of German PV installers was deployed to collect granular data on PV soft costs in Germany, and the results are compared to those of a similar survey of U.S. PV installers. Non-module hardware costs and all analyzed soft costs are lower in Germany, especially for customer acquisition, installation labor, and profit/overhead costs, but also for expenses related to permitting, interconnection, and inspection procedures. Additional costs occur in the United States due to state and local sales taxes, smaller average system sizes, and longer project-development times. To reduce the identified additional costs of residential PV systems, the United States could introduce policies that enable a robust and lasting market while minimizing market fragmentation. Regularly declining incentives offering a transparent and certain value proposition might help accelerate PV cost reductions in the United States. Performance analysis of large-scale solar installations in the United States: This paper presents the first known use of multi-variate regression techniques to statistically explore empirical variation in utility-scale PV project performance across the United States. Among a sample of 128 utility-scale PV projects totaling 3,201 MWAC, net capacity factors in 2014 varied by more than a factor of two. Regression models developed for this analysis find that just three highly significant independent variables can explain 92% of this project-level variation. Adding the commercial operation year as a fourth independent variable and three interactive variables improves the model further and reveals interesting relationships. Taken together, the empirical data and statistical modeling results presented in this paper can provide a useful indication of the level of performance that solar project developers and investors can expect from various project configurations in different regions of the United States. Moreover, the tight relationship between fitted and actual capacity factors should instill confidence among investors that the utility-scale projects in this sample have largely performed as predicted by our models, with no significant outliers to date. Holistic assessment of future cost reduction opportunities of wind energy applications: Wind energy supply has grown rapidly over the last decade. However, the long-term contribution of wind to future energy supply, and the degree to which policy support is necessary to motivate higher levels of deployment, depends on the future costs of both onshore and offshore wind. Here, I summarize the results of an expert elicitation survey of 163 of the world's foremost wind experts, aimed at better understanding future costs and technology advancement possibilities. Results suggest significant opportunities for cost reductions, but also underlying uncertainties. Costs could be even lower: experts predict a 10% chance that reductions will be more than 40% by 2030 and more than 50% by 2050. The main identified drivers for near term cost reductions are rotor-related advancements and taller towers for onshore installations, fixed-bottom offshore turbines can benefit from an upscaling in generator capacity, streamlined foundation design and reduced financing costs, while floating offshore turbines require further progress in buoyant support structure design and installation process efficiencies. Insights gained through this expert elicitation complement other tools for evaluating cost-reduction potential, and help inform policy, planning, R&D, and industry strategy. (Abstract shortened by ProQuest.).

Comparison of hard- and soft-copy digital chest images with different matrix sizes for managing coronary care unit patients.

PubMed

Steckel, R J; Batra, P; Johnson, S; Sayre, J; Brown, K; Haker, K; Young, D; Zucker, M

1995-04-01

This study was to determine whether different digital display formats for portable chest radiographs of coronary care unit patients would provide comparable information for clinical care. In particular, we tried to ascertain whether 1024 x 1024 pixel (1K) images on a picture archiving and communication system (PACS) workstation would be comparable to 1760 x 2140 pixel (2K) images on workstations or to digital films. If comparability could be proved, we hypothesized that 1K workstations could considerably lower equipment and film costs and facilitate image transmission from point to point. Four chest radiologists read a panel of chest studies assembled from 98 coronary care unit patients, comparing 1K and 2K soft-copy images with digital hard copies. For all three image types for the 98 patients, the readers evaluated nine image parameters that the cardiologists deemed essential for clinical decision making. Two other chest radiologists reviewed each patient's three image types, historical chest images, current and prior radiologic reports, and medical record to determine the consensus, or "truth findings." With one exception (small pleural effusions), the receiver operating characteristic analysis showed no significant differences in the clinical information derived from the three image types. For clinical management in a coronary care unit, comparable information can be obtained from digital radiologic chest studies using a 1K x 1K soft-copy format, a 2K x 2K soft-copy format, or a hard copy (film). Substantial savings in cost and time are therefore possible by using soft-copy images and lower resolution (1K x 1K) workstations and, when necessary, by transmitting images on regular telephone lines.

An Electronic Patient-Reported Outcome Measures System in UK Chiropractic Practices: A Feasibility Study of Routine Collection of Outcomes and Costs.

PubMed

Newell, Dave; Diment, Emily; Bolton, Jenni E

2016-01-01

The purpose of this study was to test the feasibility of collecting valid and widely used health outcomes, including information concerning cost of care, using a Web-based patient-driven patient-reported outcome measure (PROM) collection process within a cohort of UK chiropractic practices. A Web-based PROM system (Care Response) was used. Patients with low back and neck pain were recruited from a group of chiropractic practices located in the United Kingdom. Information collected included demographic data, generic and condition-specific PROMs at the initial consultation and 90 days later, patient-reported experience measures, and additional health seeking to estimate costs of care. A group of 33 clinics provided information from a total of 1895 patients who completed baseline questionnaires with 844 (45%) completing the measures at 90-day follow-up. Subsequent outcomes suggest that more than 70% of patients improved over the course of treatment regardless of the outcome used. Using the baseline as a virtual counterfactual with respect to follow-up, we calculated quality-adjusted life years and the cost thereof resulting in a mean quality-adjusted life years gained of 0.8 with an average cost of £895 per quality-adjusted life year. Routine collection of PROMs, including information about cost, is feasible and can be achieved using an online system within a clinical practice environment. We describe a Web-based collection system and discuss the choice of measures leading to a comprehensive understanding of outcomes and costs in routine practice. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

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.

Decision analysis of visual range improvements attributable to sulfur dioxide emission reductions in the eastern United States

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

Balson, W.E.; Rice, J.S.

1988-01-01

The Environmental Protection Agency (EPA) recently published an advanced notice of proposed rulemaking (ANPR) (Federal Register, July 1, 1987) inquiring into the need for a secondary ambient standard for fine particles to protect visibility in the east and urban west. The EPA has solicited comments on the application of cost and benefits analyses in making decisions about such standards. In response to this request for comments, the utility air regulatory group (UARG) requested that Decision Focus Incorporated (DFI) estimate the benefits of visibility improvements reasonably associated with changes in SO{sub 2} emissions, to compare those benefits with the cost ofmore » achieving those emission reduction, and to assess the value of acquiring more information before making a decision, taking into account the uncertainties associated with these estimates. This request followed a presentation by DFI on such a method at the Grand Teton Specialty Conference on Visibility. In coordination with this cost and benefit comparison, UARG has also requested that other contractors estimate the levels of uncertainty in visibility improvements, the household value for visibility improvements, and the costs of implementation. The information provided by those contractors served as key inputs for the methodology and the results that are described in this paper. The information on visibility improvements was provided by AeroVironment Incorporated (AV), Zannetti. The information on household value was provided by Dr. Paul Ruud. Finally, the information on costs was provided by Temple, Baker, and Sloane, Incorporated (TBS). The three reports described above are discussed in this paper.« less

Measuring NO, NO2, CO2 and O3 with low-cost sensors

NASA Astrophysics Data System (ADS)

Müller, Michael; Graf, Peter; Hüglin, Christoph

2017-04-01

Inexpensive sensors measuring ambient gas concentrations can be integrated in sensor units forming dense sensor networks. The utilized sensors have to be sufficiently accurate as the value of such networks directly depends on the information they provide. Thus, thorough testing of sensors before bringing them into service and the application of effective strategies for performance monitoring and adjustments during service are key elements for operating the low-cost sensors that are currently available on the market. We integrated several types of low-cost sensors into sensor units (Alphasense NO2 B4/B42F/B43F, Alphasense NO B4, SensAir CO2 LP8, Aeroqual O3 SM50), run them in the field next to instruments of air quality monitoring stations and performed tests in the laboratory. The poster summarizes our findings regarding the achieved sensor accuracy, methods to improve sensor performance as well as strategies to monitor the current state of the sensor (drifts, sensitivity) within a sensor network.

Principles and methods of managerial cost-accounting systems.

PubMed

Suver, J D; Cooper, J C

1988-01-01

An introduction to cost-accounting systems for pharmacy managers is provided; terms are defined and examples of specific applications are given. Cost-accounting systems determine, record, and report the resources consumed in providing services. An effective cost-accounting system must provide the information needed for both internal and external reports. In accounting terms, cost is the value given up to secure an asset. In determining how volumes of activity affect costs, fixed costs and variable costs are calculated; applications include pricing strategies, cost determinations, and break-even analysis. Also discussed are the concepts of direct and indirect costs, opportunity costs, and incremental and sunk costs. For most pharmacy department services, process costing, an accounting of intermediate outputs and homogeneous units, is used; in determining the full cost of providing a product or service (e.g., patient stay), job-order costing is used. Development of work-performance standards is necessary for monitoring productivity and determining product costs. In allocating pharmacy department costs, a ratio of costs to charges can be used; this method is convenient, but microcosting (specific identification of the costs of products) is more accurate. Pharmacy managers can use cost-accounting systems to evaluate the pharmacy's strategies, policies, and services and to improve budgets and reports.

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.

Commentary: public disclosure in the health field: is there a relevant option?

PubMed

Weil, T P

2001-01-01

Steadily increasing numbers of private, not-for-profit, and public agencies are releasing quality of care and financial information to enhance the market power of those purchasing America's health services. These sources range widely from the Health Plan Employer Data and Information Set (HEDIS) to the federal Securities and Exchange Commission (SEC). A growing interest in publicly disclosing performance information that concerns providers, as recently recommended by the Institute of Medicine (IOM) report on patient safety, until now has only achieved a modest impact. A major exception is in those metropolitan areas where acute-care facilities experience intense competition for patient admissions. Although the comparative quality and cost information currently available is for the most part in the public interest, it is concluded that, in the foreseeable future, these report cards as now structured will not result in any significant enhancement in access, improvement in quality, or reduction in cost. Options to encourage more public disclosure explored in this paper are Congress potentially passing legislation (a) to establish a Center for Patient Safety within the US Department of Health and Human Services as recommended by the recent Institute of IOM study, or (b) empowering the SEC beyond its current mandate to collect and disseminate all pertinent quality of care and cost information on every provider in the United States. The latter alternative would include user-friendly, comparative analyses to be provided on the Internet and elsewhere and would make readily available information from HEDIS, the Joint Commission on the Accreditation of Healthcare Organization (JCAHO), coronary artery bypass graft (CABG) surgery studies, cost comparisons based on Medicare cost reports and SEC filings, and other similar sources.

Advanced Neonatal Medicine in China: A National Baseline Database

PubMed Central

Chipenda-Dansokho, Selma; Lewin, Antoine; Abdelouahab, Nadia; Wei, Shu-Qin

2017-01-01

Previous surveys of neonatal medicine in China have not collected comprehensive information on workforce, investment, health care practice, and disease expenditure. The goal of the present study was to develop a national database of neonatal care units and compare present outcomes data in conjunction with health care practices and costs. We summarized the above components by extracting data from the databases of the national key clinical subspecialty proposals issued by national health authority in China, as well as publicly accessible databases. Sixty-one newborn clinical units from provincial or ministerial hospitals at the highest level within local areas in mainland China, were included for the study. Data were gathered for three consecutive years (2008–2010) in 28 of 31 provincial districts in mainland China. Of the 61 newborn units in 2010, there were 4,948 beds (median = 62 [IQR 43–110]), 1,369 physicians (median = 22 [IQR 15–29]), 3,443 nurses (median = 52 [IQR 33–81]), and 170,159 inpatient discharges (median = 2,612 [IQR 1,436–3,804]). During 2008–2010, the median yearly investment for a single newborn unit was US$344,700 (IQR 166,100–585,800), median length of hospital stay for overall inpatient newborns 9.5 (IQR 8.2–10.8) days, median inpatient antimicrobial drug use rate 68.7% (IQR 49.8–87.0), and median nosocomial infection rate 3.2% (IQR1.7–5.4). For the common newborn diseases of pneumonia, sepsis, respiratory distress syndrome, and very low birth weight (<1,500 grams) infants, their lengths of hospital stay, daily costs, hospital costs, ratios of hospital cost to per-capita disposable income, and ratios of hospital cost to per-capita health expenditure, were all significantly different across regions (North China, Northeast China, East China, South Central China, Southwest China, and Northwest China). The survival rate of extremely low birth weight (ELBW) infants (Birth weight <1,000 grams) was 76.0% during 2008–2010 in the five hospitals where each unit had more than 20 admissions of ELBW infants in 2010; and the median hospital cost for a single hospital stay in ELBW infants was US$8,613 (IQR 8,153–9,216), which was 3.0 times (IQR 2.0–3.2) the average per-capita disposable income, or 63 times (IQR 40.3–72.1) the average per-capita health expenditure of local urban residents in 2011. Our national database provides baseline data on the status of advanced neonatal medicine in China, gathering valuable information for quality improvement, decision making, longitudinal studies and horizontal comparisons. PMID:28099450

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.

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.

Direct costs of care for hepatocellular carcinoma in patients with hepatitis C cirrhosis.

PubMed

Tapper, Elliot B; Catana, Andreea M; Sethi, Nidhi; Mansuri, Daniel; Sethi, Saurabh; Vong, Annie; Afdhal, Nezam H

2016-03-15

Hepatitis C virus (HCV) is the commonest cause of hepatocellular carcinoma (HCC) in the United States. The benefits of HCV therapy may be measured in part by the prevention of HCC and other complications of cirrhosis. The true cost of care of the HCV patient with HCC is unknown. One hundred patients were randomly selected from a cohort of all HCC patients with HCV at a US transplant center between 2003 and 2013. Patients were categorized by the primary treatment modality, Barcelona class, and ultimate transplant status. Costs included the unit costs of procedures, imaging, hospitalizations, medications, and all subsequent care of the HCC patient until either death or the end of follow-up. Associations with survival and cost were assessed in multivariate regression models. Overall costs included a median of $176,456 (interquartile range [IQR], $84,489-$292,192) per patient or $6279 (IQR, $4043-$9720) per patient-month of observation. The median costs per patient-month were $7492 (IQR, $5137-$11,057) for transplant patients and $4830 for nontransplant patients. The highest median monthly costs were for transplant patients with Barcelona A4 disease ($11,349) and patients who received chemoembolization whether they underwent transplantation ($10,244) or not ($8853). Transarterial chemoembolization and radiofrequency ablation were independently associated with a 28% increase and a 22% decrease in costs, respectively, with adjustments for the severity of liver disease and Barcelona class. These data represent real-world estimates of the cost of HCC care provided at a transplant center and should inform economic studies of HCV therapy. © 2015 American Cancer Society.

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.

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.

Essays in Health Economics and Health Information Systems

ERIC Educational Resources Information Center

Terrizzi, Sabrina Ann

2013-01-01

The accelerating cost of healthcare in the United States has prompted increased policy debate. Although it is estimated that prescription drug spending accounts for only eleven percent of total healthcare expenditures, there is evidence that this rate of spending is increasing faster than spending on other types of healthcare. A proven method of…

Public/Private Partnership--A Cost Effective Model for Child Day Care Services.

ERIC Educational Resources Information Center

Alisberg, Helene R.

Trends suggest that 11 million children in the United States will need day care services by 1995. Presently, corporations provide child care support through subsidies to low income employees or through community facilities, parent education, and information and referral (I & R) services. Such support results in reduced rates of absenteeism and…

Education and the Economy.

ERIC Educational Resources Information Center

Hollenbeck, Kevin M.

2001-01-01

The relationship between education and the United States (U.S.) economy was explored to identify research needed to inform employment policy in the future. Special attention was paid to the following topics: the state of education in the U.S.; key problems in grades K-12 that must be addressed; student achievement; inequity; costs of special…

The 1977 Rankings of Programs for an In-Depth Evaluation. Research Note.

ERIC Educational Resources Information Center

Baratta, Mary Kathryne

Placement, unit cost, retention and attraction data for all programs at Moraine Valley Community College for which information was available were used to determine which programs needed in-depth evaluation. Four of the 24 associate degree programs (secretarial science, radiologic technology, power machine technology, and industrial supervision)…

International Trade: A Small Business Primer. Growing Businesses.

ERIC Educational Resources Information Center

Axtell, Roger E.

The United States' declining share of world trade is connected with the fact that hundreds of thousands of medium- and small-sized businesses are ignoring trade and exports. The cure for their fear of the unknown is information and education. Exports have a number of advantages: increased profits, spread of overhead costs, smooth seasonal…

75 FR 57271 - Creating an Offshore Wind Industry in the United States: A National Vision

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-20

... Webinar is available at: http://www.windpoweringamerica.gov/filter_detail.asp?itemid=2817 . Information on the September 21 seminar is available at: http://www.windpoweringamerica.gov/filter_detail.asp?itemid.../filter_detail.asp?itemid=2820 . Disclaimer DOE will not reimburse costs associated with participation in...

The SOLS TICE Project: Satellite Television and Audioconferencing in Continuing Professional Development for LIS Staff.

ERIC Educational Resources Information Center

Hughes, Alun; Priestley, John

1992-01-01

Describes SOLS TICE, the Satellite On-Line Searching Interactive Conferencing Experiment, conducted at the University of Plymouth (United Kingdom) to meet the training needs of staff in the library and information science (LIS) sector. Continuing professional development is discussed, instructional effectiveness and cost effectiveness are…

10 CFR 600.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., program, subaward, function or activity supported by the award. Recipients shall monitor subawards to... overruns or high unit costs. DOE may specify in the award that the recipient provide this information on... § 600.112 with regard to use of this form as part of the award application.) (e) Recipients shall not be...

10 CFR 600.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., program, subaward, function or activity supported by the award. Recipients shall monitor subawards to... overruns or high unit costs. DOE may specify in the award that the recipient provide this information on... § 600.112 with regard to use of this form as part of the award application.) (e) Recipients shall not be...

10 CFR 600.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., program, subaward, function or activity supported by the award. Recipients shall monitor subawards to... overruns or high unit costs. DOE may specify in the award that the recipient provide this information on... § 600.112 with regard to use of this form as part of the award application.) (e) Recipients shall not be...

10 CFR 600.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., program, subaward, function or activity supported by the award. Recipients shall monitor subawards to... overruns or high unit costs. DOE may specify in the award that the recipient provide this information on... § 600.112 with regard to use of this form as part of the award application.) (e) Recipients shall not be...

Growth-promoting technologies decrease the carbon footprint, ammonia emissions, and costs of California beef production systems

USDA-ARS?s Scientific Manuscript database

Improved animal performance is suggested as one of the most effective mitigation strategies to reduce greenhouse gas (GHG) and ammonia (NH3) emissions from livestock production per unit of product produced. However, little information exists on the effects of increased animal productivity on the net...

Production, consumption, and prices of softwood products in North America: regional time series data, 1950 to 1985.

Treesearch

Darius M. Adams; Kristine C. Jackson; Richard W. Haynes

1988-01-01

This report provides 35 years of information on softwood timber production and consumption in the United States and Canada. Included are regional time series on production and prices of softwood lumber, plywood, residues, and pulpwood; timber harvest volumes and values; production costs; and recovery factors.

75 FR 57769 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

... treatment works (POTWs) and other water pollution control facilities in the United States, as well as an... records cost and technical data associated with POTWs and other water pollution control facilities... mail to: EPA Docket Center, Environmental Protection Agency, Water Docket, 1200 Pennsylvania Ave., NW...

Pathways to Success; A Resource Manual for the Dissemination of Successful Educational Programs.

ERIC Educational Resources Information Center

Soper, Dorothy

This manual is designed to describe and disseminate information about innovative New Jersey educational programs that have been validated by the standards and guidelines of the United States Office of Education as successful, cost effective, and exportable. Chapter 1 contains an overview of the development process for educational programs and…

Economics of immunization information systems in the United States: assessing costs and efficiency

PubMed Central

Bartlett, Diana L; Molinari, Noelle-Angelique M; Ortega-Sanchez, Ismael R; Urquhart, Gary A

2006-01-01

Background One of the United States' national health objectives for 2010 is that 95% of children aged <6 years participate in fully operational population-based immunization information systems (IIS). Despite important progress, child participation in most IIS has increased slowly, in part due to limited economic knowledge about IIS operations. Should IIS need further improvement, characterizing costs and identifying factors that affect IIS efficiency become crucial. Methods Data were collected from a national sampling frame of the 56 states/cities that received federal immunization grants under U.S. Public Health Service Act 317b and completed the federal 1999 Immunization Registry Annual Report. The sampling frame was stratified by IIS functional status, children's enrollment in the IIS, and whether the IIS had been developed as an independent system or was integrated into a larger system. These sites self-reported IIS developmental and operational program costs for calendar years 1998–2002 using a standardized data collection tool and underwent on-site interviews to verify reported data with information from the state/city financial management system and other financial records. A parametric cost-per-patient-record (CPR) model was estimated. The model assessed the impact of labor and non-labor resources used in development and operations tasks, as well as the impact of information technology, local providers' participation and compliance with federal IIS performance standards (e.g., ensuring the confidentiality and security of information, ensure timely vaccination data at the time of patient encounter, and produce official immunization records). Given the number of records minimizing CPR, the additional amount of resources needed to meet national health goals for the year 2010 was also calculated. Results Estimated CPR was as high as $10.30 and as low as $0.09 in operating IIS. About 20% of IIS had between 2.9 to 3.2 million records and showed CPR estimates of $0.09. Overall, CPR was highly sensitive to local providers' participation. To achieve the 2010 goals, additional aggregated costs were estimated to be $75.6 million nationwide. Conclusion Efficiently increasing the number of records in IIS would require additional resources and careful consideration of various strategies to minimize CPR, such as boosting providers' participation. PMID:16925823

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...

Error Cost Escalation Through the Project Life Cycle

NASA Technical Reports Server (NTRS)

Stecklein, Jonette M.; Dabney, Jim; Dick, Brandon; Haskins, Bill; Lovell, Randy; Moroney, Gregory

2004-01-01

It is well known that the costs to fix errors increase as the project matures, but how fast do those costs build? A study was performed to determine the relative cost of fixing errors discovered during various phases of a project life cycle. This study used three approaches to determine the relative costs: the bottom-up cost method, the total cost breakdown method, and the top-down hypothetical project method. The approaches and results described in this paper presume development of a hardware/software system having project characteristics similar to those used in the development of a large, complex spacecraft, a military aircraft, or a small communications satellite. The results show the degree to which costs escalate, as errors are discovered and fixed at later and later phases in the project life cycle. If the cost of fixing a requirements error discovered during the requirements phase is defined to be 1 unit, the cost to fix that error if found during the design phase increases to 3 - 8 units; at the manufacturing/build phase, the cost to fix the error is 7 - 16 units; at the integration and test phase, the cost to fix the error becomes 21 - 78 units; and at the operations phase, the cost to fix the requirements error ranged from 29 units to more than 1500 units

A Master Plan for Unit Cost Studies Among Community Junior Colleges.

ERIC Educational Resources Information Center

Sims, Howard D.

The need for higher education programs is being challenged, and unit cost studies may become an integral part of the funding process for junior colleges. This paper describes the major tasks in a cost study and reviews the problems encountered in the unit costing efforts. The main tasks are: (1) identifying units of measurement (the language used…

The economics of biosimilars.

PubMed

Blackstone, Erwin A; Joseph, P Fuhr

2013-09-01

The high cost of pharmaceuticals, especially biologics, has become an important issue in the battle to control healthcare costs. The Hatch-Waxman Act encourages generic competition but still provides incentives for pioneers to develop new drugs. The Biologics Price Competition and Innovation Act is intended to do the same for biologics and biosimilars. To examine information related to biosimilars to determine their potential impact on competition in the biologic market. Using information concerning the European Union (EU) and the pharmaceutical industry, this article reviews and analyzes the experience of biosimilars in the EU, as well as the obstacles and opportunities that biosimilars face in the United States. Much of the analysis is based on examining current trends in biologic drugs and the potential implications on the future of biosimilars. This article reviews the mixed success of biosimilars in the EU and the implications for the United States. Because biologics are produced from living organisms, manufacturing issues are more important than in the chemical drug market. The barriers to biosimilar entry into the marketplace are much more difficult to overcome than challenges generic manufacturers typically face and are similar to obstacles specialty injectable producers encounter. The competitive responses by pioneers are also likely to be more important. The capital costs and risk issues with biosimilars make alliances and partnering arrangements very likely. Biosimilars often enter emerging markets, where the barriers to entry are easier to overcome. Nevertheless, the United States represents the greatest opportunity for biosimilar producers, in part because it is the largest biologics market and has high prices for biologics. As the United States enters the biosimilar market, the pharmaceutical industry is likely to grow at an accelerated pace. Automatic substitution is likely to be slow to develop, because of safety and quality concerns. The beneficial impact of biosimilars is likely to take a long time to be realized and to be fraught with more difficulties than was the case for small-molecule generics. Various factors, such as safety, pricing, manufacturing, entry barriers, physician acceptance, and marketing, will make the biosimilar market develop different from the generic market. The high cost to enter the market and the size of the biologic drug market make entry attractive but risky.

Developing a costing framework for palliative care services.

PubMed

Mosoiu, Daniela; Dumitrescu, Malina; Connor, Stephen R

2014-10-01

Palliative care services have been reported to be a less expensive alternative to traditional treatment; however, little is known about how to measure the cost of delivering quality palliative care. The purpose of this project was to develop a standardized method for measuring the cost of palliative care delivery that could potentially be replicated in multiple settings. The project was implemented in three stages. First, an interdisciplinary group of palliative care experts identified standards of quality palliative care delivery in the inpatient and home care services. Surveys were conducted of government agencies and palliative care providers to identify payment practices and budgets for palliative care services. In the second phase, unit costs were defined and a costing framework was designed to measure inpatient and home-based palliative care unit costs. The final phase was advocacy for inclusion of calculated costs into the national funding system. In this project, a reliable framework for determining the cost of inpatient and home-based palliative care services was developed. Inpatient palliative care cost in Romania was calculated at $96.58 per day. Home-based palliative care was calculated at $30.37 per visit, $723.60 per month, and $1367.71 per episode of care, which averaged 45 visits. A standardized methodology and framework for costing palliative care are presented. The framework allows a country or provider of care to substitute their own local costs to generate cost information relevant to the health-care system. In Romania, this allowed the palliative care provider community to advocate for a consistent payment system. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

An international aerospace information system - A cooperative opportunity

NASA Technical Reports Server (NTRS)

Blados, Walter R.; Cotter, Gladys A.

1992-01-01

This paper presents for consideration new possibilities for uniting the various aerospace database efforts toward a cooperative international aerospace database initiative that can optimize the cost-benefit equation for all members. The development of astronautics and aeronautics in individual nations has led to initiatives for national aerospace databases. Technological developments in information technology and science, as well as the reality of scarce resources, makes it necessary to reconsider the mutually beneficial possibilities offered by cooperation and international resource sharing.

Cost and unit cost calculations using step-down accounting.

PubMed

Conteh, Lesong; Walker, Damian

2004-03-01

There is paucity of unit cost data from low- and middle-income countries, although recent initiatives have emerged to help rectify this. The limited budgets assigned to health care facilities mean that health planners and managers must be able to account for the resources used in health facilities as well as use them efficiently. Step-down cost accounting (SDCA) offers a relatively simple method for generating cost and unit cost data at the facility level. However, to the best of our knowledge, there is a lack of clear and concise guidance on how to undertake SDCA. Therefore, this paper, using a worked example, illustrates the different steps involved to generate cost and unit costs for a small hospital.

Low Cost Large Core Vehicle Structures Assessment

NASA Technical Reports Server (NTRS)

Hahn, Steven E.

1998-01-01

Boeing Information, Space, and Defense Systems executed a Low Cost Large Core Vehicle Structures Assessment (LCLCVSA) under contract to NASA Marshall Space Flight Center (MSFC) between November 1997 and March 1998. NASA is interested in a low-cost launch vehicle, code named Magnum, to place heavy payloads into low earth orbit for missions such as a manned mission to Mars, a Next Generation Space Telescope, a lunar-based telescope, the Air Force's proposed space based laser, and large commercial satellites. In this study, structural concepts with the potential to reduce fabrication costs were evaluated in application to the Magnum Launch Vehicle (MLV) and the Liquid Fly Back Booster (LFBB) shuttle upgrade program. Seventeen concepts were qualitatively evaluated to select four concepts for more in-depth study. The four structural concepts selected were: an aluminum-lithium monocoque structure, an aluminum-lithium machined isogrid structure, a unitized composite sandwich structure, and a unitized composite grid structure. These were compared against a baseline concept based on the Space Shuttle External Tank (ET) construction. It was found that unitized composite structures offer significant cost and weight benefits to MLV structures. The limited study of application to LFBB structures indicated lower, but still significant benefits. Technology and facilities development roadmaps to prepare the approaches studied for application to MLV and LFBB were constructed. It was found that the cost and schedule to develop these approaches were in line with both MLV and LFBB development schedules. Current Government and Boeing programs which address elements of the development of the technologies identified are underway. It is recommended that NASA devote resources in a timely fashion to address the specific elements related to MLV and LFBB structures.

Improvement in neonatal intensive care unit care: a cluster randomised controlled trial of active dissemination of information.

PubMed

Acolet, Dominique; Allen, Elizabeth; Houston, Rosie; Wilkinson, Andrew R; Costeloe, Kate; Elbourne, Diana

2011-11-01

Research findings are not rapidly or fully implemented into policies and practice in care. To assess whether an 'active' strategy was more likely to lead to changes in policy and practice in preterm baby care than traditional information dissemination. Cluster randomised trial. 180 neonatal units (87 active, 93 control) in England; clinicians from active arm units; babies born <27 weeks gestation. CONTROL ARM: Dissemination of research report; slides; information about newborn care position statement. ACTIVE ARM: As above plus offer to become 'regional 'champion' (attend two workshops, support clinicians to implement research evidence regionally), or attend one workshop, promote implementation of research evidence locally. timing of surfactant administration; admission temperature; staffing of resuscitation team present at birth. 48/87 Lead clinicians in the active arm attended one or both workshops. There was no evidence of difference in post-intervention policies between trial arms. Practice outcomes based on babies in the active (169) and control arms (186), in 45 and 49 neonatal units respectively, showed active arm babies were more likely to have been given surfactant on labour ward (RR=1.30; 95% CI 0.99 to 1.70); p=0.06); to have a higher temperature on admission to neonatal intensive care unit (mean difference=0.29(o)C; 95% CI 0.22 to 0.55; p=0.03); and to have had the baby's trunk delivered into a plastic bag (RR=1.27; 95% CI 1.01 to 1.60; p=0.04) than the control group. The effect on having an 'ideal' resuscitation team at birth was in the same direction of benefit for the active arm (RR=1.18; 95% CI 0.97 to 1.43; p=0.09). The costs of the intervention were modest. This is the first trial to evaluate methods for transferring information from neonatal research into local policies and practice in England. An active approach to research dissemination is both feasible and cost-effective. Current controlled trials ISRCTN89683698.

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.

Voluntary medical male circumcision: logistics, commodities, and waste management requirements for scale-up of services.

PubMed

Edgil, Dianna; Stankard, Petra; Forsythe, Steven; Rech, Dino; Chrouser, Kristin; Adamu, Tigistu; Sakallah, Sameer; Thomas, Anne Goldzier; Albertini, Jennifer; Stanton, David; Dickson, Kim Eva; Njeuhmeli, Emmanuel

2011-11-01

The global HIV prevention community is implementing voluntary medical male circumcision (VMMC) programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President's Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in "Voluntary Medical Male Circumcision: Modeling the Impact and Cost of Expanding Male Circumcision for HIV Prevention in Eastern and Southern Africa." Program planners and policy makers should consider the significant contribution of supply chain and waste management to VMMC program costs as they determine future resource needs for VMMC programs.

TU-F-213AB-01: Diagnostic Workforce and Manpower Survey.

PubMed

Mills, M; Nickoloff, E

2012-06-01

Since AAPM Report No. 33 on Diagnostic Radiology Physics staffing is more than 20 years old, the Diagnostic Work and Workforce Study Subcommittee (DWWSS) of the Professional Council was formed to conduct a new study and update the data. The intent of the DWWSS study has two goals. First, it wanted to assess the number of FTE diagnostic physicists needed to support the QC, acceptance tests, radiation safety and other clinical functions for various imaging modalities, such as: CT scanners, MRI units, angiography rooms, ultrasound units, nuclear medicine imagers and other equipment. For example, the preliminary results indicate that the median annual physics support for one CT scanner is 0.007 FTE or 12.6 hours per unit. Second, the study wanted to provide an estimate of the cost of these physics services in terms of a fraction of a dollar per patient examination performed. For example, the cost for physics support of CT would be $0.27 for each CT procedure. This information would be similar to the Abt study conducted in Radiation Oncology. Radiation therapy physicists have utilized the Abt studies to generate re-imbursement for physics services and to justify financially the cost of their work efforts. Appropriate recognition for physics efforts in Diagnostic Radiology has never been properly quantified nor appreciated. With all the current and future changes occurring in healthcare, the information from the DWWSS survey could be important to the future of diagnostic physicists. Although diagnostic physicists are involved with many other activities such as teaching of residents and research, information about the clinical equipment support effort could be used to assess diagnostic physics staffing needs. The goals of the DWWSS study and the preliminary findings will be presented. 1. Present the goals of the DWWSS Diagnostic Physicist Survey.2. Present potential benefits to the AAPM members from this survey.3. Present findings from the preliminary analysis of the survey. © 2012 American Association of Physicists in Medicine.

Annual research review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders.

PubMed

Beecham, Jennifer

2014-06-01

Resources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses. The aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012. Sixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n = 15), conduct disorder (CD; n = 7), and anxiety or depression (n = 8). Only 14 studies used a cost perspective wider than health care; most included education costs (n = 11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders. © 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.

Annual Research Review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders

PubMed Central

Beecham, Jennifer

2014-01-01

Background Resources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses. Scope and methods The aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012. Findings Sixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n = 15), conduct disorder (CD; n = 7), and anxiety or depression (n = 8). Conclusion Only 14 studies used a cost perspective wider than health care; most included education costs (n = 11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders. PMID:24580503

[Cost of functioning of a centralised pharmaceutical unit: evaluation of mean costs of chemotherapy preparations according to the level of production of the unit].

PubMed

Galy, Guillaume; Bauler, Stéphanie; Buchi, Marjolaine; Pirot, Fabrice; Pivot, Christine

2011-10-01

The interest of centralization of preparations of chemotherapy drugs is in addition to its economic aspect, to secure drugs circuit. The aims of this study are to determine needs in employees and equipments of 11 theoretical levels of production from 1,000 to 50,000 preparations per year and to determine the cost of chemotherapy's preparation for each theoretical unit. The operating cost was divided in four areas of expenditure: employees (66-78%), investment (5-15%), maintenance (3-15%) and consumables (4-16%). If we consider the 11 units, the theoretical cost varies between 27.4 € for a unit with 50,000 preparations per year and 114.1 € for a unit with 1,000 preparations per year. This study shows the importance of setting up an optimal unit of preparations according to its activity and highlights the high cost's variation in relation to the activity of the unit.

[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.

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-Effectiveness of Screening and Treating Foreign-Born Students for Tuberculosis before Entering the United States

PubMed Central

Wingate, La’Marcus T.; Posey, Drew L.; Zhou, Weigong; Olson, Christine K.; Maskery, Brian

2015-01-01

Introduction The Centers for Disease Control and Prevention is considering implementation of overseas medical screening of student-visa applicants to reduce the numbers of active tuberculosis cases entering the United States. Objective To evaluate the costs, cases averted, and cost-effectiveness of screening for, and treating, tuberculosis in United States-bound students from countries with varying tuberculosis prevalence. Methods Costs and benefits were evaluated from two perspectives, combined and United States only. The combined perspective totaled overseas and United States costs and benefits from a societal perspective. The United States only perspective was a domestic measure of costs and benefits. A decision tree was developed to determine the cost-effectiveness of tuberculosis screening and treatment from the combined perspective. Results From the United States only perspective, overseas screening programs of Chinese and Indian students would prevent the importation of 157 tuberculosis cases annually, and result in $2.7 million in savings. From the combined perspective, screening programs for Chinese students would cost more than $2.8 million annually and screening programs for Indian students nearly $440,000 annually. From the combined perspective, the incremental cost for each tuberculosis case averted by screening Chinese and Indian students was $22,187 and $15,063, respectively. Implementing screening programs for German students would prevent no cases in most years, and would result in increased costs both overseas and in the United States. The domestic costs would occur because public health departments would need to follow up on students identified overseas as having an elevated risk of tuberculosis. Conclusions Tuberculosis screening and treatment programs for students seeking long term visas to attend United States schools would reduce the number of tuberculosis cases imported. Implementing screening in high-incidence countries could save the United States millions of dollars annually; however there would be increased costs incurred overseas for students and their families. PMID:25924009

The role of informed consent in patient complaints: Reducing hidden health system costs and improving patient engagement through shared decision making.

PubMed

Posner, Karen L; Severson, Julie; Domino, Karen B

2015-09-01

Patient complaints about physicians are strongly associated with malpractice risk. Physicians at high risk for lawsuits tend to have poor communication skills and are more commonly the subject of patient complaints about communication issues. If a malpractice action does not arise, patient complaints nonetheless represent significant prelitigation transaction costs for the healthcare system that have not been previously quantified. Informed consent complaints represent a unique constellation of clinical communication skills clearly tied to malpractice risk. The goal of this study was to measure institutional resource consumption allocated to informed consent (IC) complaints, which are both costly and preventable. We compared IC complaints to other complaints about medical care in a single medical center in the United States, estimating the absolute and relative burden of IC deficiencies within this healthcare system. Resource consumption for the resolution of IC complaints far exceeded their proportional representation of complaints, representing half of all complaints, while disproportionately absorbing two-thirds of staff time devoted to complaint resolution. Complaint resolution represents an unrecognized remediable cost and an underappreciated opportunity for reducing waste in healthcare. We suggest that healthcare systems can reduce costs and elevate their patient-centered care practices by improving patient-provider communication during medical decision making via engagement strategies such as shared decision making. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

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

Cost-effectiveness analysis of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome in Colombia.

PubMed

Mejía, Aurelio; Senior, Juan Manuel; Ceballos, Mateo; Atehortúa, Sara; Toro, Juan Manuel; Saldarriaga, Clara; Mejía, María Elena; Ramírez, Carolina

2015-01-01

Acute coronary syndrome is one of the most frequent medical emergencies in developing countries. To determine, from the perspective of the Colombian health system, the cost-effectiveness of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome. We conducted a cost-effectiveness analysis from the perspective of the Colombian health system comparing ticagrelor and clopidogrel for the treatment of patients with acute coronary syndrome. To estimate the expected costs and outcomes, a Markov model was constructed in which patients could remain stable without experiencing new cardiovascular events, suffer from a new event, or die. For the baseline case, a 10-year time horizon and a discount ratio of 3% for costs and benefits were adopted. The transition probabilities were extracted from the PLATO (Platelet Inhibition and Patient Outcomes) clinical trial. Vital statistics were drawn from the Departmento Administrativo Nacional de Estadística (DANE) and additional information from Colombian patients included in the Access registry. To identify and measure resource use, a standard case was built by consulting guidelines and protocols. Unit costs were obtained from Colombian rate lists. A probabilistic sensitivity analysis was conducted in which costs were represented by a triangular distribution, and the effectiveness through a beta distribution. In the base case, the additional cost per quality-adjusted life-year gained with ticagrelor was COP$ 28,411,503. The results were sensitive to changes in the time horizon and the unit cost of clopidogrel. For a willingness-to-pay equivalent to three times the Colombian per capita gross domestic product, the probability of ticagrelor being cost-effective was 75%. Ticagrelor is a cost-effective strategy for the treatment of patients with acute coronary syndrome in Colombia.

The role of the microbiology laboratory in guiding formulary decisions.

PubMed

Stratton, C W

1988-08-01

Typically, P & T Committee antibiotic selection criteria have included such factors as cost, pharmacokinetics, side effects profile, spectrum of activity, and relative activity against specific pathogens. The microbiology laboratory can provide the P & T Committee with other useful information to help guide them in making even more appropriate and cost-effective formulary decisions. This information includes specific susceptibility data (including prevalence of pathogens, source of infection [community or nosocomial], anatomical site of isolates, specific unit or service where isolated, type of culture specimen, total number of pathogens in the hospital), resistance trends data, an evaluation of microbiologic data presented in published studies, further data regarding an antimicrobial's spectrum of activity and activity against specific pathogens, and the relevance and limitations of in vitro data. With this information in hand, P & T Committee should be in a much better position to optimize formulary decision-making.

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

Optimizing sterilization logistics in hospitals.

PubMed

van de Klundert, Joris; Muls, Philippe; Schadd, Maarten

2008-03-01

This paper deals with the optimization of the flow of sterile instruments in hospitals which takes place between the sterilization department and the operating theatre. This topic is especially of interest in view of the current attempts of hospitals to cut cost by outsourcing sterilization tasks. Oftentimes, outsourcing implies placing the sterilization unit at a larger distance, hence introducing a longer logistic loop, which may result in lower instrument availability, and higher cost. This paper discusses the optimization problems that have to be solved when redesigning processes so as to improve material availability and reduce cost. We consider changing the logistic management principles, use of visibility information, and optimizing the composition of the nets of sterile materials.

Use of the DPP4BIT System for the Management of Hospital Medical Equipment.

PubMed

Tsoromokos, Dimitrios; Tsaloukidis, Nikolaos; Zarakovitis, Dimitrios; Lazakidou, Athina

2017-01-01

The Information and Communication Technologies (ICT) combined with the development of innovative skills within the broader health sector, can significantly improve and upgrade health care quality services. The proposed DDP4BIT system supports an alternative channel for digital information recording and equipment handling of Biomedical Technology Departments (BITs) of Health Care Units. This technology is ideal for all types of procedures based on handwritten forms that are commonly used in Health Care Units. The collection of useful statistics for analyzing and exporting data indicators is used in order to reduce ratios, such as operating time ratio, ideal operating time indicator, number of repetitive quality failures, total maintenance cost, etc. and supports decision-making.

Improving the estimated cost of sustained power interruptions to electricity customers

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

LaCommare, Kristina Hamachi; Eto, Joseph H.; Dunn, Laurel N.

Electricity reliability and resiliency have become a topic of heightened interest in recent years in the United States. As utilities, regulators, and policymakers determine how to achieve optimal levels of electricity reliability while considering how best to prepare for future disruptions in power, the related issue of how much it costs when customers lose power remains a largely unanswered question. In 2006, Lawrence Berkeley National Laboratory developed an end-use based framework that estimates the cost of power interruptions in the U.S that has served as a foundational paper using the best available, yet far from perfect, information at that time.more » Since then, an abundance of work has been done to improve the quality and availability of information that now allow us to make a much more robust assessment of the cost of power interruptions to U.S. customers. In this paper, we find that the total U.S. cost of sustained power interruptions is 44 billion dollars per year (2015-) -25% more than the 26 billion dollars per year in 2002- (or 35 billion dollars per year in 2015-) estimated in our 2006 study.« less

Improving the estimated cost of sustained power interruptions to electricity customers

DOE PAGES

LaCommare, Kristina Hamachi; Eto, Joseph H.; Dunn, Laurel N.; ...

2018-04-18

Electricity reliability and resiliency have become a topic of heightened interest in recent years in the United States. As utilities, regulators, and policymakers determine how to achieve optimal levels of electricity reliability while considering how best to prepare for future disruptions in power, the related issue of how much it costs when customers lose power remains a largely unanswered question. In 2006, Lawrence Berkeley National Laboratory developed an end-use based framework that estimates the cost of power interruptions in the U.S that has served as a foundational paper using the best available, yet far from perfect, information at that time.more » Since then, an abundance of work has been done to improve the quality and availability of information that now allow us to make a much more robust assessment of the cost of power interruptions to U.S. customers. In this paper, we find that the total U.S. cost of sustained power interruptions is 44 billion dollars per year (2015-) -25% more than the 26 billion dollars per year in 2002- (or 35 billion dollars per year in 2015-) estimated in our 2006 study.« less

New Approach to Sea Level Monitoring Tested at Shemya, Alaska

NASA Astrophysics Data System (ADS)

Urban, G. W.; Medbery, A. H.; Burgy, M. C.

2003-12-01

Due to the prohibitive installation cost to replace a storm damaged stilling well type tide gauge at Earickson Air Force Station on Shemya Island, Alaska, an alternative sea-level gauge was sought by the West Coast and Alaska Tsunami Warning Center (WCATWC). An Omart-Vega radar system was chosen as the alternative, since it had low power needs, did not require a stilling well and its design included observation of rough surface liquids. The Omart-Vega radar system works by emitting a 5 gHz radar wave which reflects off the water surface and then back to the unit at a specified rate. This information is then telemetered directly to a computer which records the sample. Although the cost of the Vega system (3500USD) was similar to that of the stilling well unit (2500USD), the comparison of the installation costs of the two different units was an issue. To install the stilling well system, two certified under-water welding divers were required at a cost of 40K-USD or more. In comparison, the installation of the Vega system simply required an arm constructed so as to hang and support the Vega unit off the pier at Shemya. This arm assembly would also house the unit to protect it from surf and weather. The arm was designed in-house and built by a local metal contractor for less than 500USD. This portable unit was sent to Shemya via C-130 aircraft. The arm assembly and housed radar tide gauge was installed by one person. The circuitry to run the Vega was developed and tested at the WCATWC. Software was designed and tested there as well, although the software was written by Omart at no cost to the Warning Center. The circuitry allows for direct remote reconfiguration from Palmer to the radar system. The Vega is accessed by software directly from the WCATWC computer to sample the water level at numerous settable sample rates, which include one second, five second, fifteen second, and thirty second. After nearly one year of operation at Earickson, which included many major storms, the radar unit is proving to be a reliable substitute for the previous stilling well type gauge.

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

Sharing the Costs of Higher Education. Student Financial Assistance in the United Kingdom, the Federal Republic of Germany, France, Sweden, and the United States.

ERIC Educational Resources Information Center

Johnstone, D. Bruce

The educational and living costs of undergraduate studies and the ways these costs are shared among parents, students, taxpayers, and philanthropists/donors are considered for five countries: the United States, the United Kingdom, the Federal Republic of Germany, France, and Sweden. Five policy issues that are linked to how costs are shared by…

Costs of Providing Infusion Therapy for Rheumatoid Arthritis in a Hospital-based Infusion Center Setting.

PubMed

Schmier, Jordana; Ogden, Kristine; Nickman, Nancy; Halpern, Michael T; Cifaldi, Mary; Ganguli, Arijit; Bao, Yanjun; Garg, Vishvas

2017-08-01

Many hospital-based infusion centers treat patients with rheumatoid arthritis (RA) with intravenous biologic agents, yet may have a limited understanding of the overall costs of infusion in this setting. The purposes of this study were to conduct a microcosting analysis from a hospital perspective and to develop a model using an activity-based costing approach for estimating costs associated with the provision of hospital-based infusion services (preparation, administration, and follow-up) in the United States for maintenance treatment of moderate to severe RA. A spreadsheet-based model was developed. Inputs included hourly wages, time spent providing care, supply/overhead costs, laboratory testing, infusion center size, and practice pattern information. Base-case values were derived from data from surveys, published studies, standard cost sources, and expert opinion. Costs are presented in year-2017 US dollars. The base case modeled a hospital infusion center serving patients with RA treated with abatacept, tocilizumab, infliximab, or rituximab. Estimated overall costs of infusions per patient per year were $36,663 (rituximab), $36,821 (tocilizumab), $44,973 (infliximab), and $46,532 (abatacept). Of all therapies, the biologic agents represented the greatest share of overall costs, ranging from 87% to $91% of overall costs per year. Excluding infusion drug costs, labor accounted for 53% to 57% of infusion costs. Biologic agents represented the highest single cost associated with RA infusion care; however, personnel, supplies, and overhead costs also contributed substantially to overall costs (8%-16%). This model may provide a helpful and adaptable framework for use by hospitals in informing decision making about services offered and their associated financial implications. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

The Distributed Wind Cost Taxonomy

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

Forsyth, Trudy; Jimenez, Tony; Preus, Robert

To date, there has been no standard method or tool to analyze the installed and operational costs for distributed wind turbine systems. This report describes the development of a classification system, or taxonomy, for distributed wind turbine project costs. The taxonomy establishes a framework to help collect, sort, and compare distributed wind cost data that mirrors how the industry categorizes information. The taxonomy organizes costs so they can be aggregated from installers, developers, vendors, and other sources without losing cost details. Developing a peer-reviewed taxonomy is valuable to industry stakeholders because a common understanding the details of distributed wind turbinemore » costs and balance of station costs is a first step to identifying potential high-value cost reduction opportunities. Addressing cost reduction potential can help increase distributed wind's competitiveness and propel the U.S. distributed wind industry forward. The taxonomy can also be used to perform cost comparisons between technologies and track trends for distributed wind industry costs in the future. As an initial application and piloting of the taxonomy, preliminary cost data were collected for projects of different sizes and from different regions across the contiguous United States. Following the methods described in this report, these data are placed into the established cost categories.« less

Evaluation of proposed casemix criteria as a basis for costing patients in the adult general intensive care unit.

PubMed

Stevens, V G; Hibbert, C L; Edbrooke, D L

1998-10-01

This study analyses the relationship between the actual patient-related costs of care calculated for 145 patients admitted sequentially to an adult general intensive care unit and a number of factors obtained from a previously described consensus of opinion study. The factors identified in the study were suggested as potential descriptors for the casemix in an intensive care unit that could be used to predict the costs of care. Significant correlations between the costs of care and severity of illness, workload and length of stay were found but these failed to predict the costs of care with sufficient accuracy to be used in isolation to define isoresource groups in the intensive care unit. No associations between intensive care unit mortality, reason for admission and intensive and unit treatments and costs of care were found. Based on these results, it seems that casemix descriptors and isoresource groups for the intensive care unit that would allow costs to be predicted cannot be defined in terms of single factors.

Affordability of Meteorology Graduate Programs in the United States and Canada.

NASA Astrophysics Data System (ADS)

Gilmore, Matthew S.; Toracinta, E. Richard

1998-06-01

The authors surveyed 55 university departments in the United States and Canada that grant doctor of philosophy and/or master of science degrees in meteorology or the atmospheric sciences. Two-thirds of university departments responded. Survey topics included graduate student income (stipends and health insurance benefits) and mandatory costs (tuition, fees, and health insurance costs) incurred for fall 1996.Results show that most graduate students do have funding but only one-quarter of departments indicate that health insurance benefits are provided to graduate assistants. The largest mandatory cost is typically housing, which was estimated (except for Canadian schools) with 1996 Fair Market Rent data from the U.S. Department of Housing and Urban Development. For schools not providing it, the second largest cost is typically health insurance. The smallest costs are typically tuition (waived for graduate assistants in most cases) and fees.The difference between income and mandatory costs over a nine-month period gives an "effective income." Evidence was found associating greater effective income with larger departments and with locations where housing costs are larger. No significant evidence was found to associate differences in effective income with city size or geographic region. The broad range in effective income between the departments suggests that some graduate programs may be much more affordable than others.This information can aid university departments in planning budgets that keep them competitive with one another. This paper will also help prospective graduate students by raising awareness about important issues of graduate program affordability.

Information, regulation and coordination: realist analysis of the efforts of community health committees to limit informal health care providers in Nigeria.

PubMed

Abimbola, Seye; Ogunsina, Kemi; Charles-Okoli, Augustina N; Negin, Joel; Martiniuk, Alexandra L; Jan, Stephen

2016-12-01

One of the consequences of ineffective governments is that they leave space for unlicensed and unregulated informal providers without formal training to deliver a large proportion of health services. Without institutions that facilitate appropriate health care transactions, patients tend to navigate health care markets from one inappropriate provider to another, receiving sub-optimal care, before they find appropriate providers; all the while incurring personal transaction costs. But the top-down interventions to address this barrier to accessing care are hampered by weak governments, as informal providers are entrenched in communities. To explore the role that communities could play in limiting informal providers, we applied the transaction costs theory of the firm which predicts that economic agents tend to organise production within firms when the costs of coordinating exchange through the market are greater than within a firm. In a realist analysis of qualitative data from Nigeria, we found that community health committees sometimes seek to limit informal providers in a manner that is consistent with the transaction costs theory of the firm. The committees deal not through legal sanction but by subtle influence and persuasion in a slow and faltering process of institutional change, leveraging the authority and resources available within their community, and from governments and NGOs. First, they provide information to reduce the market share controlled by informal providers, and then regulation to keep informal providers at bay while making the formal provider more competitive. When these efforts are ineffective or insufficient, committees are faced with a "make-or-buy" decision. The "make" decision involves coordination to co-produce formal health services and facilitate referrals from informal to formal providers. What sometimes results is a quasi-firm-informal and formal providers are networked in a single but loose production unit. These findings suggest that efforts to limit informal providers should seek to, among other things, augment existing community responses.

Cost unit accounting based on a clinical pathway: a practical tool for DRG implementation.

PubMed

Feyrer, R; Rösch, J; Weyand, M; Kunzmann, U

2005-10-01

Setting up a reliable cost unit accounting system in a hospital is a fundamental necessity for economic survival, given the current general conditions in the healthcare system. Definition of a suitable cost unit is a crucial factor for success. We present here the development and use of a clinical pathway as a cost unit as an alternative to the DRG. Elective coronary artery bypass grafting was selected as an example. Development of the clinical pathway was conducted according to a modular concept that mirrored all the treatment processes across various levels and modules. Using service records and analyses the process algorithms of the clinical pathway were developed and visualized with CorelTM iGrafix Process 2003. A detailed process cost record constituted the basis of the pathway costing, in which financial evaluation of the treatment processes was performed. The result of this study was a structured clinical pathway for coronary artery bypass grafting together with a cost calculation in the form of cost unit accounting. The use of a clinical pathway as a cost unit offers considerable advantages compared to the DRG or clinical case. The variance in the diagnoses and procedures within a pathway is minimal, so the consumption of resources is homogeneous. This leads to a considerable improvement in the value of cost unit accounting as a strategic control instrument in hospitals.

Corporate Information Management and Business Process Improvement under the Unit Cost Program: An Analysis of a System for the Air Force Institute of Technology

DTIC Science & Technology

1992-12-01

rights or on management issues such as personnel and infrastructure investments are addresseud in the directive only at the broadest level, or in many...area with investments , including information systems. c. Functional processes improvements shall be accomplished though activity modeling and busi ass...an enterprise has invested considerable time, money and effort into the current system and has limited funds to upgrade the system (111:37). Software

Large-scale implementation of disease control programmes: a cost-effectiveness analysis of long-lasting insecticide-treated bed net distribution channels in a malaria-endemic area of western Kenya-a study protocol.

PubMed

Gama, Elvis; Were, Vincent; Ouma, Peter; Desai, Meghna; Niessen, Louis; Buff, Ann M; Kariuki, Simon

2016-11-21

Historically, Kenya has used various distribution models for long-lasting insecticide-treated bed nets (LLINs) with variable results in population coverage. The models presently vary widely in scale, target population and strategy. There is limited information to determine the best combination of distribution models, which will lead to sustained high coverage and are operationally efficient and cost-effective. Standardised cost information is needed in combination with programme effectiveness estimates to judge the efficiency of LLIN distribution models and options for improvement in implementing malaria control programmes. The study aims to address the information gap, estimating distribution cost and the effectiveness of different LLIN distribution models, and comparing them in an economic evaluation. Evaluation of cost and coverage will be determined for 5 different distribution models in Busia County, an area of perennial malaria transmission in western Kenya. Cost data will be collected retrospectively from health facilities, the Ministry of Health, donors and distributors. Programme-effectiveness data, defined as the number of people with access to an LLIN per 1000 population, will be collected through triangulation of data from a nationally representative, cross-sectional malaria survey, a cross-sectional survey administered to a subsample of beneficiaries in Busia County and LLIN distributors' records. Descriptive statistics and regression analysis will be used for the evaluation. A cost-effectiveness analysis will be performed from a health-systems perspective, and cost-effectiveness ratios will be calculated using bootstrapping techniques. The study has been evaluated and approved by Kenya Medical Research Institute, Scientific and Ethical Review Unit (SERU number 2997). All participants will provide written informed consent. The findings of this economic evaluation will be disseminated through peer-reviewed publications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Evaluating the Effectiveness of Nurse-Focused Computerized Clinical Decision Support on Urinary Catheter Practice Guidelines

ERIC Educational Resources Information Center

Lang, Robin Lynn Neal

2012-01-01

A growing national emphasis has been placed on health information technology (HIT) with robust computerized clinical decision support (CCDS) integration into health care delivery. Catheter-associated urinary tract infection is the most frequent health care-associated infection in the United States and is associated with high cost, high volumes and…

?Cuan buenas son nuestras viviendas?: Los hispanos [How Good Is Our Housing? Hispanics].

ERIC Educational Resources Information Center

Yezer, Anthony; Limmer, Ruth

This report provides statistical information regarding the quality and cost of housing occupied by Hispanic Americans throughout the United States. Some of the findings include: (1) Hispanos occupy older and worse dwellings than the general U.S. population, with a significant number of dwellings lacking heat and adequate electricity and plumbing…

Estimating Travel Cost Model: Spatial Approach

Treesearch

S.G. Kim; J.M. Bowker; S.H. Cho; D.M. Lambert; D.B.K. English; C.M. Starbuck

2010-01-01

High gasoline prices made headlines in 2008 and 2009. The average gasoline price in the United States peaked at $4.05 per gallon in the second week of July, and it remained fairly high most of the third quarter of 2008, dropped significantly through September to December in 2008, and began to rise again in January 2009 (Energy Information Administration, 2009).

78 FR 27951 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-13

...-0757. Form Number(s): H-100, H-108, H-100(L), H-100L(A). Type of Request: Reinstatement, with change... vacancy rate of housing in the city. The NYCHPD must take this survey every three years. The Census Bureau... rental or real estate agent (vacant units) to gather information on vacancy rates, housing costs, and the...

Index of Free and Inexpensive Food and Nutrition Information Materials.

ERIC Educational Resources Information Center

Gordon, Kathleen, Comp.; And Others

This annotated index contains approximately 2,000 free or inexpensive pamphlets or brochures about food and nutrition. The prime criterion for inclusion of materials was that they be easily available and inexpensive; the cut-off cost was set at $3.00. The majority of materials listed were produced in either Canada or the United States. These…

14 CFR 152.205 - United States share of project costs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false United States share of project costs. 152... share of project costs. (a) Airport development. Except as provided in paragraphs (b) and (c) of this section, the following is the United States share of the allowable cost of an airport development project...

14 CFR 152.205 - United States share of project costs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false United States share of project costs. 152... share of project costs. (a) Airport development. Except as provided in paragraphs (b) and (c) of this section, the following is the United States share of the allowable cost of an airport development project...

14 CFR 152.205 - United States share of project costs.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false United States share of project costs. 152... share of project costs. (a) Airport development. Except as provided in paragraphs (b) and (c) of this section, the following is the United States share of the allowable cost of an airport development project...

14 CFR 152.205 - United States share of project costs.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false United States share of project costs. 152... share of project costs. (a) Airport development. Except as provided in paragraphs (b) and (c) of this section, the following is the United States share of the allowable cost of an airport development project...

14 CFR 152.205 - United States share of project costs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false United States share of project costs. 152... share of project costs. (a) Airport development. Except as provided in paragraphs (b) and (c) of this section, the following is the United States share of the allowable cost of an airport development project...

Manual for Reducing Educational Unit Costs in Latin American Countries.

ERIC Educational Resources Information Center

Centro Multinacional de Investigacion Educativa, San Jose (Costa Rica).

Designed for educational administrators, this manual provides suggestions for reducing educational unit costs in Latin America without reducing the quality of the education. Chapter one defines unit cost concepts and compares the costs of the Latin American countries. Chapter two deals with the different policies which could affect the principal…

Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States.

PubMed

Rasu, Rafia S; Vouthy, Kiengkham; Crowl, Ashley N; Stegeman, Anne E; Fikru, Bithia; Bawa, Walter Agbor; Knell, Maureen E

2014-09-01

Nonmalignant chronic pain (NMCP) is a public health concern. Among primary care appointments, 22% focus on pain management. The American Academy of Pain Medicine guidelines for NMCP recommend combination medication therapy (including analgesics, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, antidepressants, and anticonvulsants) as a key component to effective treatment for many chronic pain diagnoses. However, there has been little evidence outlining the costs of pain medications in adult patients with NMCP in the United States, an area that necessitates further consideration as the nation moves toward value-based benefit design. To estimate the cost of pain medication attributable to treating adult patients with NMCP in the United States and to analyze the trend of outpatient pain visits. This cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) data from 2000-2007. The Division of Health Care Statistics, National Center for Health Statistics, and the Centers for Disease Control and Prevention conducted the survey. The study included patients aged ≥18 years with chronic pain diagnoses (identified by the ICD-9-CM codes: primary, secondary, and tertiary). Patients prescribed at least 1 pain medication were included in the cost analysis. Pain-related prescription medications prescribed during ambulatory care visits were retrieved by using NAMCS drug codes/National Drug Code numbers. National pain prescription frequencies (weighted) were obtained from NAMCS data, using the statistical software STATA. We created pain therapy categories (drug classes) for cost analysis based on national pain guidelines. Drug classes used in this analysis were opioids/opioid-like agents, analgesics/NSAIDs, tricyclic antidepressants, selective serotonin reuptake inhibitors, antirheumatics/immunologics, muscle relaxants, topical products, and corticosteroids. We calculated average prices based on the 3 lowest average wholesale prices reported in the Red Book 2009 for maximum recommended daily dose. Total pain medication costs were calculated in 2009 and 2013 dollar values. The study analyzed NMCP-related outpatient visit trends and used time series analysis to forecast visits using U.S. population data and statistics. The total costs of prescription medications prescribed for pain were $17.8 billion annually in the United States. Cost estimates were captured based on a total of 690,205,290 (~690 million) weighted outpatient visits made for chronic pain from 2000 to 2007 in the United States. Of those patients, 99% received a medication that could be used for NMCP. Among the patients, 29% reported taking ≥5 medications. A linear trend of pain visits is visible, reporting change (from 11% to 14%) from 2000 to 2007 in the United States. All agents except opioids/opioid-like agents and analgesics/NSAIDs were further categorized as adjuvant therapy to create 3 major drug class categories. The largest 3 categories of pain therapy for the United States (annually) were analgesics/NSAIDs ($1.9 billion), opioids ($3.6 billion), and adjuvants ($12.3 billion). Despite having the highest prescription frequency nationally, analgesics/NSAIDS accounted for about 11% of the overall pain medication costs. This study found that adjuvant therapy accounted for 69% of the total pain medication costs. Among adjuvants, 33.5% of the cost was contributed by antirheumatics/immunologics. Other adjuvants included muscle relaxants (4.4%), topical products (8.6%), and corticosteroids (9.4%). This study demonstrated national prescribing costs and use within various drug categories of pain medications in a large outpatient population over an 8-year period in the United States. Policymakers, stakeholders, and health plan decision makers may consider this cost analysis, since they need to know how drug costs are being allocated. Moreover, information about costs and use of pain medications is valuable for the practitioner making individual patient care decisions, as well as for those who make population based decisions. This study reported an increasing trend of outpatient pain visits in the United States. Therefore, policymakers and health plan decision makers may expect a growing number of pain-related outpatient visits in coming years and allocate resources accordingly to meet the need.

[The evaluation of the self-financing capacity within the territorial compass of a primary care management].

PubMed

Clua Espuny, J L; Baucells Lluís, J; Mauri Roselló, J A

1999-05-15

The main objective of this study is to calculate the point of financial balance in the geographical setting of the Tortosa PC Area, to evaluate the business results, and to reflect on the side-effects and potential problems of self-management. Retrospective and descriptive study. The units studied were the seven base health districts operating during 1997. The products or services considered for the calculation of income are included in the Order of 29/9/97. The overall result meant a deficit of 0.019 milliards. Pharmaceutical prescription accounted for 58.45% of the total cost. 96.26% of the total activity was products or services undertaken in the PCC, where 95.95% of the income was obtained. All the points of balance, except for in-home activity of nursing personnel, were above the activity recorded. The products with greatest volume were the most profitable overall for the business. 1. The overall result meant a subsidy to running costs of 0.019 milliards. 2. If it did not occur otherwise, our systems for recording activity would have to be adapted to the products financed and accountancy information at the operational unit level. 3. Given that what is measured can be improved, we can identify problems and synergically involve the clinics in improving service efficiency and at the same time achieving a higher level of responsibility for services in a new context of self-management both for each operational unit and overall. 4. Defining the point of financial balance has to enable a framework of target incentives to be established by means of simultaneous information on cost and profit elements in the activity undertaken.

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

Economic evaluation of nivolumab as a second-line treatment for advanced renal cell carcinoma from US and Chinese perspectives.

PubMed

Wan, Xiao Min; Peng, Liu Bao; Ma, Jin An; Li, Yuan Jian

2017-07-15

Nivolumab is a new standard of care for patients with metastatic renal cell carcinoma (mRCC) and provides an overall survival benefit of 5.40 months in comparison with everolimus. This study evaluated the cost-effectiveness of nivolumab for the second-line treatment of mRCC from the perspective of US payers and identified the range of drug costs for which the addition of nivolumab to standard therapy could be considered cost-effective from a Chinese perspective. A partitioned survival model was constructed to estimate lifetime costs, life-years, and quality-adjusted life-years (QALYs). Costs were estimated for the US and Chinese health care systems. One-way and probabilistic sensitivity analyses were performed. Nivolumab provided an additional 0.29 QALYs at a cost of $151,676/QALY in the United States. The probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100,000/QALY, at the current cost of nivolumab, the chance of nivolumab being cost-effective was 3.10%. For China, when nivolumab cost less than $7.90 or $9.70/mg, there was a nearly 90% likelihood that the incremental cost-effectiveness ratio for nivolumab would be less than $22,785 or $48,838/QALY, respectively. For the United States, nivolumab is unlikely to be a high-value treatment for mRCC at the current price, and a price reduction appears to be justified. In China, value-based prices for nivolumab are $7.90 and $9.70/mg for the country and Beijing City, respectively. This study could and should inform the multilateral drug-price negotiations in China that may be upcoming for nivolumab. Cancer 2017;123:2634-41. © 2017 American Cancer Society. © 2017 American Cancer Society.

Evaluating the total costs of chemotherapy-induced toxicity: results from a pilot study with ovarian cancer patients.

PubMed

Calhoun, E A; Chang, C H; Welshman, E E; Fishman, D A; Lurain, J R; Bennett, C L

2001-01-01

While chemotherapy-related toxicities affect cancer patients' activities of daily living and result in large expenditures of medical care for treatment, few studies have assessed the out-of-pocket and indirect costs incurred by patients who experience toxicity. The objective of this study was to evaluate the feasibility of obtaining detailed and comprehensive cost information from patients who experienced neutropenia, thrombocytopenia, or neurotoxicity during treatment. Ovarian cancer patients who experienced chemotherapy-associated hematologic or neurologic toxicities were asked to record detailed information about hospitalization, laboratories, physician visits, phone calls, home visits, medication, medical devices, lost productivity, and caregivers. Resource estimates were converted into cost units, with direct medical cost estimates based on hospital cost-accounting data and indirect costs (i.e., productivity loss) on modified labor force, employment, and earnings data. Direct medical costs were highest for neutropenia (mean of $7,546/episode), intermediate for thrombocytopenia (mean of $3,268/episode), and lowest for neurotoxicity (mean of $688/episode). Indirect costs relating to patient and caregiver work loss and payments for caregiver support were substantial, accounting for $4,220, $3,834, and $4,282 for patients who developed neurotoxicity, neutropenia, and thrombocytopenia, respectively. The total costs of chemotherapy-related neurotoxicity, neutropenia, and thrombocytopenia were $4,908, $11,830, and $7,550. Our study has shown that, with the assistance of patients who are experiencing toxicity, estimation of the total costs of cancer-related toxicities is feasible. Indirect costs, while not included in prior estimates of the costs of toxicity studies, accounted for 34% to 86% of the total costs of cancer supportive care.

Direct and indirect cost of myasthenia gravis: A prospective study from a tertiary care teaching hospital in India.

PubMed

Sonkar, Kamlesh Kumar; Bhoi, Sanjeev Kumar; Dubey, Deepanshu; Kalita, Jayantee; Misra, Usha Kant

2017-04-01

Myasthenia gravis (MG) requires lifelong treatment. The cost of management MG is very high in developed countries but there is no information on the cost of management of MG in the developing countries. This study reports the direct and indirect cost and predictors of cost of MG in a tertiary care teaching hospital in India. In a prospective hospital based study, from a tertiary hospital in India 66 consecutive patient during 2014-2015 were included. The age of the patients ranged between 6 and 75years. The severity of MG was assessed by myasthenia gravis foundation association (MGFA) class (MGFA) I-V. The patient data was collected s and their direct cost was calculated from the computerized Hospital information system. The indirect cost was calculated from patient's memory, checking the bills of transportation and wages loss by the patient or the care giver. Total annual cost of MG ranged between INR (4560-532227) with median INR 61390.5 (US$911.64). The median cost of outpatient department (OPD) consultation of 16 patients was INR 20439.9 (US$303.53), of 50 admitted patients was INR 44311.8 (US$658.03) and 21 intensive care unit (ICU) patients was INR 59574.3 (US$ 884.6) and the direct cost of thymectomy was INR 45000 (US$ 668.25). Direct cost was related to indirect cost (r=0.55; p=0.0001). Predictors of patient outcome were severity of MG, ICU admission, and thymectomy. The total median cost for management of myasthenia gravis was INR 61390.5 (4560-532227, US$911.64) per year, and the cost was mainly determined by the severity of MG. Copyright © 2016 Elsevier Ltd. All rights reserved.

A cost-effectiveness analysis of a residential radon remediation programme in the United Kingdom.

PubMed

Kennedy, C A; Gray, A M; Denman, A R; Phillips, P S

1999-12-01

As residential radon programmes of identification and remediation have proceeded, so questions have been raised about their costs and benefits. This study presents a generalizable model for estimating the cost-effectiveness of a radon mitigation programme using the methodological framework now considered appropriate in the economic evaluation of health interventions. Its use will help to inform future discussion of radon remediation and lung cancer prevention programmes. Data from Northamptonshire were analysed, resulting in a societal cost-effectiveness ratio of Pounds Sterling 13250 per life-year gained in 1997. The percentage of houses found to be over the action level, and the percentage of householders who decide to remediate are shown to be important parameters for the cost-effectiveness analysis. Questions are raised about the particular importance of perspective in this type of analysis and suggestions are made for future research directions.

Analysis of nonformulary use of PPIs and excess drug cost in a Veterans Affairs population.

PubMed

Ajumobi, Adewale B; Vuong, Ronald; Ahaneku, Hycienth

2012-01-01

In the Veterans Affairs (VA) health care system, a formulary-based approach without beneficiary cost-share incentives is used to limit the pharmacy cost of proton pump inhibitors (PPIs). However, the effectiveness of this approach in reducing the cost of PPIs is unknown. To (a) compare cost differences between the formulary PPI (generic omeprazole) and nonformulary PPIs and (b) evaluate reasons for nonformulary PPI use in order to identify opportunities to increase formulary drug use and discourage unnecessary use of nonformulary PPIs. A list of patients with receipt of PPIs from July 1, 2008, through June 30, 2009, was obtained from the Loma Linda VA Healthcare System pharmacy. Subjects with receipt of at least 120 units (capsules or tablets) of any PPI in the study period were considered long-term users. Demographic information was collected. Pharmacy consult records were reviewed to identify reasons for nonformulary use and dosing regimen of the formulary PPI prior to the switch. Cost analysis was done based on the VA contract prices for the drugs at the time of the study. Of 58,605 unique patients seen in this VA health care system in the 12-month period from July 1, 2008, through June 30, 2009, 13,713 (23.4%) received a PPI, and of these, 10,483 (76.4%) received at least 120 PPI units and were defined as long-term users. Of the long-term users, 9,462 (90.3%) were on the formulary PPI generic omeprazole, and 1,021 were nonformulary PPI users. Use of nonformulary PPIs (esomeprazole, pantoprazole, lansoprazole, rabeprazole) accounted for 10.5% of the PPI units and 9.7% of the users but 57.3% of total PPI cost. This pattern resulted in $570,263 in excess spending (i.e., $570,263 would have been saved in the study period if the nonformulary PPI users had used the formulary drug). The most common reason for nonformulary long-term PPI use was persistent symptoms (n=901, 88.2%). Adverse reaction was cited by 111 (10.9%) of nonformulary PPI users, 33.3% (n=37) of whom reported diarrhea. Of those who switched to a nonformulary PPI due to persistent symptoms, 363 (40.3%) were on once-daily dosing prior to the switch; 379 (42.1%) were on twice-daily dosing; and 159 (17.6%) were transfers from other places in which prior dosing information was not available in the hospital pharmacy records. One-year PPI use prevalence was 23% in this VA population, and long-term use prevalence was 18%. Nonformulary PPI use accounted for 10.5% of the PPI units and 9.7% of the users but 57.3% of total PPI drug cost. Opportunities to reduce nonformulary PPI use in order to reduce overall expenditures on PPIs include verification of optimal formulary PPI use, titration to twice-daily dosing, and confirmation of adverse reaction as being attributable to PPI use.

Keep in touch (KIT): perspectives on introducing internet-based communication and information technologies in palliative care.

PubMed

Guo, Qiaohong; Cann, Beverley; McClement, Susan; Thompson, Genevieve; Chochinov, Harvey Max

2016-08-02

Hospitalized palliative patients need to keep in touch with their loved ones. Regular social contact may be especially difficult for individuals on palliative care in-patient units due to the isolating nature of hospital settings. Technology can help mitigate isolation by facilitating social connection. This study aimed to explore the acceptability of introducing internet-based communication and information technologies for patients on a palliative care in-patient unit. In the first phase of the Keep in Touch (KIT) project, a diverse group of key informants were consulted regarding their perspectives on web-based communication on in-patient palliative care units. Participants included palliative patients, family members, direct care providers, communication and information technology experts, and institutional administrators. Data was collected through focus groups, interviews and drop-in consultations, and was analyzed for themes, consensus, and major differences across participant groups. Hospitalized palliative patients and their family members described the challenges of keeping in touch with family and friends. Participants identified numerous examples of ways that communication and information technologies could benefit patients' quality of life and care. Patients and family members saw few drawbacks associated with the use of such technology. While generally supportive, direct care providers were concerned that patient requests for assistance in using the technology would place increased demands on their time. Administrators and IT experts recognized issues such as privacy and costs related to offering these technologies throughout an organization and in the larger health care system. This study affirmed the acceptability of offering internet-based communication and information technologies on palliative care in-patient units. It provides the foundation for trialing these technologies on a palliative in-patient unit. Further study is needed to confirm the feasibility of offering these technologies at the bedside.

Achievable steps toward building a National Health Information infrastructure in the United States.

PubMed

Stead, William W; Kelly, Brian J; Kolodner, Robert M

2005-01-01

Consensus is growing that a health care information and communication infrastructure is one key to fixing the crisis in the United States in health care quality, cost, and access. The National Health Information Infrastructure (NHII) is an initiative of the Department of Health and Human Services receiving bipartisan support. There are many possible courses toward its objective. Decision makers need to reflect carefully on which approaches are likely to work on a large enough scale to have the intended beneficial national impacts and which are better left to smaller projects within the boundaries of health care organizations. This report provides a primer for use by informatics professionals as they explain aspects of that dividing line to policy makers and to health care leaders and front-line providers. It then identifies short-term, intermediate, and long-term steps that might be taken by the NHII initiative.

Achievable Steps Toward Building a National Health Information Infrastructure in the United States

PubMed Central

Stead, William W.; Kelly, Brian J.; Kolodner, Robert M.

2005-01-01

Consensus is growing that a health care information and communication infrastructure is one key to fixing the crisis in the United States in health care quality, cost, and access. The National Health Information Infrastructure (NHII) is an initiative of the Department of Health and Human Services receiving bipartisan support. There are many possible courses toward its objective. Decision makers need to reflect carefully on which approaches are likely to work on a large enough scale to have the intended beneficial national impacts and which are better left to smaller projects within the boundaries of health care organizations. This report provides a primer for use by informatics professionals as they explain aspects of that dividing line to policy makers and to health care leaders and front-line providers. It then identifies short-term, intermediate, and long-term steps that might be taken by the NHII initiative. PMID:15561783

Costs and outcomes associated with IVF using recombinant FSH.

PubMed

Ledger, W; Wiebinga, C; Anderson, P; Irwin, D; Holman, A; Lloyd, A

2009-09-01

Cost and outcome estimates based on clinical trial data may not reflect usual clinical practice, yet they are often used to inform service provision and budget decisions. To expand understanding of assisted reproduction treatment in clinical practice, an economic evaluation of IVF/intracytoplasmic sperm injection (ICSI) data from a single assisted conception unit (ACU) in England was performed. A total of 1418 IVF/ICSI cycles undertaken there between October 2001 and January 2006 in 1001 women were analysed. The overall live birth rate was 22% (95% CI: 19.7-24.2), with the 30- to 34-year age group achieving the highest rate (28%). The average recombinant FSH (rFSH) dose/cycle prescribed was 1855 IU. Average cost of rFSH/cycle was 646 pound(SD: 219 pound), and average total cost/cycle was 2932 pound (SD: 422 pound). Economic data based on clinical trials informing current UK guidance assumes higher doses of rFSH dose/cycle (1750-2625 IU), higher average cost of drugs/cycle (1179 pound), and higher average total cost/cycle (3266 pound). While the outcomes in this study matched UK averages, total cost/cycle was lower than those cited in UK guidelines. Utilizing the protocols and (lower) rFSH dosages reported in this study may enable other ACU to provide a greater number of IVF/ICSI cycles to patients within given budgets.

Cost calculator methods for estimating casework time in child welfare services: A promising approach for use in implementation of evidence-based practices and other service innovations.

PubMed

Holmes, Lisa; Landsverk, John; Ward, Harriet; Rolls-Reutz, Jennifer; Saldana, Lisa; Wulczyn, Fred; Chamberlain, Patricia

2014-04-01

Estimating costs in child welfare services is critical as new service models are incorporated into routine practice. This paper describes a unit costing estimation system developed in England (cost calculator) together with a pilot test of its utility in the United States where unit costs are routinely available for health services but not for child welfare services. The cost calculator approach uses a unified conceptual model that focuses on eight core child welfare processes. Comparison of these core processes in England and in four counties in the United States suggests that the underlying child welfare processes generated from England were perceived as very similar by child welfare staff in California county systems with some exceptions in the review and legal processes. Overall, the adaptation of the cost calculator for use in the United States child welfare systems appears promising. The paper also compares the cost calculator approach to the workload approach widely used in the United States and concludes that there are distinct differences between the two approaches with some possible advantages to the use of the cost calculator approach, especially in the use of this method for estimating child welfare costs in relation to the incorporation of evidence-based interventions into routine practice.

[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).

Who Would Pay for State Alcohol Tax Increases in the United States?

PubMed Central

Daley, James I.; Xuan, Ziming; Blanchette, Jason G.; Chaloupka, Frank J.; Jernigan, David H.

2016-01-01

Introduction Despite strong evidence that increasing alcohol taxes reduces alcohol-related harm, state alcohol taxes have declined in real terms during the past 3 decades. Opponents of tax increases argue that they are unfair to “responsible” drinkers and those who are financially disadvantaged. The objectives of this study were to assess the impact of hypothetical state alcohol tax increases on the cost of alcohol for adults in the United States on the basis of alcohol consumption and sociodemographic characteristics. Methods The increased net cost of alcohol (ie, product plus tax) from a series of hypothetical state alcohol tax increases was modeled for all 50 states using data from the 2011 Behavioral Risk Factor Surveillance System, IMPACT Databank, and the Alcohol Policy Information System. Costs were assessed by drinking pattern (excessive vs nonexcessive) and by sociodemographic characteristics. Results Among states, excessive drinkers would pay 4.8 to 6.8 times as much as nonexcessive drinkers on a per capita basis and would pay at least 72% of aggregate costs. For nonexcessive drinkers, the annual cost from even the largest hypothetical tax increase ($0.25 per drink) would average less than $10.00. Drinkers with higher household incomes and non-Hispanic white drinkers would pay higher per capita costs than people with lower incomes and racial/ethnic minorities. Conclusion State-specific tax increases would cost more for excessive drinkers, those with higher incomes, and non-Hispanic whites. Costs to nonexcessive drinkers would be modest. Findings are relevant to developing evidence-based public health practice for a leading preventable cause of death. PMID:27197080

[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.

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.

Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs.

PubMed

Halpern, Neil A; Pastores, Stephen M

2010-01-01

To analyze the evolving role, patterns of use, and costs of critical care medicine in the United States from 2000 to 2005. Retrospective study of data from the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, Maryland). Nonfederal, acute care hospitals with critical care medicine beds in the United States. None. None. We analyzed hospital and critical care medicine beds, bed types, days, occupancy rates, payer mix (Medicare and Medicaid), and costs. Critical care medicine costs were compared with national cost indexes. Between 2000 and 2005, the total number of U.S. hospitals with critical care medicine beds decreased by 12.2% (from 3,586 to 3,150). Although the number of hospital beds decreased by 4.2% (from 655,785 to 628,409), both hospital days and occupancy rates increased by 5.1% (from 145.1 to 152.5 million) and 13.7% (from 59% to 67%), respectively. Critical care medicine beds increased by 6.5% (from 88,252 to 93,955), days by 10.6% (from 21.0 to 23.2 million), and occupancy rates by 4.5% (from 65% to 68%). The majority (90%) of critical care medicine beds were classified as intensive care, premature/neonatal, and coronary care unit beds. The percentage of critical care medicine days used by Medicare decreased by 3.8% (from 37.9% to 36.5%) compared with an increase of 15.5% (from 14.5% to 16.8%) by Medicaid. From 2000 to 2005, critical care medicine costs per day increased by 30.4% (from $2698 to $3518). Although annual critical care medicine costs increased by 44.2% (from $56.6 to $81.7 billion), the proportion of hospital costs and national health expenditures allocated to critical care medicine decreased by 1.6% and 1.8%, respectively. However, the proportion of the gross domestic product used by critical care medicine increased by 13.7%. In 2005, critical care medicine costs represented 13.4% of hospital costs, 4.1% of national health expenditures, and 0.66% of the gross domestic product. Critical care medicine continues to grow in a shrinking U.S. hospital system. The critical care medicine payer mix is evolving, with Medicaid increasing in its percentage of critical care medicine use. Critical care medicine is more cost controlled than other healthcare indexes, but is still using an increasing percentage of the gross domestic product. Our updated and comprehensive critical care medicine use and cost analysis provides a contemporary benchmark for the strategic planning of critical care medicine services within the U.S. healthcare system.

Cost accounting in radiation oncology: a computer-based model for reimbursement.

PubMed

Perez, C A; Kobeissi, B; Smith, B D; Fox, S; Grigsby, P W; Purdy, J A; Procter, H D; Wasserman, T H

1993-04-02

The skyrocketing cost of medical care in the United States has resulted in multiple efforts in cost containment. The present work offers a rational computer-based cost accounting approach to determine the actual use of resources in providing a specific service in a radiation oncology center. A procedure-level cost accounting system was developed by using recorded information on actual time and effort spent by individual staff members performing various radiation oncology procedures, and analyzing direct and indirect costs related to staffing (labor), facilities and equipment, supplies, etc. Expenditures were classified as direct or indirect and fixed or variable. A relative value unit was generated to allocate specific cost factors to each procedure. Different costs per procedure were identified according to complexity. Whereas there was no significant difference in the treatment time between low-energy (4 and 6 MV) or high-energy (18 MV) accelerators, there were significantly higher costs identified in the operation of a high-energy linear accelerator, a reflection of initial equipment investment, quality assurance and calibration procedures, maintenance costs, service contract, and replacement parts. Utilization of resources was related to the complexity of the procedures performed and whether the treatments were delivered to inpatients or outpatients. In analyzing time motion for physicians and other staff, it was apparent that a greater effort must be made to train the staff to accurately record all times involved in a given procedure, and it is strongly recommended that each institution perform its own time motion studies to more accurately determine operating costs. Sixty-six percent of our facility's global costs were for labor, 20% for other operating expenses, 10% for space, and 4% for equipment. Significant differences were noted in the cost allocation for professional or technical functions, as labor, space, and equipment costs are higher in the latter. External beam treatment-related procedures accounted for more than 50% of all technical and professional revenues, simulation for 8% to 10%, and other physics/dosimetry procedures for 11% to 14% of revenues. Some discrepancies were identified between the actual cost and level of reimbursement of various procedures. Details are described in the manuscript. It is imperative to develop an equitable reimbursement system for radiation oncology services, based on cost accounting and other measures that may enhance productivity and reduce the cost per procedure unit, while at the same time preserving the highest quality of service provided to patients.

Telemedicine: legal and licensure issues

NASA Astrophysics Data System (ADS)

Wood, Michael B.; Whelan, Leo J.

1995-10-01

The National Information Infrastructure program offers a great opportunity for the United States to capitalize on remarkable technological advancements over a broad range of applications benefiting society. One such application, telemedicine, has the potential to offer widespread access to sophisticated medical care, curtailed health care delivery costs, and homogeneous health and health-related educational opportunities. However, there are a variety of barriers to widespread application of telemedicine once the technical infrastructure of the information highway is well established and ubiquitous. These barriers include technical limitations, reimbursement issues, equipment and networking costs, and appropriate scientific studies to document efficacy and cost effectiveness. These issues may prove to be only transient disincentives which can be surmounted. Additional barriers exist, however, that may not be as readily resolved by traditional methods of analysis and more widespread practice applications. These political and regulatory obstacles will require clarification of the issues and solutions based on national consensus. It is the purpose of this discussion to amplify on these particular barriers which include licensure and tort jurisdiction.

Cost-effectiveness of Human Papilloma Virus (HPV) vaccination in Nigeria: a decision analysis using pragmatic parameter estimates for cost and programme coverage.

PubMed

Ekwunife, Obinna I; Lhachimi, Stefan K

2017-12-08

World Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered. We therefore aimed to evaluate cost-effectiveness of HPV vaccination in Nigeria using pragmatic parameter estimates for cost and programme coverage, i.e. realistically achievable in the studied context. A microsimulation frame-work was used. The natural history for cervical cancer disease was remodelled from a previous Nigerian model-based study. Costing was based on health providers' perspective. Disability adjusted life years attributable to cervical cancer mortality served as benefit estimate. Suitable policy option was obtained by calculating the incremental costs-effectiveness ratio. Probabilistic sensitivity analysis was used to assess parameter uncertainty. One-way sensitivity analysis was used to explore the robustness of the policy recommendation to key parameters alteration. Expected value of perfect information (EVPI) was calculated to determine the expected opportunity cost associated with choosing the optimal scenario or strategy at the maximum cost-effectiveness threshold. Combination of the current scenario of opportunistic screening and national HPV vaccination programme (CS + NV) was the only cost-effective and robust policy option. However, CS + NV scenario was only cost-effective so far the unit cost of HPV vaccine did not exceed $5. EVPI analysis showed that it may be worthwhile to conduct additional research to inform the decision to adopt CS + NV. National HPV vaccination combined with opportunist cervical cancer screening is cost-effective in Nigeria. However, adoption of this strategy should depend on its relative efficiency when compared to other competing new vaccines and health interventions.

Resource Use and Cost of Alzheimer's Disease in France: 18-Month Results from the GERAS Observational Study.

PubMed

Rapp, Thomas; Andrieu, Sandrine; Chartier, Florence; Deberdt, Walter; Reed, Catherine; Belger, Mark; Vellas, Bruno

2018-03-01

There is little longitudinal data on resource use and costs associated with Alzheimer's disease (AD) in France. To evaluate resource use and societal costs associated with AD in a French cohort of patients and their caregivers and the effect of patient cognitive decline on costs over an 18-month period. Community-dwelling patients with mild, moderate, or moderately severe/severe AD dementia (n = 419) were followed-up for 18 months. Total societal costs were estimated by applying 2010 unit costs to resource use, including outpatient visits, hospital days, institutionalization, and caregiver hours. Cognitive function was assessed by Mini-Mental State Examination scores. Mean cumulative total costs over the 18-month period were €24,140 for patients with mild AD dementia, €34,287 for those with moderate AD dementia, and €44,171 for those with moderately severe/severe AD dementia (P < 0.001; ANOVA comparison between severity groups). The biggest contributor to total societal costs was caregiver informal care (>50% of total costs at all stages of AD dementia). Cognitive decline (≥3-point decrease in Mini-Mental State Examination score or institutionalization) was associated with a 12.5% increase in total costs (P = 0.02). Significant differences were observed across severity groups for caregiver time (P < 0.001); mean monthly caregiver time increased at each time point over the 18 months in each severity group. Increasing severity of AD dementia in France is associated with increased use of resources as well as increased total societal and patient costs; informal care was the greatest cost contributor. Clinically meaningful cognitive decline is associated with significantly increased costs. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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...

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.

Unit Costs of Interlibrary Loans and Photocopies at a Regional Medical Library: Preliminary Report *

PubMed Central

Spencer, Carol C.

1970-01-01

Unit costs of providing interlibrary loans and photocopies were determined by a method not previously used for library cost studies: random time sampling with self-observation. The working time of all appropriate personnel was sampled using Random Alarm Mechanisms and a structured checklist of tasks. The total lender's unit cost per request received, including direct labor, materials, fringe benefits, and overhead, was $1.526 for originals mailed postpaid by lender, and $1.534 for photocopies mailed. Corresponding unit costs per request filled were: originals, $1.932, and photocopies, $1.763. PMID:5439910

Costing the OMNIUM-G system 7500

NASA Technical Reports Server (NTRS)

Fortgang, H. R.

1980-01-01

A complete OMNIUM-G System 7500 was cost analyzed for annual production quantities ranging from 25 to 10,000 units per year. Parts and components were subjected to in-depth scrutiny to determine optimum manufacturing processes, coupled with make or buy decisions on materials and small parts. When production quantities increase both labor and material costs reduce substantially. A redesign of the system that was analyzed could result in lower costs when annual production runs approach 100,000 units/year. Material and labor costs for producing 25, 100, 25,000 and 100,00 units are given for 17 subassembly units.

Can academic radiology departments become more efficient and cost less?

PubMed

Seltzer, S E; Saini, S; Bramson, R T; Kelly, P; Levine, L; Chiango, B F; Jordan, P; Seth, A; Elton, J; Elrick, J; Rosenthal, D; Holman, B L; Thrall, J H

1998-11-01

To determine how successful two large academic radiology departments have been in responding to market-driven pressures to reduce costs and improve productivity by downsizing their technical and support staffs while maintaining or increasing volume. A longitudinal study was performed in which benchmarking techniques were used to assess the changes in cost and productivity of the two departments for 5 years (fiscal years 1992-1996). Cost per relative value unit and relative value units per full-time equivalent employee were tracked. Substantial cost reduction and productivity enhancement were realized as linear improvements in two key metrics, namely, cost per relative value unit (decline of 19.0% [decline of $7.60 on a base year cost of $40.00] to 28.8% [$12.18 of $42.21]; P < or = .001) and relative value unit per full-time equivalent employee (increase of 46.0% [increase of 759.55 units over a base year productivity of 1,651.45 units] to 55.8% [968.28 of 1,733.97 units]; P < .001), during the 5 years of study. Academic radiology departments have proved that they can "do more with less" over a sustained period.

The anatomy of health care in the United States.

PubMed

Moses, Hamilton; Matheson, David H M; Dorsey, E Ray; George, Benjamin P; Sadoff, David; Yoshimura, Satoshi

2013-11-13

Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7% of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3% per year, exceeds any other industry and GDP overall. Government funding increased from 31.1% in 1980 to 42.3% in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91% of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and (3) chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources of information, and self-management software. These forces create tension among patient aims for choice, personal care, and attention; physician aims for professionalism and autonomy; and public and private payer aims for aggregate economic value across large populations. Measurements of cost and outcome (applied to groups) are supplanting individuals' preferences. Clinicians increasingly are expected to substitute social and economic goals for the needs of a single patient. These contradictory forces are difficult to reconcile, creating risk of growing instability and political tensions. A national conversation, guided by the best data and information, aimed at explicit understanding of choices, tradeoffs, and expectations, using broader definitions of health and value, is needed.

An integrated approach to evaluating alternative risk prediction strategies: a case study comparing alternative approaches for preventing invasive fungal disease.

PubMed

Sadique, Z; Grieve, R; Harrison, D A; Jit, M; Allen, E; Rowan, K M

2013-12-01

This article proposes an integrated approach to the development, validation, and evaluation of new risk prediction models illustrated with the Fungal Infection Risk Evaluation study, which developed risk models to identify non-neutropenic, critically ill adult patients at high risk of invasive fungal disease (IFD). Our decision-analytical model compared alternative strategies for preventing IFD at up to three clinical decision time points (critical care admission, after 24 hours, and end of day 3), followed with antifungal prophylaxis for those judged "high" risk versus "no formal risk assessment." We developed prognostic models to predict the risk of IFD before critical care unit discharge, with data from 35,455 admissions to 70 UK adult, critical care units, and validated the models externally. The decision model was populated with positive predictive values and negative predictive values from the best-fitting risk models. We projected lifetime cost-effectiveness and expected value of partial perfect information for groups of parameters. The risk prediction models performed well in internal and external validation. Risk assessment and prophylaxis at the end of day 3 was the most cost-effective strategy at the 2% and 1% risk threshold. Risk assessment at each time point was the most cost-effective strategy at a 0.5% risk threshold. Expected values of partial perfect information were high for positive predictive values or negative predictive values (£11 million-£13 million) and quality-adjusted life-years (£11 million). It is cost-effective to formally assess the risk of IFD for non-neutropenic, critically ill adult patients. This integrated approach to developing and evaluating risk models is useful for informing clinical practice and future research investment. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

United States Air Force 611th Civil Engineer Squadron, Elmendorf AFB, Alaska. Final engineering evaluation/cost analysis: Petroleum, oil, and lubricants area, Galena Airport, Alaska

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

NONE

1996-02-05

This decision document presents the selected removal action for the Installation Restoration Program (IRP) site ST005, otherwise known as the POL Tank Farm, at Galena Airport, Alaska. This decision is based on the administrative record for this site, specifically the draft Remedial Investigation Report (March 1995) and the Treatability Study Report (January 1995) (PB95-225314). The information from these documents is summarized, along with an analysis of potential removal action alternatives in the Engineering Evaluation/Cost Analysis (EE/CA).

Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application

PubMed Central

Fitzpatrick, Christopher; Fleming, Fiona M.; Madin-Warburton, Matthew; Schneider, Timm; Meheus, Filip; Asiedu, Kingsley; Solomon, Anthony W.; Montresor, Antonio; Biswas, Gautam

2016-01-01

Background Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$ 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering “free” donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (https://healthy.shinyapps.io/benchmark/) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked. Methods We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to “predict” country-specific unit cost benchmarks. Results We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the “last mile”, or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher. Discussion The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms. PMID:27918573

Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application.

PubMed

Fitzpatrick, Christopher; Fleming, Fiona M; Madin-Warburton, Matthew; Schneider, Timm; Meheus, Filip; Asiedu, Kingsley; Solomon, Anthony W; Montresor, Antonio; Biswas, Gautam

2016-12-01

Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$ 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering "free" donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (https://healthy.shinyapps.io/benchmark/) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked. We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to "predict" country-specific unit cost benchmarks. We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the "last mile", or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher. The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms.

Economic cost of initial attack and large-fire suppression

Treesearch

Armando González-Cabán

1983-01-01

A procedure has been developed for estimating the economic cost of initial attack and large-fire suppression. The procedure uses a per-unit approach to estimate total attack and suppression costs on an input-by-input basis. Fire management inputs (FMIs) are the production units used. All direct and indirect costs are charged to the FMIs. With the unit approach, all...

Fiscal Year 1989 Unit Cost Report for the Public Community Colleges of Illinois.

ERIC Educational Resources Information Center

Illinois Community Coll. Board, Springfield.

Fiscal year (FY) 1989 results of the annual unit cost study of the Illinois public community colleges are presented in this report, based on data on course offerings, enrollments, and costs provided by the colleges. After an initial summary overview, data and analyses are presented showing net instructional unit costs for FY 1989 compared with…

The impact of economic evaluation on quality management in spine surgery

PubMed Central

2009-01-01

Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer’s monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits. PMID:19337760

Outcomes and costs of incorporating a multibiomarker disease activity test in the management of patients with rheumatoid arthritis.

PubMed

Michaud, Kaleb; Strand, Vibeke; Shadick, Nancy A; Degtiar, Irina; Ford, Kerri; Michalopoulos, Steven N; Hornberger, John

2015-09-01

The multibiomarker disease activity (MBDA) blood test has been clinically validated as a measure of disease activity in patients with RA. We aimed to estimate the effect of the MBDA test on physical function for patients with RA (based on HAQ), quality-adjusted life years and costs over 10 years. A decision analysis was conducted to quantify the effect of using the MBDA test on RA-related outcomes and costs to private payers and employers. Results of a clinical management study reporting changes to anti-rheumatic drug recommendations after use of the MBDA test informed clinical utility. The effect of treatment changes on HAQ was derived from 5 tight-control and 13 treatment-switch trials. Baseline HAQ scores and the HAQ score relationship with medical costs and quality of life were derived from published National Data Bank for Rheumatic Diseases data. Use of the MBDA test is projected to improve HAQ scores by 0.09 units in year 1, declining to 0.02 units after 10 years. Over the 10 year time horizon, quality-adjusted life years increased by 0.08 years and costs decreased by US$457 (cost savings in disability-related medical costs, US$659; in productivity costs, US$2137). The most influential variable in the analysis was the effect of the MBDA test on clinician treatment recommendations and subsequent HAQ changes. The MBDA test aids in the assessment of disease activity in patients with RA by changing treatment decisions, improving the functional status of patients and cost savings. Further validation is ongoing and future longitudinal studies are warranted. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Cost and effectiveness comparison of two methods for screening potential blood donors for anaemia in Vietnam.

PubMed

Tyrrell, A; Worrall, E; Que, T N; Bates, I

2011-06-01

To compare the cost and effectiveness of Copper Sulphate (CS) and HemoCue (HC) methods for screening blood donors for anaemia. Robust information from developing countries about cost and effectiveness of anaemia screening methods for blood donors is scarce. In such countries there are widespread shortages of blood, so the most cost-effective method should maximise blood supply without compromising donor safety. Economic data (e.g. staff time, equipment and buildings) were collected from direct observation of procedures and purchase data from Hanoi's Central Blood Bank administrative department. A framework for comparing the cost and effectiveness of anaemia screening methods was developed and a cost per effective (i.e. usable and accurate) test was generated for each method. Samples from 100 potential donors from the Hanoi Central Blood Bank (static) and 198 from two mobile units were tested. The mean probability of an ineffective anaemia test was 0·1 (0·05-0·2). The average cost of an HC test was $0·75 (static $0·61 and mobile $0·89) and a CS test was $0·31 (static $0·17 and mobile $0·45). The difference between static and mobile units was predominantly due to transport costs; the difference between the two methods was predominantly due to the HC microcuvettes. In this setting the CS yields greater value for money than the HC method for screening blood donors. The relative cost and effectiveness of CS and HC may be different in places with higher staff turnover, lower test accuracy, higher anaemia prevalence or lower workload than in Vietnam. © 2010 Liverpool School of Tropical Medicine. Transfusion Medicine © 2010 British Blood Transfusion Society.

The impact of economic evaluation on quality management in spine surgery.

PubMed

Boos, Norbert

2009-08-01

Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer's monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits.

Economic costs of outbreaks of acute viral gastroenteritis due to norovirus in Catalonia (Spain), 2010-2011.

PubMed

Navas, Encarna; Torner, Nuria; Broner, Sonia; Godoy, Pere; Martínez, Ana; Bartolomé, Rosa; Domínguez, Angela

2015-10-01

To determine the direct and indirect costs of outbreaks of acute viral gastroenteritis (AVG) due to norovirus in closed institutions (hospitals, social health centers or nursing homes) and the community in Catalonia in 2010-11. Information on outbreaks were gathered from the reports made by epidemiological surveillance units. Direct costs (medical visits, hospital stays, drug treatment, sample processing, transport, diagnostic tests, monitoring and control of the outbreaks investigated) and indirect costs (lost productivity due to work absenteeism, caregivers time and working hours lost due to medical visits) were calculated. Twenty-seven outbreaks affecting 816 people in closed institutions and 74 outbreaks affecting 1,940 people in the community were detected. The direct and indirect costs of outbreaks were € 131,997.36 (€ 4,888.79 per outbreak) in closed institutions and € 260,557.16 (€ 3,521.04 per outbreak) in community outbreaks. The cost per case was € 161.76 in outbreaks in closed institutions and € 134.31 in community outbreaks. The main costs were surveillance unit monitoring (€ 116,652.93), laboratory diagnoses (€ 119,950.95), transport of samples (€ 69,970.90), medical visits (€ 25,250.50) and hospitalization (€ 13,400.00). The cost of outbreaks of acute viral gastroenteritis due to norovirus obtained in this study was influenced by the number of people affected and the severity of the outbreak, which determined hospitalizations and work absenteeism. Urgent reporting of outbreaks would allow the implementation of control measures that could reduce the numbers affected and the duration of the illness and thus the costs derived from them.

The cost-effectiveness of etanercept in patients with severe ankylosing spondylitis in the UK.

PubMed

Ara, R M; Reynolds, A V; Conway, P

2007-08-01

To examine the costs and benefits associated with long-term etanercept (ETN) treatment in patients with severe ankylosing spondylitis (AS) in the UK in accordance with the BSR guidelines. A mathematical model was constructed to estimate the costs and benefits associated with ETN plus non-steroidal anti-inflammatory drugs (NSAIDs) compared with NSAIDs alone. Individual patient data from Phase III RCTs was used to inform the proportion and magnitude of initial response to treatment and changes in health-related quality of life. A retrospective costing exercise on patients attending a UK secondary care rheumatology unit was used to inform disease costs. Published evidence on long-term disease progression was extrapolated over a 25-yr horizon. Uncertainty was examined using probabilistic sensitivity analyses. Over a 25-yr horizon, ETN plus NSAIDs gave 1.58 more QALYs at an additional cost of 35,978 pounds when compared with NSAID treatment alone. This equates to a central estimate of 22,700 pounds per QALY. The incremental cost per QALYs using shorter time periods were 27,600 pounds, 23,600 pounds and 22,600 pounds at 2, 5 and 15 yrs, respectively. Using a 25-yr horizon, 93% of results from the probabilistic analyses fall below a threshold of 25,000 pounds per QALY. This study demonstrates the potential cost-effectiveness of ETN plus NSAIDs compared with NSAIDs alone in patients with severe AS treated according to the BSR guidelines in the UK.

Economic burden of stroke: a systematic review on post-stroke care.

PubMed

Rajsic, S; Gothe, H; Borba, H H; Sroczynski, G; Vujicic, J; Toell, T; Siebert, Uwe

2018-06-16

Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated. We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors. The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.

Multiobjective assessment of distributed energy storage location in electricity networks

NASA Astrophysics Data System (ADS)

Ribeiro Gonçalves, José António; Neves, Luís Pires; Martins, António Gomes

2017-07-01

This paper presents a methodology to provide information to a decision maker on the associated impacts, both of economic and technical nature, of possible management schemes of storage units for choosing the best location of distributed storage devices, with a multiobjective optimisation approach based on genetic algorithms. The methodology was applied to a case study, a known distribution network model in which the installation of distributed storage units was tested, using lithium-ion batteries. The obtained results show a significant influence of the charging/discharging profile of batteries on the choice of their best location, as well as the relevance that these choices may have for the different network management objectives, for example, for reducing network energy losses or minimising voltage deviations. Results also show a difficult cost-effectiveness of an energy-only service, with the tested systems, both due to capital cost and due to the efficiency of conversion.

Gas engine heat pump cycle analysis. Volume 1: Model description and generic analysis

NASA Astrophysics Data System (ADS)

Fischer, R. D.

1986-10-01

The task has prepared performance and cost information to assist in evaluating the selection of high voltage alternating current components, values for component design variables, and system configurations and operating strategy. A steady-state computer model for performance simulation of engine-driven and electrically driven heat pumps was prepared and effectively used for parametric and seasonal performance analyses. Parametric analysis showed the effect of variables associated with design of recuperators, brine coils, domestic hot water heat exchanger, compressor size, engine efficiency, insulation on exhaust and brine piping. Seasonal performance data were prepared for residential and commercial units in six cities with system configurations closely related to existing or contemplated hardware of the five GRI engine contractors. Similar data were prepared for an advanced variable-speed electric unit for comparison purposes. The effect of domestic hot water production on operating costs was determined. Four fan-operating strategies and two brine loop configurations were explored.

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.

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

A survey of health care benefits in the apparel industry.

PubMed

Moore, W B

1985-09-01

Each day as Americans prepare to begin their days, many put on their clothing often without a thought as to how or where it was manufactured. The manufacture of clothing in the United States is a labor intensive industry pressed by competition in foreign countries where labor is abundant and less expensive; therefore, the manufacturers must look for every opportunity to reduce their costs. The survey presented here reviews the health benefit plans in the apparel industry and current initiatives for cost reduction. The results are interesting, for they give the hospital administrator vital information on the types of programs that might be in place in local manufacturers and the method of cost containment expected in this industry.

Mendel-GPU: haplotyping and genotype imputation on graphics processing units

PubMed Central

Chen, Gary K.; Wang, Kai; Stram, Alex H.; Sobel, Eric M.; Lange, Kenneth

2012-01-01

Motivation: In modern sequencing studies, one can improve the confidence of genotype calls by phasing haplotypes using information from an external reference panel of fully typed unrelated individuals. However, the computational demands are so high that they prohibit researchers with limited computational resources from haplotyping large-scale sequence data. Results: Our graphics processing unit based software delivers haplotyping and imputation accuracies comparable to competing programs at a fraction of the computational cost and peak memory demand. Availability: Mendel-GPU, our OpenCL software, runs on Linux platforms and is portable across AMD and nVidia GPUs. Users can download both code and documentation at http://code.google.com/p/mendel-gpu/. Contact: gary.k.chen@usc.edu Supplementary information: Supplementary data are available at Bioinformatics online. PMID:22954633

Un/Paid Labor: Medicaid Home and Community Based Services Waivers That Pay Family as Personal Care Providers

ERIC Educational Resources Information Center

Friedman, Carli; Rizzolo, Mary C.

2016-01-01

The United States long-term services and supports system is built on largely unpaid (informal) labor. There are a number of benefits to allowing family caregivers to serve as paid personal care providers including better health and satisfaction outcomes, expanded workforces, and cost effectiveness. The purpose of this study was to examine how…

Mapping sudden oak death risk nationally using host, climate, and pathways data

Treesearch

Frank H. Koch; William D. Smith

2008-01-01

In 2002, a team of United States Department of Agriculture-Forest Service (USDA-FS) scientists developed a preliminary risk map to serve as the foundation for an efficient, cost effective sample design for the national sudden oak death detection survey. At the time, a need to initiate rapid detection in the face of limited information on Phytophthora ramorum...

Littoral Combat Ship (LCS)

DTIC Science & Technology

2015-12-01

Selected Acquisition Report ( SAR ) RCS: DD-A&T(Q&A)823-374 Littoral Combat Ship (LCS) As of FY 2017 President’s Budget Defense Acquisition...Management Information Retrieval (DAMIR) UNCLASSIFIED LCS December 2015 SAR UNCLASSIFIED 2 Table of Contents Common Acronyms and Abbreviations for...and Support PAUC - Program Acquisition Unit Cost LCS December 2015 SAR UNCLASSIFIED 3 PB - President’s Budget PE - Program Element PEO - Program

A trial of direct control of pine engraver beetles on a small logging unit

Treesearch

W. L. Jackson

1960-01-01

Laboratory tests and small-scale field trials have shown the insecticide lindane to be highly toxic to pine engraver beetles. On the basis of that information, the insecticide was applied to fresh logging slash heavily infested with pine engraver beetles at Challenge Experimental Forest in 1959. Costs were reasonable and no insurmountable problems were encountered....

To Whom Do They Belong? "A Profile of America's Runaway and Homeless Youth and the Programs That Help Them."

ERIC Educational Resources Information Center

National Network of Runaway and Youth Services, Inc., Washington, DC.

A profile and needs assessment of runaway and homeless children was produced using survey data gathered from 210 youth services agencies throughout the United States. The National Network of Runaway and Youth Services conducted this survey to provide policymakers and the media with information about successful, cost-effective crisis intervention…

An integrated approach to evaluating the economic costs of wildfire hazard reduction through wood utilization opportunities in the southwestern United States

Treesearch

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

2008-01-01

This research provides an important step in the conceptualization and development of an integrated wildfire fuels reduction system from silvicultural prescription, through stem selection, harvesting, in-woods processing, transport, and market selection. Decisions made at each functional step are informed by knowledge about subsequent functions. Data on the resource...

An integrated approach to evaluating the economic costs of wildfire hazard reduction through wood utilization opportunities in the Southwestern United States

Treesearch

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

2008-01-01

This research provides an important step in the conceptualization and development of an integrated wildfire fuels reduction system from silvicultural prescription, through stem selection, harvesting, in-woods processing, transport, and market selection. Decisions made at each functional step are informed by knowledge about subsequent functions. Data on the resource...

Applying Activity Based Costing (ABC) Method to Calculate Cost Price in Hospital and Remedy Services

PubMed Central

Rajabi, A; Dabiri, A

2012-01-01

Background Activity Based Costing (ABC) is one of the new methods began appearing as a costing methodology in the 1990’s. It calculates cost price by determining the usage of resources. In this study, ABC method was used for calculating cost price of remedial services in hospitals. Methods: To apply ABC method, Shahid Faghihi Hospital was selected. First, hospital units were divided into three main departments: administrative, diagnostic, and hospitalized. Second, activity centers were defined by the activity analysis method. Third, costs of administrative activity centers were allocated into diagnostic and operational departments based on the cost driver. Finally, with regard to the usage of cost objectives from services of activity centers, the cost price of medical services was calculated. Results: The cost price from ABC method significantly differs from tariff method. In addition, high amount of indirect costs in the hospital indicates that capacities of resources are not used properly. Conclusion: Cost price of remedial services with tariff method is not properly calculated when compared with ABC method. ABC calculates cost price by applying suitable mechanisms but tariff method is based on the fixed price. In addition, ABC represents useful information about the amount and combination of cost price services. PMID:23113171

Estimating the cost-effectiveness of stroke units in France compared with conventional care.

PubMed

Launois, R; Giroud, M; Mégnigbêto, A C; Le Lay, K; Présenté, G; Mahagne, M H; Durand, I; Gaudin, A F

2004-03-01

The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year. This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care. Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units. Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 for conventional care and 34 638 in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 per year of life gained without disability was estimated. The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 ) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.

[Cost of assisted reproduction technology in a public hospital].

PubMed

Navarro Espigares, José Luis; Martínez Navarro, Luis; Castilla Alcalá, José Antonio; Hernández Torres, Elisa

2006-01-01

Most studies on the costs of assisted reproductive technologies (ART) identify the total cost of the procedure with the direct cost, without considering important items such as overhead or intermediate costs. The objective of this study was to determine the cost per ART procedure in a public hospital in 2003 and to compare the results with those in the same hospital in 1998. Data from the Human Reproduction Unit of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998 and 2003 were analyzed. Since the total costs of the unit were known, the cost of the distinct ART procedures performed in the hospital was calculated by means of a methodology for cost distribution. Between 1998 and 2003, the activity and costs of the Human Reproduction Unit analyzed evolved differently. Analysis of activity showed that some techniques, such as intracytoplasmic sperm injection, were consolidated while others, such as stimulation without assisted reproduction or intracervical insemination were abandoned. In all procedures, unit costs per cycle and per delivery decreased in the period analyzed. Important changes took place in the structure of costs of ART in the Human Reproduction Unit of the Virgen de las Nieves University Hospital between 1998 and 2003. Some techniques were discontinued, while others gained importance. Technological advances and structural innovations, together with a "learning effect," modified the structure of ART-related costs.

43 CFR 12.951 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... readily quantified, such quantitative data should be related to cost data for computation of unit costs... including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e) Recipients... performance data from recipients. ...

41 CFR 105-72.601 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... readily quantified, such quantitative data should be related to cost data for computation of unit costs... including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e) Recipients... performance data from recipients. ...

7 CFR 3019.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... readily quantified, such quantitative data should be related to cost data for computation of unit costs... including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e) Recipients... performance data from recipients. ...

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...

Costs and quality of life associated with acute upper gastrointestinal bleeding in the UK: cohort analysis of patients in a cluster randomised trial.

PubMed

Campbell, H E; Stokes, E A; Bargo, D; Logan, R F; Mora, A; Hodge, R; Gray, A; James, M W; Stanley, A J; Everett, S M; Bailey, A A; Dallal, H; Greenaway, J; Dyer, C; Llewelyn, C; Walsh, T S; Travis, S P L; Murphy, M F; Jairath, V

2015-04-29

Data on costs associated with acute upper gastrointestinal bleeding (AUGIB) are scarce. We provide estimates of UK healthcare costs, indirect costs and health-related quality of life (HRQoL) for patients presenting to hospital with AUGIB. Six UK university hospitals with >20 AUGIB admissions per month, >400 adult beds, 24 h endoscopy, and on-site access to intensive care and surgery. 936 patients aged ≥18 years, admitted with AUGIB, and enrolled between August 2012 and March 2013 in the TRIGGER trial of AUGIB comparing restrictive versus liberal red blood cell (RBC) transfusion thresholds. Healthcare resource use during hospitalisation and postdischarge up to 28  days, unpaid informal care, time away from paid employment and HRQoL using the EuroQol EQ-5D at 28  days were measured prospectively. National unit costs were used to value resource use. Initial in-hospital treatment costs were upscaled to a UK level. Mean initial in-hospital costs were £2458 (SE=£216) per patient. Inpatient bed days, endoscopy and RBC transfusions were key cost drivers. Postdischarge healthcare costs were £391 (£44) per patient. One-third of patients received unpaid informal care and the quarter in paid employment required time away from work. Mean HRQoL for survivors was 0.74. Annual initial inhospital treatment cost for all AUGIB cases in the UK was estimated to be £155.5 million, with exploratory analyses of the incremental costs of treating hospitalised patients developing AUGIB generating figures of between £143 million and £168 million. AUGIB is a large burden for UK hospitals with inpatient stay, endoscopy and RBC transfusions as the main cost drivers. It is anticipated that this work will enable quantification of the impact of cost reduction strategies in AUGIB and will inform economic analyses of novel or existing interventions for AUGIB. ISRCTN85757829 and NCT02105532. 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.

U.S. Residential Miscellaneous Refrigeration Products: Results from Amazon Mechanical Turk Surveys

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

Greenblatt, Jeffery B.; Young, Scott J.; Yang, Hung-Chia

Amazon Mechanical Turk was used, for the first time, to collect statistically representative survey data from U.S. households on the presence, number, type and usage of refrigerators, freezers, and various “miscellaneous” refrigeration products (wine/beverage coolers, residential icemakers and non-vapor compression refrigerators and freezers), along with household and demographic information. Such products have been poorly studied to date, with almost no information available about shipments, stocks, capacities, energy use, etc. A total of 9,981 clean survey responses were obtained from five distinct surveys deployed in 2012. General refrigeration product survey responses were weighted to demographics in the U.S. Energy Information Administration’smore » Residential Energy Consumption Survey 2009 dataset. Miscellaneous refrigeration product survey responses were weighted according to demographics of product ownership found in the general refrigeration product surveys. Model number matching for a portion of miscellaneous refrigeration product responses allowed validation of refrigeration product characteristics, which enabled more accurate estimates of the penetrations of these products in U.S. households. We estimated that there were 12.3±1.0 million wine/beverage coolers, 5.5(–3.5,+3.2) million residential icemakers and 4.4(–2.7,+2.3) million non-vapor compression refrigerators in U.S. households in 2012. (All numerical results are expressed with ranges indicating the 95% confidence interval.) No evidence was found for the existence of non-vapor compression freezers. Moreover, we found that 15% of wine/beverage coolers used vapor compression cooling technology, while 85% used thermoelectric cooling technology, with the vast majority of thermoelectric units having capacities of less than 30 wine bottles (approximately 3.5 cubic feet). No evidence was found for the existence of wine/beverage coolers with absorption cooling technology. Additionally, we estimated that there were 3.6±1.0 million hybrid refrigerator-wine/beverage coolers and 0.9±0.5 million hybrid freezer-wine/beverage coolers in U.S. households. We also obtained estimates of miscellaneous refrigeration product capacities, lifetimes, purchase and installation costs, repair frequencies and costs, and maintenance costs. For wine/beverage coolers, we also obtained information on the penetration of built-in units, AC/DC operating capability, the use of internal lights, and distributions of door opening frequencies. This information is essential to develop detailed estimates of national energy usage and life-cycle costs, and would be helpful in obtaining information on other plug-load appliances. Additional information not highlighted in the main report was presented in Appendices.« less

U.S. Residential Miscellaneous Refrigeration Products: Results from Amazon Mechanical Turk Surveys

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

Greenblatt, Jeffery B.; Young, Scott J.; Yang, Hung-Chia

Amazon Mechanical Turk was used, for the first time, to collect statistically representative survey data from U.S. households on the presence, number, type and usage of refrigerators, freezers, and various “miscellaneous” refrigeration products (wine/beverage coolers, residential icemakers and non-vapor compression refrigerators and freezers), along with household and demographic information. Such products have been poorly studied to date, with almost no information available about shipments, stocks, capacities, energy use, etc. A total of 9,820 clean survey responses were obtained from four distinct surveys deployed in 2012. General refrigeration product survey responses were weighted to demographics in the U.S. Energy Information Administration’smore » Residential Energy Consumption Survey 2009 dataset. Miscellaneous refrigeration product survey responses were weighted according to demographics of product ownership found in the general refrigeration product surveys. Model number matching for a portion of miscellaneous refrigeration product responses allowed validation of refrigeration product characteristics, which enabled more accurate estimates of the penetrations of these products in U.S. households. We estimated that there were 12.3±1.0 million wine/beverage coolers, 5.5(–3.5,+3.2) million residential icemakers and 2.9(–2.5,+4.5) million non-vapor compression refrigerators in U.S. households in 2012. (All numerical results are expressed with ranges indicating the 95% confidence interval.) No evidence was found for the existence of non-vapor compression freezers. Moreover, we found that 15% of wine/beverage coolers used vapor compression cooling technology, while 85% used thermoelectric cooling technology, with the vast majority of thermoelectric units having capacities of less than 30 wine bottles (approximately 3.5 cubic feet). No evidence was found for the existence of wine/beverage coolers with absorption cooling technology. Additionally, we estimated that there were 3.6±1.0 million hybrid refrigerator-wine/beverage coolers and 0.9±0.5 million hybrid freezer-wine/beverage coolers in U.S. households. We also obtained estimates of miscellaneous refrigeration product capacities, lifetimes, purchase and installation costs, repair frequencies and costs, and maintenance costs. For wine/beverage coolers, we also obtained information on the penetration of built-in units, AC/DC operating capability, the use of internal lights, and distributions of door opening frequencies. This information is essential to develop detailed estimates of national energy usage and life-cycle costs, and would be helpful in obtaining information on other plug-load appliances. Additional information not highlighted in the main report was presented in Appendices.« less

Bottom-up or top-down: unit cost estimation of tuberculosis diagnostic tests in India.

PubMed

Rupert, S; Vassall, A; Raizada, N; Khaparde, S D; Boehme, C; Salhotra, V S; Sachdeva, K S; Nair, S A; Hoog, A H Van't

2017-04-01

Of 18 sites that participated in an implementation study of the Xpert® MTB/RIF assay in India, we selected five microscopy centres and two reference laboratories. To obtain unit costs of diagnostic tests for tuberculosis (TB) and drug-resistant TB. Laboratories were purposely selected to capture regional variations and different laboratory types. Both bottom-up and the top-down methods were used to estimate unit costs. At the microscopy centres, mean bottom-up unit costs were respectively US$0.83 (range US$0.60-US$1.10) and US$12.29 (US$11.61-US$12.89) for sputum smear microscopy and Xpert. At the reference laboratories, mean unit costs were US$1.69 for the decontamination procedure, US$9.83 for a solid culture, US$11.06 for a liquid culture, US$29.88 for a drug susceptibility test, and US$18.18 for a line-probe assay. Top-down mean unit cost estimates were higher for all tests, and for sputum smear microscopy and Xpert these increased to respectively US$1.51 and US$13.58. The difference between bottom-up and top-down estimates was greatest for tests performed at the reference laboratories. These unit costs for TB diagnostics can be used to estimate resource requirements and cost-effectiveness in India, taking into account geographical location, laboratory type and capacity utilisation.

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

Assessing community values for reducing agricultural emissions to improve water quality and protect coral health in the Great Barrier Reef

NASA Astrophysics Data System (ADS)

Rolfe, John; Windle, Jill

2011-12-01

Policymakers wanting to increase protection of the Great Barrier Reef from pollutants generated by agriculture need to identify when measures to improve water quality generate benefits to society that outweigh the costs involved. The research reported in this paper makes a contribution in several ways. First, it uses the improved science understanding about the links between management changes and reef health to bring together the analysis of costs and benefits of marginal changes, helping to demonstrate the appropriate way of addressing policy questions relating to reef protection. Second, it uses the scientific relationships to frame a choice experiment to value the benefits of improved reef health, with the results of mixed logit (random parameter) models linking improvements explicitly to changes in "water quality units." Third, the research demonstrates how protection values are consistent across a broader population, with some limited evidence of distance effects. Fourth, the information on marginal costs and benefits that are reported provide policymakers with information to help improve management decisions. The results indicate that while there is potential for water quality improvements to generate net benefits, high cost water quality improvements are generally uneconomic. A major policy implication is that cost thresholds for key pollutants should be set to avoid more expensive water quality proposals being selected.