COMPLEAT (Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies): A planning tool for publicly owned electric utilities. [Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies (Compleat)

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

Not Available

1990-09-01

COMPLEAT takes its name, as an acronym, from Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies. It is an electric utility planning model designed for use principally by publicly owned electric utilities and agencies serving such utilities. As a model, COMPLEAT is significantly more full-featured and complex than called out in APPA's original plan and proposal to DOE. The additional complexity grew out of a series of discussions early in the development schedule, in which it became clear to APPA staff and advisors that the simplicity characterizing the original plan, while highly desirable in terms of utility applications, wasmore » not achievable if practical utility problems were to be addressed. The project teams settled on Energy 20/20, an existing model developed by Dr. George Backus of Policy Assessment Associates, as the best candidate for the kinds of modifications and extensions that would be required. The remainder of the project effort was devoted to designing specific input data files, output files, and user screens and to writing and testing the compute programs that would properly implement the desired features around Energy 20/20 as a core program. This report presents in outline form, the features and user interface of COMPLEAT.« less

Determinants of Patient-Centered Financial Stress in Patients With Locally Advanced Head and Neck Cancer.

PubMed

de Souza, Jonas A; Kung, Sunny; O'Connor, Jeremy; Yap, Bonnie J

2017-04-01

To prospectively estimate patient-centered financial stress and its relationship with health care utilization in patients with head and neck cancer. This was a survey-based, longitudinal, prospective study of treatment-naïve patients with stage III, IVa, or IVb locally advanced head and neck cancer at a single-institution tertiary care hospital from May 2013 to November 2014. With 121 patients approached, 73 (60%) agreed to participate. Self-reported data were collected on demographics, income, wealth, cost-coping strategies, out-of-pocket costs, supportive medication compliance, and perceived social isolation. Health care utilization was measured by hospital admissions and outpatient appointments on a 6-month timeline. Logistic regression models were constructed to identify factors associated with use of cost-coping strategies. Covariates included all demographics, measures of income, wealth, out-of-pocket costs, indirect costs, and perceived social isolation. Fifty-one patients (69%) relied on at least one coping strategy. On multivariable analysis, Medicaid patients were more likely than privately insured patients to use cost-coping strategies (odds ratio, 42.3; P = .0042). Decreased wealth ( P = .002) and higher total out-of-pocket costs ( P = .003) were independently associated with using cost-coping strategies. Patients with high perceived social isolation were also more likely to use cost-coping strategies (odds ratio, 11.5; P = .01). Patients with high perceived social isolation were more likely to report nonadherence to supportive medications (21.4 v 5.45 days over 6 months; P = .0278) and missed appointments (seven v three; P = .0077). A majority of patients used at least one cost-coping strategy during their treatment, highlighting the financial stress that patients experience. Perceived social isolation is an important social determinant of increased medication nonadherence, missed appointments, and use of cost-coping strategies. Interventions should be investigated in at-risk patients who may suffer from financial stress.

Technique for Very High Order Nonlinear Simulation and Validation

NASA Technical Reports Server (NTRS)

Dyson, Rodger W.

2001-01-01

Finding the sources of sound in large nonlinear fields via direct simulation currently requires excessive computational cost. This paper describes a simple technique for efficiently solving the multidimensional nonlinear Euler equations that significantly reduces this cost and demonstrates a useful approach for validating high order nonlinear methods. Up to 15th order accuracy in space and time methods were compared and it is shown that an algorithm with a fixed design accuracy approaches its maximal utility and then its usefulness exponentially decays unless higher accuracy is used. It is concluded that at least a 7th order method is required to efficiently propagate a harmonic wave using the nonlinear Euler equations to a distance of 5 wavelengths while maintaining an overall error tolerance that is low enough to capture both the mean flow and the acoustics.

Do Zero-Cost Workers’ Compensation Medical Claims Really Have Zero Costs?

PubMed Central

Asfaw, Abay; Rosa, Roger; Mao, Rebecca

2015-01-01

Objective Previous research suggests that non–workers’ compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs. Methods Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments. Results Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims. Conclusion Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year. PMID:24316724

Policy analysis of the budget used in training program for reducing lower back pain among heavy equipment operators in the construction industry: System dynamics approach

NASA Astrophysics Data System (ADS)

Vitharana, V. H. P.; Chinda, T.

2018-04-01

Lower back pain (LBP), prevalence is high among the heavy equipment operators leading to high compensation cost in the construction industry. It is found that proper training program assists in reducing chances of having LBP. This study, therefore aims to examine different safety related budget available to support LBP related training program for different age group workers, utilizing system dynamics modeling approach. The simulation results show that at least 2.5% of the total budget must be allocated in the safety and health budget to reduce the chances of having LBP cases.

Electric Industry Restructuring in Ohio: Residential and Low Income Customer Impacts

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

Eisenberg, J

2001-03-26

Throughout the country the long standing administratively based regulatory structure for determining the cost and service parameters for electric utilities is changing. More and more market elements are coming into the structure. There is a push by many players to eliminate much of the current regulation. For the production side of electricity at least, these players argue that a market approach will do a better n job of pricing power and making it available to customers. However, the electricity industry currently has a large base of investment in power production equipment, some of which may have difficulty competing in amore » market-based system. What to do about this potentially uneconomic existing investment is an important question receiving a great deal of attention at the policy discussion level. Some argue that if the investment in existing facilities is uneconomic in a new market based system, that is too bad for the owners of the above-market cost facilities, and customers should bear no responsibility to help make those owners whole. Others argue that the owners of above-market cost facilities invested in those facilities in good faith and should not be made to bear the cost of a changing underlying industry structure. The arguments on both sides are long and involved, and this paper is not the place to explore them. However, it is clear that the result of the debate is uncertain, and both approaches must be explored. The purpose of this report is to analyze the current electric utility cost structure in Ohio, estimate the expected changes in that structure and cost levels under various restructuring proposals, and determine the likely impact on low income and other residential customers. The report analyzes the likely cost impacts of a variety of approaches to the above-market cost facility problem. The range of potential outcomes is very wide.« less

Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members.

PubMed

Ackermann, Ronald T; Williams, Barbara; Nguyen, Huong Q; Berke, Ethan M; Maciejewski, Matthew L; LoGerfo, James P

2008-08-01

To determine whether participation in a physical activity benefit by Medicare managed care enrollees is associated with lower healthcare utilization and costs. Retrospective cohort study. Medicare managed care. A cohort of 1,188 older adult health maintenance organization enrollees who participated at least once in the EnhanceFitness (EF) physical activity benefit and a matched group of enrollees who never used the program. Healthcare costs and utilization were estimated. Ordinary least squares regression was used, adjusting for demographics, comorbidity, indicators of preventive service use, and baseline utilization or cost. Robustness of findings was tested in sensitivity analyses involving continuous propensity score adjustment and generalized linear models with nonconstant variance assumptions. EF participants had similar total healthcare costs during Year 1 of the program, but during Year 2, adjusted total costs were $1,186 lower (P=.005) than for non-EF users. Differences were partially attributable to lower inpatient costs (-$3,384; P=.02), which did not result from high-cost outliers. Enrollees who attended EF an average of one visit or more per week had lower adjusted total healthcare costs in Year 1 (-$1,929; P<.001) and Year 2 (-$1,784; P<.001) than nonusers. Health plan coverage of a preventive physical activity benefit for seniors is a promising strategy to avoid significant healthcare costs in the short term.

Improving operating room schedules.

PubMed

Li, Fei; Gupta, Diwakar; Potthoff, Sandra

2016-09-01

Operating rooms (ORs) in US hospitals are costly to staff, generate about 70 % of a hospital's revenues, and operate at a staffed-capacity utilization of 60-70 %. Many hospitals allocate blocks of OR time to individual or groups of surgeons as guaranteed allocation, who book surgeries one at a time in their blocks. The booking procedure frequently results in unused time between surgeries. Realizing that this presents an opportunity to improve OR utilization, hospitals manually reschedule surgery start times one or two days before each day of surgical operations. The purpose of rescheduling is to decrease OR staffing costs, which are determined by the number of concurrently staffed ORs. We formulate the rescheduling problem as a variant of the bin-packing problem with interrelated items, which are the surgeries performed by the same surgeon. We develop a lower bound (LB) construction algorithm and prove that the LB is at least (2/3) of the optimal staffing cost. A key feature of our approach is that we allow hospitals to have two shift lengths. Our analytical results form the basis of a branch-and-bound algorithm, which we test on data obtained from three hospitals. Experiments show that rescheduling saves significant staffing costs.

Decision and cost-utility analyses of surgical versus transcatheter closure of patent ductus arteriosus: should you let a smile be your umbrella?

PubMed

Gray, D T; Weinstein, M C

1998-01-01

Decision and cost-utility analyses considered the tradeoffs of treating patent ductus arteriosus (PDA) using conventional surgery versus transcatheter implantation of the Rashkind occluder. Physicians and informed lay parents assigned utility scores to procedure success/complications combinations seen in prognostically similar pediatric patients with isolated PDA treated from 1982 to 1987. Utility scores multiplied by outcome frequencies from a comparative study generated expected utility values for the two approaches. Cost-utility analyses combined these results with simulated provider cost estimates from 1989. On a 0-100 scale (worst to best observed outcome), the median expected utility for surgery was 99.96, versus 98.88 for the occluder. Results of most sensitivity analyses also slightly favored surgery. Expected utility differences based on 1987 data were minimal. With a mean overall simulated cost of $8,838 vs $12,466 for the occluder, surgery was favored in most cost-utility analyses. Use of the inherently less invasive but less successful, more risky, and more costly occluder approach conferred no apparent net advantage in this study. Analyses of comparable current data would be informative.

Impact of Anterior vs Posterior Approach for Total Hip Arthroplasty on Post-Acute Care Service Utilization.

PubMed

L'Hommedieu, Coles E; Gera, James J; Rupp, Gerald; Salin, Jeffery W; Cox, John S; Duwelius, Paul J

2016-09-01

Controversy exists as to which surgical approach is best for total hip arthroplasty (THA). Previous studies suggested that the tissue-sparing anterior approach should result in a more rapid recovery requiring fewer postacute services, ultimately decreasing overall episodic cost. The purpose of this cross-sectional study was to determine if any significant differences exist between the anterior vs posterior approaches on postacute care service utilization, readmissions, or episodic cost. Claims data from 26,773 Medicare fee-for-service beneficiaries receiving elective THAs (Medical Severity-Diagnosis Related Groups (MS-DRGs) 469/470) were analyzed. Claims data were collected from the 2-year period, January 2013 through December 2014. The posterior surgical approach was performed on 23,653 patients while 3120 patients received the anterior approach. Data analysis showed negligible effect sizes in postacute care service utilization, readmission rate, and cost between the surgical approaches for elective THA (MS-DRG 469 and 470). Average THA total episode cost was negligibly higher for procedures using the anterior approach compared to the posterior approach ($22,517 and $22,068, respectively). Statistically significant differences were observed in inpatient rehab and home health cost and service utilization. However, the effect sizes of these comparisons are negligible when accounting for the large sample size. All other comparisons showed minimal and statistically insignificant variation. The results indicate that surgical approach alone is not the primary driver of postacute care service utilization, quality outcomes, or cost. Other factors such as physician-led patient-focused care pathways, care coordination, rapid rehabilitation protocols, perioperative pain management protocols, and patient education are integral for effective patient care. Copyright © 2016 Elsevier Inc. All rights reserved.

Homeless Veterans' Use of Peer Mentors and Effects on Costs and Utilization in VA Clinics.

PubMed

Yoon, Jean; Lo, Jeanie; Gehlert, Elizabeth; Johnson, Erin E; O'Toole, Thomas P

2017-06-01

The study compared health care utilization and costs among homeless veterans randomly assigned to peer mentors or usual care and described contacts with peer mentors. Homeless patients at four Department of Veterans Affairs clinics were randomly assigned to a peer mentor (N=195) or to usual care (N=180). Administrative data on utilization and costs over a six-month follow-up were combined with peer mentors' reports of patient contacts. Most patients (87%) in the peer mentor group had at least one peer contact. Patients in this group spent the largest proportions of time discussing housing and health issues with peer mentors and had more outpatient encounters than those in usual care, although differences were not significant. No other between-group differences were found in utilization or costs. Although significant impacts of peer mentors on health care patterns or costs were not detected, some patients had frequent contact with peer mentors.

Reformation of PURPA contracts: Strategies for success in power marketing

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

Scalzo, P.J.

With the passage of the Energy Policy Act of 1992, real competition entered into the world of electric utilities. A slide presentations is given on reformation of Public Utility Regulatory Policies Act (PURPA) Contracts for success in power marketing strategies. Two ways to compete: Be the least cost provider or add value and `sell hard`. The PURPA vision was to increase efficiency in power generation, utilize renewable or waste fuels, and bolster the independent producers. Cogenerators and small power producers qualified. Utility planners predicted, avoided cost, utility loads, and oil and gas prices to increase. However, avoided costs, and oilmore » and gase prices declined. Two scenarios are discussed for contract reformation: Contract buyouts, and renegotiation of contracts. Options for for dealing with existing fuel agreements are presented.« less

Full Costing of Business Programs: Benefits and Caveats

ERIC Educational Resources Information Center

Simmons, Cynthia; Wright, Michael; Jones, Vernon

2006-01-01

Purpose: To suggest an approach to program costing that includes the approaches and concepts developed in activity based costing. Design/methodology/approach: The paper utilizes a hypothetical case study of an Executive MBA program as a means of illustrating the suggested approach to costing. Findings: The paper illustrates both the benefits of…

Reductions in Diagnostic Imaging With High Deductible Health Plans.

PubMed

Zheng, Sarah; Ren, Zhong Justin; Heineke, Janelle; Geissler, Kimberley H

2016-02-01

Diagnostic imaging utilization grew rapidly over the past 2 decades. It remains unclear whether patient cost-sharing is an effective policy lever to reduce imaging utilization and spending. Using 2010 commercial insurance claims data of >21 million individuals, we compared diagnostic imaging utilization and standardized payments between High Deductible Health Plan (HDHP) and non-HDHP enrollees. Negative binomial models were used to estimate associations between HDHP enrollment and utilization, and were repeated for standardized payments. A Hurdle model were used to estimate associations between HDHP enrollment and whether an enrollee had diagnostic imaging, and then the magnitude of associations for enrollees with imaging. Models with interaction terms were used to estimate associations between HDHP enrollment and imaging by risk score tercile. All models included controls for patient age, sex, geographic location, and health status. HDHP enrollment was associated with a 7.5% decrease in the number of imaging studies and a 10.2% decrease in standardized imaging payments. HDHP enrollees were 1.8% points less likely to use imaging; once an enrollee had at least 1 imaging study, differences in utilization and associated payments were small. Associations between HDHP and utilization were largest in the lowest (least sick) risk score tercile. Increased patient cost-sharing may contribute to reductions in diagnostic imaging utilization and spending. However, increased cost-sharing may not encourage patients to differentiate between high-value and low-value diagnostic imaging services; better patient awareness and education may be a crucial part of any reductions in diagnostic imaging utilization.

ASSESSMENT OF CONTROL TECHNOLOGIES FOR REDUCING EMISSIONS OF SO2 AND NOX FROM EXISTING COAL-FIRED UTILITY BOILERS

EPA Science Inventory

The report reviews information and estimated costs on 15 emissioncontrol technology categories applicable to existing coal-fired electric utility boilers. he categories include passive controls such as least emission dispatching, conventional processes, and emerging technologies ...

Estimating patient-borne water and electricity costs in home hemodialysis: a simulation

PubMed Central

Nickel, Matthew; Rideout, Wes; Shah, Nikhil; Reintjes, Frances; Chen, Justin Z.; Burrell, Robert; Pauly, Robert P.

2017-01-01

Background: Home hemodialysis is associated with lower costs to the health care system compared with conventional facility-based hemodialysis because of lower staffing and overhead costs, and by transferring the treatment cost of utilities (water and power) to the patient. The purpose of this study was to determine the utility costs of home hemodialysis and create a formula such that patients and renal programs can estimate the annual patient-borne costs involved with this type of treatment. Methods: Seven common combinations of treatment duration and dialysate flows were replicated 5 times using various combinations of home hemodialysis and reverse osmosis machines. Real-time utility (electricity and water) consumption was monitored during these simulations. A generic formula was developed to allow patients and programs to calculate a more precise estimate of utility costs based on individual combinations of dialysis intensity, frequency and utility costs unique to any patient. Results: Using typical 2014 utility costs for Edmonton, the most expensive prescription was for nocturnal home hemodialysis (8 h at 300 mL/min, 6 d/wk), which resulted in a utility cost of $1269 per year; the least expensive prescription was for conventional home hemodialysis (4 h at 500 mL/min, 3 d/wk), which cost $420 per year. Water consumption makes up most of this expense, with electricity accounting for only 12% of the cost. Interpretation: We show that a substantial cost burden is transferred to the patient on home hemodialysis, which would otherwise be borne by the renal program. PMID:28401120

The resource utilization group system: its effect on nursing home case mix and costs.

PubMed

Thorpe, K E; Gertler, P J; Goldman, P

1991-01-01

Using data from 1985 and 1986, we examine how New York state's prospective payment system affected nursing homes. The system, called Resource Utilization Group (RUG-II), aimed to limit nursing home cost growth and improve access to nursing homes by "heavy-care" patients. As in Medicare's prospective hospital reimbursement system, payments to nursing homes were based on a "price," rather than facility-specific rates. With respect to cost growth, we observed considerable diversity among homes. Specifically, those nursing homes most financially constrained by the RUG-II methodology exhibited the slowest rates of cost growth; we observed higher cost growth among the homes least constrained. This higher rate of cost growth raises a question about the desirability of using a pricing methodology to determine nursing home payment rates. In addition to moderating cost growth, we also observed a significant change in the mix of patients admitted to nursing homes. During the first year of the RUG-II program, nursing homes admitted more heavy-care patients and reduced days of care to lighter-care patients. Thus, through 1986, the RUG-II program appeared to satisfy at least one of its major policy objectives.

Evaluation of resource impact factors versus social cost estimates in determining building energy performance standard levels

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

Nieves, L.A.; Nesse, R.J.; Adams, R.C.

1979-12-01

In order to increase the welfare of society through the implementation of a building energy-performance standard, a method is required by which the least-cost means of obtaining the desired space conditioning of a building can be estimated. In other words, a life-cycle cost model must be developed to simulate the energy-related building-design decisions that would take place if resources were being allocated efficiently. The cost-minimizing model must incorporate technically efficient conservation strategies and fuel-conversion equipment, and the prices used must reflect the social value of the fuels and capital equipment used. This report explores the feasibility of developing a factormore » that could be used to adjust a design energy budget to account for the external costs associated with that energy consumption. One such factor, RIF (resource impact factor) has been proposed by ASHRAE. Though ASHRAE suggested the RIF x RUF (resource utilization factor) multiplier concept, RIF's were not explicitly defined. Weber (1978) suggested that RIF be defined as a ratio of social costs to effective market price. The basis for a RIF used in conjunction with a RUF is evaluated here and is found lacking. To fill the gap, a social-cost approach is developed that addresses the goals of both RIF's and RUF's. The rationale for using such an approach stems from the existence of differences between retail prices and the actual social costs of fuels.« less

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility.

PubMed

Kovac, Jason Ronald; Fantus, Jake; Lipshultz, Larry I; Fischer, Marc Anthony; Klinghoffer, Zachery

2014-09-01

Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility. A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes. Primary treatment with MV was the most cost-effective strategy at $5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about $7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >$4100 CAD/pregnancy. MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

An Assessment Model for Energy Efficiency Program Planning in Electric Utilities: Case of the Pacific of Northwest U.S.A

NASA Astrophysics Data System (ADS)

Iskin, Ibrahim

Energy efficiency stands out with its potential to address a number of challenges that today's electric utilities face, including increasing and changing electricity demand, shrinking operating capacity, and decreasing system reliability and flexibility. Being the least cost and least risky alternative, the share of energy efficiency programs in utilities' energy portfolios has been on the rise since the 1980s, and their increasing importance is expected to continue in the future. Despite holding great promise, the ability to determine and invest in only the most promising program alternatives plays a key role in the successful use of energy efficiency as a utility-wide resource. This issue becomes even more significant considering the availability of a vast number of potential energy efficiency programs, the rapidly changing business environment, and the existence of multiple stakeholders. This dissertation introduces hierarchical decision modeling as the framework for energy efficiency program planning in electric utilities. The model focuses on the assessment of emerging energy efficiency programs and proposes to bridge the gap between technology screening and cost/benefit evaluation practices. This approach is expected to identify emerging technology alternatives which have the highest potential to pass cost/benefit ratio testing procedures and contribute to the effectiveness of decision practices in energy efficiency program planning. The model also incorporates rank order analysis and sensitivity analysis for testing the robustness of results from different stakeholder perspectives and future uncertainties in an attempt to enable more informed decision-making practices. The model was applied to the case of 13 high priority emerging energy efficiency program alternatives identified in the Pacific Northwest, U.S.A. The results of this study reveal that energy savings potential is the most important program management consideration in selecting emerging energy efficiency programs. Market dissemination potential and program development and implementation potential are the second and third most important, whereas ancillary benefits potential is the least important program management consideration. The results imply that program value considerations, comprised of energy savings potential and ancillary benefits potential; and program feasibility considerations, comprised of program development and implementation potential and market dissemination potential, have almost equal impacts on assessment of emerging energy efficiency programs. Considering the overwhelming number of value-focused studies and the few feasibility-focused studies in the literature, this finding clearly shows that feasibility-focused studies are greatly understudied. The hierarchical decision model developed in this dissertation is generalizable. Thus, other utilities or power systems can adopt the research steps employed in this study as guidelines and conduct similar assessment studies on emerging energy efficiency programs of their interest.

When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions.

PubMed

Anis, Aslam H; Guh, Daphne P; Lacaille, Diane; Marra, Carlo A; Rashidi, Amir A; Li, Xin; Esdaile, John M

2005-11-22

Previous research has shown that patient cost-sharing leads to a reduction in overall health resource utilization. However, in Canada, where health care is provided free of charge except for prescription drugs, the converse may be true. We investigated the effect of prescription drug cost-sharing on overall health care utilization among elderly patients with rheumatoid arthritis. Elderly patients (> or = 65 years) were selected from a population-based cohort with rheumatoid arthritis. Those who had paid the maximum amount of dispensing fees (200 dollars) for the calendar year (from 1997 to 2000) were included in the analysis for that year. We defined the period during which the annual maximum co-payment had not been reached as the "cost-sharing period" and the one beyond which the annual maximum co-payment had been reached as the "free period." We compared health services utilization patterns between these periods during the 4 study years, including the number of hospital admissions, the number of physician visits, the number of prescriptions filled and the number of prescriptions per physician visit. Overall, 2968 elderly patients reached the annual maximum cost-sharing amount at least once during the study periods. Across the 4 years, there were 0.38 more physician visits per month (p < 0.001), 0.50 fewer prescriptions filled per month (p = 0.001) and 0.52 fewer prescriptions filled per physician visit (p < 0.001) during the cost-sharing period than during the free period. Among patients who were admitted to the hospital at least once, there were 0.013 more admissions per month during the cost-sharing period than during the free period (p = 0.03). In a predominantly publicly funded health care system, the implementation of cost-containment policies such as prescription drug cost-sharing may have the unintended effect of increasing overall health utilization among elderly patients with rheumatoid arthritis.

The Effects of Rising Interest Rates on Electric Utility Stock Prices: Regulatory Considerations and Approaches

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

Kihm, Steve; Satchwell, Andrew; Cappers, Peter

This technical brief identifies conditions under which utility regulators should consider implementing policy approaches that seek to mitigate negative outcomes due to an increase in interest rates. Interest rates are a key factor in determining a utility’s cost of equity and investors find value when returns exceed the cost of equity. Through historical observations of periods of rising and falling interest rates and application of a pro forma financial tool, we identify the key drivers of utility stock valuations and estimate the degree to which those valuations might be affected by increasing interest rates.3 We also analyze the efficacy ofmore » responses by utility regulators to mitigate potential negative financial impacts. We find that regulators have several possible approaches to mitigate a decline in value in an environment of increasing interest rates, though regulators must weigh the tradeoffs of improving investor value with potential increases in customer costs. Furthermore, the range of approaches reflects today’s many different electric utility regulatory models and regulatory responses to a decline in investor value will fit within state-specific models.« less

Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer.

PubMed

McGuffin, M; Merino, T; Keller, B; Pignol, J-P

2017-03-01

Standard treatment for early breast cancer includes whole breast irradiation (WBI) after breast-conserving surgery. Recently, accelerated partial breast irradiation (APBI) has been proposed for well-selected patients. A cost and cost-effectiveness analysis was carried out comparing WBI with two APBI techniques. An activity-based costing method was used to determine the treatment cost from a societal perspective of WBI, high dose rate brachytherapy (HDR) and permanent breast seed implants (PBSI). A Markov model comparing the three techniques was developed with downstream costs, utilities and probabilities adapted from the literature. Sensitivity analyses were carried out for a wide range of variables, including treatment costs, patient costs, utilities and probability of developing recurrences. Overall, HDR was the most expensive ($14 400), followed by PBSI ($8700), with WBI proving the least expensive ($6200). The least costly method to the health care system was WBI, whereas PBSI and HDR were less costly for the patient. Under cost-effectiveness analyses, downstream costs added about $10 000 to the total societal cost of the treatment. As the outcomes are very similar between techniques, WBI dominated under cost-effectiveness analyses. WBI was found to be the most cost-effective radiotherapy technique for early breast cancer. However, both APBI techniques were less costly to the patient. Although innovation may increase costs for the health care system it can provide cost savings for the patient in addition to convenience. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis.

PubMed

Bojke, Laura; Manca, Andrea; Asaria, Miqdad; Mahon, Ronan; Ren, Shijie; Palmer, Stephen

2017-08-01

Costs and utilities are key inputs into any cost-effectiveness analysis. Their estimates are typically derived from individual patient-level data collected as part of clinical studies the follow-up duration of which is often too short to allow a robust quantification of the likely costs and benefits a technology will yield over the patient's entire lifetime. In the absence of long-term data, some form of temporal extrapolation-to project short-term evidence over a longer time horizon-is required. Temporal extrapolation inevitably involves assumptions regarding the behaviour of the quantities of interest beyond the time horizon supported by the clinical evidence. Unfortunately, the implications for decisions made on the basis of evidence derived following this practice and the degree of uncertainty surrounding the validity of any assumptions made are often not fully appreciated. The issue is compounded by the absence of methodological guidance concerning the extrapolation of non-time-to-event outcomes such as costs and utilities. This paper considers current approaches to predict long-term costs and utilities, highlights some of the challenges with the existing methods, and provides recommendations for future applications. It finds that, typically, economic evaluation models employ a simplistic approach to temporal extrapolation of costs and utilities. For instance, their parameters (e.g. mean) are typically assumed to be homogeneous with respect to both time and patients' characteristics. Furthermore, costs and utilities have often been modelled to follow the dynamics of the associated time-to-event outcomes. However, cost and utility estimates may be more nuanced, and it is important to ensure extrapolation is carried out appropriately for these parameters.

Cost-effectiveness analysis in minimally invasive spine surgery.

PubMed

Al-Khouja, Lutfi T; Baron, Eli M; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel

2014-06-01

Medical care has been evolving with the increased influence of a value-based health care system. As a result, more emphasis is being placed on ensuring cost-effectiveness and utility in the services provided to patients. This study looks at this development in respect to minimally invasive spine surgery (MISS) costs. A literature review using PubMed, the Cost-Effectiveness Analysis (CEA) Registry, and the National Health Service Economic Evaluation Database (NHS EED) was performed. Papers were included in the study if they reported costs associated with minimally invasive spine surgery (MISS). If there was no mention of cost, CEA, cost-utility analysis (CUA), quality-adjusted life year (QALY), quality, or outcomes mentioned, then the article was excluded. Fourteen studies reporting costs associated with MISS in 12,425 patients (3675 undergoing minimally invasive procedures and 8750 undergoing open procedures) were identified through PubMed, the CEA Registry, and NHS EED. The percent cost difference between minimally invasive and open approaches ranged from 2.54% to 33.68%-all indicating cost saving with a minimally invasive surgical approach. Average length of stay (LOS) for minimally invasive surgery ranged from 0.93 days to 5.1 days compared with 1.53 days to 12 days for an open approach. All studies reporting EBL reported lower volume loss in an MISS approach (range 10-392.5 ml) than in an open approach (range 55-535.5 ml). There are currently an insufficient number of studies published reporting the costs of MISS. Of the studies published, none have followed a standardized method of reporting and analyzing cost data. Preliminary findings analyzing the 14 studies showed both cost saving and better outcomes in MISS compared with an open approach. However, more Level I CEA/CUA studies including cost/QALY evaluations with specifics of the techniques utilized need to be reported in a standardized manner to make more accurate conclusions on the cost effectiveness of minimally invasive spine surgery.

Marginal ambulatory teaching cost under varying levels of service utilization.

PubMed

Panton, D M; Mushlin, A I; Gavett, J W

1980-06-01

The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. These costs are usually constructed from historical accounting records. The second approach attempts to cost the joint products separately, based upon estimates of future changes in program costs, if the product in question is added to or removed from the program. The second approach relates to typical decisions facing the managers of medical centers and practices used for teaching purposes. This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.

Benefit/cost comparison for utility SMES applications

NASA Astrophysics Data System (ADS)

Desteese, J. G.; Dagle, J. E.

1991-08-01

This paper summarizes eight case studies that account for the benefits and costs of superconducting magnetic energy storage (SMES) in system-specific utility applications. Four of these scenarios are hypothetical SMES applications in the Pacific Northwest, where relatively low energy costs impose a stringent test on the viability of the concept. The other four scenarios address SMES applications on high-voltage, direct-current (HVDC) transmission lines. While estimated SMES benefits are based on a previously reported methodology, this paper presents results of an improved cost-estimating approach that includes an assumed reduction in the cost of the power conditioning system (PCS) from approximately $160/kW to $80/kW. The revised approach results in all the SMES scenarios showing higher benefit/cost ratios than those reported earlier. However, in all but two cases, the value of any single benefit is still less than the unit's levelized cost. This suggests, as a general principle, that the total value of multiple benefits should always be considered if SMES is to appear cost effective in many utility applications. These results should offer utilities further encouragement to conduct more detailed analyses of SMES benefits in scenarios that apply to individual systems.

Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis.

PubMed

Parker, Scott L; Adogwa, Owoicho; Davis, Brandon J; Fulchiero, Erin; Aaronson, Oran; Cheng, Joseph; Devin, Clinton J; McGirt, Matthew J

2013-02-01

Two-year cost-utility study comparing minimally invasive (MIS) versus open multilevel hemilaminectomy in patients with degenerative lumbar spinal stenosis. The objective of the study was to determine whether MIS versus open multilevel hemilaminectomy for degenerative lumbar spinal stenosis is a cost-effective advancement in lumbar decompression surgery. MIS-multilevel hemilaminectomy for degenerative lumbar spinal stenosis allows for effective treatment of back and leg pain while theoretically minimizing blood loss, tissue injury, and postoperative recovery. No studies have evaluated comprehensive healthcare costs associated with multilevel hemilaminectomy procedures, nor assessed cost-effectiveness of MIS versus open multilevel hemilaminectomy. Fifty-four consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach (n=27) versus midline open approach (n=27) were included. Total back-related medical resource utilization, missed work, and health state values [quality adjusted life years (QALYs), calculated from EuroQuol-5D with US valuation] were assessed after 2-year follow-up. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS versus open hemilaminectomy was assessed as incremental cost-effectiveness ratio (ICER: COST(MIS)-COST(OPEN)/QALY(MIS)-QALY(OPEN)). MIS versus open cohorts were similar at baseline. MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72 QALYs 2 years after surgery. Mean direct medical costs, indirect societal costs, and total 2-year cost ($23,109 vs. $25,420; P=0.21) were similar between MIS and open hemilaminectomy. MIS versus open approach was associated with similar total costs and utility, making it a cost equivalent technology compared with the traditional open approach. MIS versus open multilevel hemilaminectomy was associated with similar cost over 2 years while providing equivalent improvement in QALYs. In our experience, MIS versus open multilevel hemilaminectomy is a cost equivalent technology for patients with lumbar stenosis-associated radicular pain.

Economic and environmental optimization of a multi-site utility network for an industrial complex.

PubMed

Kim, Sang Hun; Yoon, Sung-Geun; Chae, Song Hwa; Park, Sunwon

2010-01-01

Most chemical companies consume a lot of steam, water and electrical resources in the production process. Given recent record fuel costs, utility networks must be optimized to reduce the overall cost of production. Environmental concerns must also be considered when preparing modifications to satisfy the requirements for industrial utilities, since wastes discharged from the utility networks are restricted by environmental regulations. Construction of Eco-Industrial Parks (EIPs) has drawn attention as a promising approach for retrofitting existing industrial parks to improve energy efficiency. The optimization of the utility network within an industrial complex is one of the most important undertakings to minimize energy consumption and waste loads in the EIP. In this work, a systematic approach to optimize the utility network of an industrial complex is presented. An important issue in the optimization of a utility network is the desire of the companies to achieve high profits while complying with the environmental regulations. Therefore, the proposed optimization was performed with consideration of both economic and environmental factors. The proposed approach consists of unit modeling using thermodynamic principles, mass and energy balances, development of a multi-period Mixed Integer Linear Programming (MILP) model for the integration of utility systems in an industrial complex, and an economic/environmental analysis of the results. This approach is applied to the Yeosu Industrial Complex, considering seasonal utility demands. The results show that both the total utility cost and waste load are reduced by optimizing the utility network of an industrial complex. 2009 Elsevier Ltd. All rights reserved.

Effects of weighting schemes on the identification of wildlife corridors generated with least-cost methods

Treesearch

Sean A. Parks; Kevin S. McKelvey; Michael K. Schwartz

2012-01-01

The importance of movement corridors for maintaining connectivity within metapopulations of wild animals is a cornerstone of conservation. One common approach for determining corridor locations is least-cost corridor (LCC) modeling, which uses algorithms within a geographic information system to search for routes with the lowest cumulative resistance between target...

Planning Routes Across Economic Terrains: Maximizing Utility, Following Heuristics

PubMed Central

Zhang, Hang; Maddula, Soumya V.; Maloney, Laurence T.

2010-01-01

We designed an economic task to investigate human planning of routes in landscapes where travel in different kinds of terrain incurs different costs. Participants moved their finger across a touch screen from a starting point to a destination. The screen was divided into distinct kinds of terrain and travel within each kind of terrain imposed a cost proportional to distance traveled. We varied costs and spatial configurations of terrains and participants received fixed bonuses minus the total cost of the routes they chose. We first compared performance to a model maximizing gain. All but one of 12 participants failed to adopt least-cost routes and their failure to do so reduced their winnings by about 30% (median value). We tested in detail whether participants’ choices of routes satisfied three necessary conditions (heuristics) for a route to maximize gain. We report failures of one heuristic for 7 out of 12 participants. Last of all, we modeled human performance with the assumption that participants assign subjective utilities to costs and maximize utility. For 7 out 12 participants, the fitted utility function was an accelerating power function of actual cost and for the remaining 5, a decelerating power function. We discuss connections between utility aggregation in route planning and decision under risk. Our task could be adapted to investigate human strategy and optimality of route planning in full-scale landscapes. PMID:21833269

The cost of energy from utility-owned solar electric systems. A required revenue methodology for ERDA/EPRI evaluations

NASA Technical Reports Server (NTRS)

1976-01-01

This methodology calculates the electric energy busbar cost from a utility-owned solar electric system. This approach is applicable to both publicly- and privately-owned utilities. Busbar cost represents the minimum price per unit of energy consistent with producing system-resultant revenues equal to the sum of system-resultant costs. This equality is expressed in present value terms, where the discount rate used reflects the rate of return required on invested capital. Major input variables describe the output capabilities and capital cost of the energy system, the cash flows required for system operation amd maintenance, and the financial structure and tax environment of the utility.

Least Life-Cycle Costs for Insulation in Alaska,

DTIC Science & Technology

1982-10-01

cost of an item by 113 and the labor conl- needed for each floor. This implies that the ma- ponent by 1.5 to arrive at the contra(ctor’s c ost for...price, the sumri of the adjusted labor structural system or the utilities It would there- and material Costs Was Multiplied by 1 15 1 inal- fore be...of fuel, the cost of transporting According to Table 5, onik\\ atter 1t0 years fuel to the sites, the labor and materianl costs of would the act

Variable population exposure and distributed travel speeds in least-cost tsunami evacuation modelling

NASA Astrophysics Data System (ADS)

Fraser, S. A.; Wood, N. J.; Johnston, D. M.; Leonard, G. S.; Greening, P. D.; Rossetto, T.

2014-11-01

Evacuation of the population from a tsunami hazard zone is vital to reduce life-loss due to inundation. Geospatial least-cost distance modelling provides one approach to assessing tsunami evacuation potential. Previous models have generally used two static exposure scenarios and fixed travel speeds to represent population movement. Some analyses have assumed immediate departure or a common evacuation departure time for all exposed population. Here, a method is proposed to incorporate time-variable exposure, distributed travel speeds, and uncertain evacuation departure time into an existing anisotropic least-cost path distance framework. The method is demonstrated for hypothetical local-source tsunami evacuation in Napier City, Hawke's Bay, New Zealand. There is significant diurnal variation in pedestrian evacuation potential at the suburb level, although the total number of people unable to evacuate is stable across all scenarios. Whilst some fixed travel speeds approximate a distributed speed approach, others may overestimate evacuation potential. The impact of evacuation departure time is a significant contributor to total evacuation time. This method improves least-cost modelling of evacuation dynamics for evacuation planning, casualty modelling, and development of emergency response training scenarios. However, it requires detailed exposure data, which may preclude its use in many situations.

Variable population exposure and distributed travel speeds in least-cost tsunami evacuation modelling

NASA Astrophysics Data System (ADS)

Fraser, S. A.; Wood, N. J.; Johnston, D. M.; Leonard, G. S.; Greening, P. D.; Rossetto, T.

2014-06-01

Evacuation of the population from a tsunami hazard zone is vital to reduce life-loss due to inundation. Geospatial least-cost distance modelling provides one approach to assessing tsunami evacuation potential. Previous models have generally used two static exposure scenarios and fixed travel speeds to represent population movement. Some analyses have assumed immediate evacuation departure time or assumed a common departure time for all exposed population. In this paper, a method is proposed to incorporate time-variable exposure, distributed travel speeds, and uncertain evacuation departure time into an existing anisotropic least-cost path distance framework. The model is demonstrated for a case study of local-source tsunami evacuation in Napier City, Hawke's Bay, New Zealand. There is significant diurnal variation in pedestrian evacuation potential at the suburb-level, although the total number of people unable to evacuate is stable across all scenarios. Whilst some fixed travel speeds can approximate a distributed speed approach, others may overestimate evacuation potential. The impact of evacuation departure time is a significant contributor to total evacuation time. This method improves least-cost modelling of evacuation dynamics for evacuation planning, casualty modelling, and development of emergency response training scenarios.

Variable population exposure and distributed travel speeds in least-cost tsunami evacuation modelling

USGS Publications Warehouse

Fraser, Stuart A.; Wood, Nathan J.; Johnston, David A.; Leonard, Graham S.; Greening, Paul D.; Rossetto, Tiziana

2014-01-01

Evacuation of the population from a tsunami hazard zone is vital to reduce life-loss due to inundation. Geospatial least-cost distance modelling provides one approach to assessing tsunami evacuation potential. Previous models have generally used two static exposure scenarios and fixed travel speeds to represent population movement. Some analyses have assumed immediate departure or a common evacuation departure time for all exposed population. Here, a method is proposed to incorporate time-variable exposure, distributed travel speeds, and uncertain evacuation departure time into an existing anisotropic least-cost path distance framework. The method is demonstrated for hypothetical local-source tsunami evacuation in Napier City, Hawke's Bay, New Zealand. There is significant diurnal variation in pedestrian evacuation potential at the suburb level, although the total number of people unable to evacuate is stable across all scenarios. Whilst some fixed travel speeds approximate a distributed speed approach, others may overestimate evacuation potential. The impact of evacuation departure time is a significant contributor to total evacuation time. This method improves least-cost modelling of evacuation dynamics for evacuation planning, casualty modelling, and development of emergency response training scenarios. However, it requires detailed exposure data, which may preclude its use in many situations.

Cost-effectiveness of an early assessment service for young people with early psychosis in Hong Kong.

PubMed

Wong, Kenny K; Chan, Sherry K W; Lam, May M L; Hui, Christy L M; Hung, Se F; Tay, Margaret; Lee, K H; Chen, Eric Y H

2011-08-01

The Early Assessment Service for Young People with Early Psychosis (EASY) was developed in Hong Kong in 2001 to provide a comprehensive and integrated approach for early detection and intervention for young people suffering from first episode psychosis. The present study examined the cost-effectiveness of the service over a period of 24 months compared to standard care. This is a historical control study. Sixty-five patients who presented to the EASY service in 2001 with first episode psychosis were individually matched (on age, sex and diagnosis) with 65 patients who received standard psychiatric care in a precursor service (pre-EASY) between 1999 and 2000. A retrospective cost-effectiveness analysis was conducted over a period of 24 months. The overall average cost of service utilization per patient and the effects on hospitalization rate were compared using bootstrapping analysis. Cost per point improvement in Positive and Negative Syndrome Scale (PANSS) was also computed with sensitivity analysis. Only direct costs were analysed in the current study. There was no significant difference in service utilization between the EASY and pre-EASY standard care groups. The cost-effectiveness acceptability curve, which was used to explore uncertainty in estimates of cost and effects, suggested that there was a probability of at least 94% that the EASY model was more cost-effective than the pre-EASY service in reducing psychiatric inpatient admissions. EASY patients also showed superior results in average cost per unit improvement in PANSS. EASY is likely to be more cost-effective in improving outcomes, particularly in reducing hospitalization and improving clinical symptoms among young people with first episode psychosis. This study provides a perspective from the east Asian region, and supports further development of similar services, particularly in the local setting. However, further studies with a longer follow up period and larger sample size are required to verify these findings.

An inexpensive, interdisciplinary, methodology to conduct an impact study of homeless persons on hospital based services.

PubMed

Parker, R David; Regier, Michael; Brown, Zachary; Davis, Stephen

2015-02-01

Homelessness is a primary concern for community health. Scientific literature on homelessness is wide ranging and diverse. One opportunity to add to existing literature is the development and testing of affordable, easily implemented methods for measuring the impact of homeless on the healthcare system. Such methodological approaches rely on the strengths in a multidisciplinary approach, including providers, both healthcare and homeless services and applied clinical researchers. This paper is a proof of concept for a methodology which is easily adaptable nationwide, given the mandated implementation of homeless management information systems in the United States and other countries; medical billing systems by hospitals; and research methods of researchers. Adaptation is independent of geographic region, budget restraints, specific agency skill sets, and many other factors that impact the application of a consistent methodological science based approach to assess and address homelessness. We conducted a secondary data analysis merging data from homeless utilization and hospital case based data. These data detailed care utilization among homeless persons in a small, Appalachian city in the United States. In our sample of 269 persons who received at least one hospital based service and one homeless service between July 1, 2012 and June 30, 2013, the total billed costs were $5,979,463 with 10 people costing more than one-third ($1,957,469) of the total. Those persons were primarily men, living in an emergency shelter, with pre-existing disabling conditions. We theorize that targeted services, including Housing First, would be an effective intervention. This is proposed in a future study.

Marginal abatement cost curves for NOx incorporating both controls and alternative measures

EPA Science Inventory

A marginal abatement cost curve (MACC) traces out the efficient marginal abatement cost level for any aggregate emissions target when a least cost approach is implemented. In order for it to represent the efficient MAC level, all abatement opportunities across all sectors and loc...

Laboratory Test Utilization Management: General Principles and Applications in Hematopathology.

PubMed

Reichard, Kaaren K; Wood, Adam J

2016-03-01

As the cost of health care continues to rise and reimbursement rates decrease, there is a growing demand and need to cut overall costs, enhance quality of services, and maintain as a top priority the needs and safety of the patient. In this article, we provide an introduction to test utilization and outline a general approach to creating an efficient, cost-effective test utilization strategy. We also present and discuss 2 test utilization algorithms that are evidence-based and may be of clinical utility as we move toward the future of doing the necessary tests at the right time. Copyright © 2016 Elsevier Inc. All rights reserved.

A cost-utility analysis of NRG Oncology/Gynecologic Oncology Group Protocol 218: incorporating prospectively collected quality-of-life scores in an economic model of treatment of ovarian cancer.

PubMed

Cohn, David E; Barnett, Jason C; Wenzel, Lari; Monk, Bradley J; Burger, Robert A; Straughn, J Michael; Myers, Evan R; Havrilesky, Laura J

2015-02-01

To estimate quality-of-life (QOL)-adjusted cost-utility with addition of bevacizumab (B) to intravenous paclitaxel/carboplatin (PC) for primary treatment of advanced-stage epithelial ovarian cancer. A modified Markov state transition model of 3 regimens evaluated in GOG 218 (PC, PC+concurrent B [PCB], and PCB+maintenance B [PCB+B]) was populated by prospectively collected survival, adverse event, and QOL data from GOG 218. Progression-free survival (PFS) and overall survival (OS) were modeled using primary event data. Costs of grade 4 hypertension, grade 3-5 bowel events, and growth factor support were incorporated. QOL scores were converted to utilities and incorporated into the model. Monte Carlo probabilistic sensitivity analysis was performed to account for uncertainty in estimates. PC was the least expensive ($4044) and least effective (mean 1.1 quality-adjusted progression-free years [QA-PFY]) regimen. PCB ($43,703 and 1.13 QA-PFY) was dominated by a combination of PC and PCB+B. PCB+B ($122,700 and 1.25 QA-PFY) was the most expensive regimen with an incremental cost-effectiveness ratio of $792,380/QA-PFY compared to PC. In a model not incorporating QOL, the incremental cost-effectiveness ratio (ICER) of PCB+B was $632,571/PFY compared to PC. In this cost-utility model, incorporation of QOL into an analysis of GOG 218 led to less favorable ICER (by >$150,000/QA-PFY) in regimens containing B compared with those that do not include B. Continued investigation of populations with ovarian cancer in whom the efficacy of treatment with bevacizumab is expected to be increased (or in whom QOL is expected to increase with use) is critical. Copyright © 2014 Elsevier Inc. All rights reserved.

Influence of transport energization on the growth yield of Escherichia coli.

PubMed

Muir, M; Williams, L; Ferenci, T

1985-09-01

The growth yields of Escherichia coli on glucose, lactose, galactose, maltose, maltotriose, and maltohexaose were estimated under anaerobic conditions in the absence of electron acceptors. The yields on these substrates exhibited significant differences when measured in carbon-limited chemostats at similar growth rates and compared in terms of grams (dry weight) of cells produced per mole of hexose utilized. Maltohexaose was the most efficiently utilized substrate, and galactose was the least efficiently utilized under these conditions. All these sugars were known to be metabolized to glucose 6-phosphate and produced the same pattern of fermentation products. The differences in growth yields were ascribed to differences in energy costs for transport and phosphorylation of these sugars. A formalized treatment of these factors in determining growth yields was established and used to obtain values for the cost of transport and hence the energy-coupling stoichiometries for the transport of substrates via proton symport and binding-protein-dependent mechanisms in vivo. By this approach, the proton-lactose stoichiometry was found to be 1.1 to 1.8 H+ per lactose, equivalent to approximately 0.5 ATP used per lactose transported. The cost of transporting maltose via a binding-protein-dependent mechanism was considerably higher, being over 1 to 1.2 ATP per maltose or maltodextrin transported. The formalized treatment also permitted estimation of the net ATP yield from the metabolism of these sugars; it was calculated that the growth yield data were consistent with the production of 2.8 to 3.2 ATP in the metabolism of glucose 6-phosphate to fermentation products.

Influence of transport energization on the growth yield of Escherichia coli.

PubMed Central

Muir, M; Williams, L; Ferenci, T

1985-01-01

The growth yields of Escherichia coli on glucose, lactose, galactose, maltose, maltotriose, and maltohexaose were estimated under anaerobic conditions in the absence of electron acceptors. The yields on these substrates exhibited significant differences when measured in carbon-limited chemostats at similar growth rates and compared in terms of grams (dry weight) of cells produced per mole of hexose utilized. Maltohexaose was the most efficiently utilized substrate, and galactose was the least efficiently utilized under these conditions. All these sugars were known to be metabolized to glucose 6-phosphate and produced the same pattern of fermentation products. The differences in growth yields were ascribed to differences in energy costs for transport and phosphorylation of these sugars. A formalized treatment of these factors in determining growth yields was established and used to obtain values for the cost of transport and hence the energy-coupling stoichiometries for the transport of substrates via proton symport and binding-protein-dependent mechanisms in vivo. By this approach, the proton-lactose stoichiometry was found to be 1.1 to 1.8 H+ per lactose, equivalent to approximately 0.5 ATP used per lactose transported. The cost of transporting maltose via a binding-protein-dependent mechanism was considerably higher, being over 1 to 1.2 ATP per maltose or maltodextrin transported. The formalized treatment also permitted estimation of the net ATP yield from the metabolism of these sugars; it was calculated that the growth yield data were consistent with the production of 2.8 to 3.2 ATP in the metabolism of glucose 6-phosphate to fermentation products. PMID:3928598

Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post-lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis.

PubMed

Manchikanti, Laxmaiah; Helm, Standiford; Pampati, Vidyasagar; Racz, Gabor B

2015-06-01

The increase in the number of interventions for the management of chronic pain and associated escalation of healthcare costs has captured the attention of health policymakers, in no small part due to the lack of documentation of efficacy, cost-effectiveness, or cost utility analysis. A recent cost utility analysis of caudal epidural injections in managing chronic low back pain of various pathologies showed a high cost utility with improvement in quality of life years, competitive with various other modalities of treatments. However, there are no analyses derived from high-quality controlled studies related to the cost utility of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome or lumbar central spinal stenosis. This analysis is based on 2 previously published controlled studies. To assess the cost utility of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain secondary to post-lumbar surgery syndrome and lumbar central spinal stenosis. A private, specialty referral interventional pain management center in the United States. Two controlled studies were conducted assessing the clinical effectiveness of percutaneous adhesiolysis for post-lumbar surgery syndrome and lumbar central spinal stenosis in an interventional pain management setting utilizing contemporary interventional pain management practices. A cost utility analysis was performed with direct payment data for a total of 130 patients in treatment groups over a 2-year period. Various outcome measures were included with significant improvement, defined as at least 50% improvement with reduction in pain and disability status. The results of 2 controlled studies of low back pain with 60 and 70 patients and a 2-year follow-up with the actual reimbursement data showed cost utility for 1 year of quality-adjusted life year (QALY) of USD $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis. The results of this assessment show that the cost utility of managing chronic, intractable low back pain with percutaneous adhesiolysis at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, spinal cord stimulation, and surgery. The limitations of this cost utility analysis are that it is a single-center evaluation, with the inclusion of costs of adhesiolysis procedures in an ambulatory surgery center and physician visits, rather than all related costs including drug therapy and costs of disability in multiple settings. This cost utility analysis of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome and lumbar central spinal stenosis shows the clinical effectiveness and cost utility of these procedures at USD $2,650 per one year of QALY when performed in an ambulatory surgery center. © 2014 World Institute of Pain.

Farm-level feasibility of bioenergy depends on variations across multiple sectors

NASA Astrophysics Data System (ADS)

Myhre, Mitchell; Barford, Carol

2013-03-01

The potential supply of bioenergy from farm-grown biomass is uncertain due to several poorly understood or volatile factors, including land availability, yield variability, and energy prices. Although biomass production for liquid fuel has received more attention, here we present a case study of biomass production for renewable heat and power in the state of Wisconsin (US), where heating constitutes at least 30% of total energy demand. Using three bioenergy systems (50 kW, 8.8 MW and 50 MW) and Wisconsin farm-level data, we determined the net farm income effect of producing switchgrass (Panicum virgatum) as a feedstock, either for on-farm use (50 kW system) or for sale to an off-farm energy system operator (8.8 and 50 MW systems). In southern counties, where switchgrass yields approach 10 Mg ha-1 yr-1, the main determinants of economic feasibility were the available land area per farm, the ability to utilize bioheat, and opportunity cost assumptions. Switchgrass yield temporal variability was less important. For the state median farm size and switchgrass yield, at least 25% (50 kW system) or 50% (8.8 MW system) bioheat utilization was required to economically offset propane or natural gas heat, respectively, and purchased electricity. Offsetting electricity only (50 MW system) did not generate enough revenue to meet switchgrass production expenses. Although the opportunity cost of small-scale (50 kW) on-farm bioenergy generation was higher, it also held greater opportunity for increasing farm net income, especially by replacing propane-based heat.

A Strategy for Helicobacter Immunohistochemistry Utilization in Pediatric Practice:  Insights From Morphologic and Cost-Benefit Analyses.

PubMed

Conces, Miriam R; Arnold, Christina A; Baker, Peter B; Carter, Christopher M; Fung, Bonita; Prasad, Vinay; Arnold, Michael A

2016-11-01

Recent studies in adults have examined the utility of immunohistochemistry (IHC) in detecting Helicobacter in gastric biopsy specimens and reached differing conclusions. Dedicated cost-benefit analysis of Helicobacter IHC in pediatric gastric biopsy specimens has not been performed. From 1,955 pediatric gastric biopsies in a 1-year period, we identified 63 Helicobacter -positive and 120 Helicobacter -negative biopsy specimens. All cases were scored according to the Updated Sydney System for the severity of inflammation. We observed that pediatric Helicobacter infection was significantly associated with germinal center formation, active inflammation, oxyntic mucosa with moderate to severe chronic inflammation, and antral mucosa with any chronic inflammation, exclusive of mild and superficial chronic inflammation. At least one associated pattern was seen in each Helicobacter -positive biopsy specimen. In comparison with adults, pediatric Helicobacter -positive biopsy specimens are more likely to lack acute inflammation and more likely to show moderate to marked chronic inflammation. We recommend performing Helicobacter IHC on pediatric gastric biopsy specimens with any of the above inflammatory patterns. This approach can sensitively identify pediatric patients with Helicobacter gastritis, limit IHC staining to approximately 30% of all gastric biopsy specimens, and reduce costs by up to $55,306.90 per 1,000 biopsy specimens. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Early Versus Delayed Surgical Decompression of Spinal Cord after Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis.

PubMed

Furlan, Julio C; Craven, B Catharine; Massicotte, Eric M; Fehlings, Michael G

2016-04-01

This cost-utility analysis was undertaken to compare early (≤24 hours since trauma) versus delayed surgical decompression of spinal cord to determine which approach is more cost effective in the management of patients with acute traumatic cervical spinal cord injury (SCI). This study includes the patients enrolled into the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) and admitted at Toronto Western Hospital. Cases were grouped into patients with motor complete SCI and individuals with motor incomplete SCI. A cost-utility analysis was performed for each group of patients by the use of data for the first 6 months after SCI. The perspective of a public health care insurer was adopted. Costs were estimated in 2014 U.S. dollars. Utilities were estimated from the STASCIS. The baseline analysis indicates early spinal decompression is more cost-effective approach compared with the delayed spinal decompression. When we considered the delayed spinal decompression as the baseline strategy, the incremental cost-effectiveness ratio analysis revealed a saving of US$ 58,368,024.12 per quality-adjusted life years gained for patients with complete SCI and a saving of US$ 536,217.33 per quality-adjusted life years gained in patients with incomplete SCI for the early spinal decompression. The probabilistic analysis confirmed the early-decompression strategy as more cost effective than the delayed-decompression approach, even though there is no clearly dominant strategy. The results of this economic analysis suggests that early decompression of spinal cord was more cost effective than delayed surgical decompression in the management of patients with motor complete and incomplete SCI, even though no strategy was clearly dominant. Copyright © 2016 Elsevier Inc. All rights reserved.

Photovoltaics and electric utilities

NASA Astrophysics Data System (ADS)

Bright, R.; Leigh, R.; Sills, T.

1981-12-01

The long term value of grid connected, residential photovoltaic (PV) systems is determined. The value of the PV electricity is defined as the full avoided cost in accordance with the Public Utilities Regulatory Policies Act of 1978. The avoided cost is computed using a long range utility planning approach to measure revenue requirement changes in response to the time phased introduction of PV systems into the grid. A case study approach to three utility systems is used. The changing value of PV electricity over a twenty year period from 1985 is presented, and the fuel and capital savings due to FY are analyzed. These values are translated into measures of breakeven capital investment under several options of power interchange and pricing.

When the 'soft-path' gets hard: demand management and financial instability for water utilities

NASA Astrophysics Data System (ADS)

Zeff, H. B.; Characklis, G. W.

2014-12-01

In the past, cost benefit analysis (CBA) has been viewed as an effective means of evaluating water utility strategies, particularly those that were dependent on the construction of new supply infrastructure. As water utilities have begun to embrace 'soft-path' approaches as a way to reduce the need for supply-centric development, CBA fails to recognize some important financial incentives affected by reduced water consumption. Demand management, both as a short-term response to drought and in longer-term actions to accommodate demand growth, can introduce revenue risks that adversely affect a utility's ability to repay debt, re-invest in aging infrastructure, or maintain reserve funds for use in a short-term emergency. A utility that does not generate sufficient revenue to support these functions may be subject to credit rating downgrades, which in turn affect the interest rate it pays on its debt. Interest rates are a critical consideration for utility managers in the capital-intensive water sector, where debt payments for infrastructure often account for a large portion of a utility's overall costs. Even a small increase in interest rates can add millions of dollars to the cost of new infrastructure. Recent studies have demonstrated that demand management techniques can lead to significant revenue variability, and credit rating agencies have begun to take notice of drought response plans when evaluating water utility credit ratings, providing utilities with a disincentive to fully embrace soft-path approaches. This analysis examines the impact of demand management schemes on key credit rating metrics for a water utility in Raleigh, North Carolina. The utility's consumer base is currently experiencing rapid population growth, and demand management has the potential to reduce the dependence on costly new supply infrastructure but could lead to financial instability that will significantly increase the costs of financing future projects. This work analyzes how 'soft-path' approaches might be more efficiently integrated with investment in supply-side infrastructure and suggests how financial hedging tools could be used to improve long-term utility planning objectives.

Household water use and conservation models using Monte Carlo techniques

NASA Astrophysics Data System (ADS)

Cahill, R.; Lund, J. R.; DeOreo, B.; Medellín-Azuara, J.

2013-10-01

The increased availability of end use measurement studies allows for mechanistic and detailed approaches to estimating household water demand and conservation potential. This study simulates water use in a single-family residential neighborhood using end-water-use parameter probability distributions generated from Monte Carlo sampling. This model represents existing water use conditions in 2010 and is calibrated to 2006-2011 metered data. A two-stage mixed integer optimization model is then developed to estimate the least-cost combination of long- and short-term conservation actions for each household. This least-cost conservation model provides an estimate of the upper bound of reasonable conservation potential for varying pricing and rebate conditions. The models were adapted from previous work in Jordan and are applied to a neighborhood in San Ramon, California in the eastern San Francisco Bay Area. The existing conditions model produces seasonal use results very close to the metered data. The least-cost conservation model suggests clothes washer rebates are among most cost-effective rebate programs for indoor uses. Retrofit of faucets and toilets is also cost-effective and holds the highest potential for water savings from indoor uses. This mechanistic modeling approach can improve understanding of water demand and estimate cost-effectiveness of water conservation programs.

Household water use and conservation models using Monte Carlo techniques

NASA Astrophysics Data System (ADS)

Cahill, R.; Lund, J. R.; DeOreo, B.; Medellín-Azuara, J.

2013-04-01

The increased availability of water end use measurement studies allows for more mechanistic and detailed approaches to estimating household water demand and conservation potential. This study uses, probability distributions for parameters affecting water use estimated from end use studies and randomly sampled in Monte Carlo iterations to simulate water use in a single-family residential neighborhood. This model represents existing conditions and is calibrated to metered data. A two-stage mixed integer optimization model is then developed to estimate the least-cost combination of long- and short-term conservation actions for each household. This least-cost conservation model provides an estimate of the upper bound of reasonable conservation potential for varying pricing and rebate conditions. The models were adapted from previous work in Jordan and are applied to a neighborhood in San Ramon, California in eastern San Francisco Bay Area. The existing conditions model produces seasonal use results very close to the metered data. The least-cost conservation model suggests clothes washer rebates are among most cost-effective rebate programs for indoor uses. Retrofit of faucets and toilets is also cost effective and holds the highest potential for water savings from indoor uses. This mechanistic modeling approach can improve understanding of water demand and estimate cost-effectiveness of water conservation programs.

Is control through utilization a cost effective Prosopis juliflora management strategy?

PubMed

Wakie, Tewodros T; Hoag, Dana; Evangelista, Paul H; Luizza, Matthew; Laituri, Melinda

2016-03-01

The invasive tree Prosopis juliflora is known to cause negative impacts on invaded ranges. High P. juliflora eradication costs have swayed developing countries to follow a new and less expensive approach known as control through utilization. However, the net benefits of this new approach have not been thoroughly evaluated. Our objective was to assess the economic feasibility of selected P. juliflora eradication and utilization approaches that are currently practiced in one of the severely affected developing countries, Ethiopia. The selected approaches include converting P. juliflora infested lands into irrigated farms (conversion), charcoal production, and seed flour production. We estimate the costs and revenues of the selected P. juliflora eradication and utilization approaches by interviewing 19 enterprise owners. We assess the economic feasibility of the enterprises by performing enterprise, break-even, investment, sensitivity, and risk analyses. Our results show that conversion to irrigated cotton is economically profitable, with Net Present Value (NPV) of 5234 US$/ha over 10 years and an interest rate of 10% per year. Conversion greatly reduces the spread of P. juliflora on farmlands. Managing P. juliflora infested lands for charcoal production with a four-year harvest cycle is profitable, with NPV of 805 US$/ha. However, the production process needs vigilant regulation to protect native plants from exploitation and caution should be taken to prevent charcoal production sites from becoming potential seed sources. Though flour from P. juliflora pods can reduce invasions by destroying viable seeds, flour enterprises in Ethiopia are unprofitable. Conversion and charcoal production can be undertaken with small investment costs, while flour production requires high investment costs. Introducing new changes in the production and management steps of P. juliflora flour might be considered to make the enterprise profitable. Our study shows that control through utilization may be a viable P. juliflora management strategy under the right environmental setting. Published by Elsevier Ltd.

Economic evaluation of nivolumab for the treatment of second-line advanced squamous NSCLC in Canada: a comparison of modeling approaches to estimate and extrapolate survival outcomes.

PubMed

Goeree, Ron; Villeneuve, Julie; Goeree, Jeff; Penrod, John R; Orsini, Lucinda; Tahami Monfared, Amir Abbas

2016-06-01

Background Lung cancer is the most common type of cancer in the world and is associated with significant mortality. Nivolumab demonstrated statistically significant improvements in progression-free survival (PFS) and overall survival (OS) for patients with advanced squamous non-small cell lung cancer (NSCLC) who were previously treated. The cost-effectiveness of nivolumab has not been assessed in Canada. A contentious component of projecting long-term cost and outcomes in cancer relates to the modeling approach adopted, with the two most common approaches being partitioned survival (PS) and Markov models. The objectives of this analysis were to estimate the cost-utility of nivolumab and to compare the results using these alternative modeling approaches. Methods Both PS and Markov models were developed using docetaxel and erlotinib as comparators. A three-health state model was used consisting of progression-free, progressed disease, and death. Disease progression and time to progression were estimated by identifying best-fitting survival curves from the clinical trial data for PFS and OS. Expected costs and health outcomes were calculated by combining health-state occupancy with medical resource use and quality-of-life assigned to each of the three health states. The health outcomes included in the model were survival and quality-adjusted-life-years (QALYs). Results Nivolumab was found to have the highest expected per-patient cost, but also improved per-patient life years (LYs) and QALYs. Nivolumab cost an additional $151,560 and $140,601 per QALY gained compared to docetaxel and erlotinib, respectively, using a PS model approach. The cost-utility estimates using a Markov model were very similar ($152,229 and $141,838, respectively, per QALY gained). Conclusions Nivolumab was found to involve a trade-off between improved patient survival and QALYs, and increased cost. It was found that the use of a PS or Markov model produced very similar estimates of expected cost, outcomes, and incremental cost-utility.

Valuing reduced antibiotic use for pediatric acute otitis media.

PubMed

Meropol, Sharon B

2008-04-01

The 2004 American Academy of Pediatrics acute otitis media guidelines urge parents to weigh the benefits of reduced antibiotic use, adverse drug events, and future resistance versus risks of extra costs and sick days resulting from guideline use. The value of decreased antibiotic resistance has not been quantified. The objective was to perform cost-utility analysis, estimating the resistance value of implementing the guidelines for acute otitis media treatment for children <2 years of age. Outcomes were described with a common denominator and the value of avoiding resistance was estimated using a parental perspective. Decision analysis results were used for outcome probabilities. Published utilities were used to describe outcomes in quality-adjusted life-day units. The minimum resistance benefit value, where the benefits of the American Academy of Pediatrics guidelines would at least balance their costs, was defined as the guidelines' incremental costs minus their other benefits. For a child 2 to <6 months of age presenting to a primary care physician with possible otitis media, parents would need to value the resistance benefit at 0.77 quality-adjusted life-days per antibiotic prescription avoided for the guidelines' benefits to balance their costs. For the 6- to <24-month-old group, results were 0.67 quality-adjusted life-days per prescription avoided. Results were sensitive to the dollar cost utility; when willingness to pay ranged from $20,000 to $200,000 per quality-adjusted life-year, results ranged from 0.36 and 0.30 quality-adjusted life-days up to 4.10 and 3.57 quality-adjusted life-days for the 2- to <6-month-old and 6- to <24-month-old groups, respectively. Costs were driven by missed parent work days. From a societal perspective, trading 0.30 to 4 quality-adjusted life-days to avoid 1 antibiotic course might be desirable; from a parental perspective, this may not be as desirable. Parent demand for antibiotics may be rational when driven by the value of parent time. Other approaches that have the potential to reduce antibiotic use, such as wider use of influenza vaccine and improved rapid viral diagnostic techniques, might be more successful.

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

PubMed

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

2016-06-01

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

Tamoxifen for breast cancer risk reduction: impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis.

PubMed

Melnikow, Joy; Birch, Stephen; Slee, Christina; McCarthy, Theodore J; Helms, L Jay; Kuppermann, Miriam

2008-09-01

In cost-effectiveness analysis (CEA), the effects of health-care interventions on multiple health dimensions typically require consideration of both quantity and quality of life. To explore the impact of alternative approaches to quality-of-life adjustment using patient preferences (utilities) on the outcome of a CEA on use of tamoxifen for breast cancer risk reduction. A state transition Markov model tracked hypothetical cohorts of women who did or did not take 5 years of tamoxifen for breast cancer risk reduction. Incremental quality-adjusted effectiveness and cost-effectiveness ratios (ICERs) for models including and excluding a utility adjustment for menopausal symptoms were compared with each other and to a global utility model. Two hundred fifty-five women aged 50 and over with estimated 5-year breast cancer risk >or=1.67% participated in utility assessment interviews. Standard gamble utilities were assessed for specified tamoxifen-related health outcomes, current health, and for a global assessment of possible outcomes of tamoxifen use. Inclusion of a utility for menopausal symptoms in the outcome-specific models substantially increased the ICER; at the threshold 5-year breast cancer risk of 1.67%, tamoxifen was dominated. When a global utility for tamoxifen was used in place of outcome-specific utilities, tamoxifen was dominated under all circumstances. CEAs may be profoundly affected by the types of outcomes considered for quality-of-life adjustment and how these outcomes are grouped for utility assessment. Comparisons of ICERs across analyses must consider effects of different approaches to using utilities for quality-of-life adjustment.

Cost-utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves' disease.

PubMed

Donovan, Peter J; McLeod, Donald S A; Little, Richard; Gordon, Louisa

2016-12-01

Little data is in existence about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia. We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies. © 2016 European Society of Endocrinology.

Choosing Models for Health Care Cost Analyses: Issues of Nonlinearity and Endogeneity

PubMed Central

Garrido, Melissa M; Deb, Partha; Burgess, James F; Penrod, Joan D

2012-01-01

Objective To compare methods of analyzing endogenous treatment effect models for nonlinear outcomes and illustrate the impact of model specification on estimates of treatment effects such as health care costs. Data Sources Secondary data on cost and utilization for inpatients hospitalized in five Veterans Affairs acute care facilities in 2005–2006. Study Design We compare results from analyses with full information maximum simulated likelihood (FIMSL); control function (CF) approaches employing different types and functional forms for the residuals, including the special case of two-stage residual inclusion; and two-stage least squares (2SLS). As an example, we examine the effect of an inpatient palliative care (PC) consultation on direct costs of care per day. Data Collection/Extraction Methods We analyzed data for 3,389 inpatients with one or more life-limiting diseases. Principal Findings The distribution of average treatment effects on the treated and local average treatment effects of a PC consultation depended on model specification. CF and FIMSL estimates were more similar to each other than to 2SLS estimates. CF estimates were sensitive to choice and functional form of residual. Conclusions When modeling cost or other nonlinear data with endogeneity, one should be aware of the impact of model specification and treatment effect choice on results. PMID:22524165

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

LeBaron, Robin; Saul-Rinaldi, Kara

There has never been a better time to launch initiatives to promote residential energy efficiency savings. Over the past several decades, residential retrofit programs have demonstrated that energy efficiency measures contribute to achieving multiple benefits, including but not limited to reductions in home energy consumption, stabilization improvements for the grid by shaving peak loads, saving consumers millions on utility bills, and significantly reducing carbon emissions. Although a number of barriers to widespread uptake of home energy upgrades persist, the lessons learned as a result of the 2009 stimulus funding1 have resulted in a set of policy approaches that create newmore » strategies for taking residential energy efficiency to scale.2 The identification of these approaches is well timed; energy efficiency is often the least expensive and most cost effective way to comply with a variety of federal, state and local policies. This Guide is designed to help state and local policymakers to take full advantage of new policy developments by providing them with a comprehensive set of tools to support launching or accelerating residential energy efficiency programs. It is written primarily for state and local policymakers, including state and local executives, legislators, public utility commissioners, and the staff who advise them.« less

A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students.

PubMed

Maloney, Stephen; Nicklen, Peter; Rivers, George; Foo, Jonathan; Ooi, Ying Ying; Reeves, Scott; Walsh, Kieran; Ilic, Dragan

2015-07-21

Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions. Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.

Economic evaluation of pressure ulcer care: a cost minimization analysis of preventive strategies.

PubMed

Schuurman, Jaap-Peter; Schoonhoven, Lisette; Defloor, Tom; van Engelshoven, Ilse; van Ramshorst, Bert; Buskens, Erik

2009-01-01

The purpose of this study was to determine the cost for prevention and treatment of pressure ulcers from a hospital perspective and to identify the least resource-intensive pressure ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was carried out alongside a prospective cohort study on the incidence and risk factors for pressure ulcers. Two large teaching hospitals in the Netherlands with (partly) opposing approaches in prevention, a technological versus a human approach, were analyzed. The main outcome measures were resource use, costs of preventive measures and treatment, and pressure ulcer incidence in both hospitals. Pressure ulcer prevention through a predominantly technical approach resulted in a similar incidence rate as prevention through a predominantly human approach. However, the technical approach was considerably less expensive.

IUS/TUG orbital operations and mission support study. Volume 5: Cost estimates

NASA Technical Reports Server (NTRS)

1975-01-01

The costing approach, methodology, and rationale utilized for generating cost data for composite IUS and space tug orbital operations are discussed. Summary cost estimates are given along with cost data initially derived for the IUS program and space tug program individually, and cost estimates for each work breakdown structure element.

Degradation of Silicone Encapsulants in CPV Optics

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

Cai, Can; Miller, David C.; Tappan, Ian A.

High efficiency multijunction solar cells in terrestrial concentrator photovoltaic (CPV) modules are becoming an increasingly cost effective and viable option in utility scale power generation. As with other utility scale photovoltaics, CPV modules need to guarantee operational lifetimes of at least 25 years. The reliability of optical elements in CPV modules poses a unique materials challenge due to the increased UV irradiance and enhanced temperature cycling associated with concentrated solar flux. The polymeric and thin film materials used in the optical elements are especially susceptible to UV damage, diurnal temperature cycling and active chemical species from the environment. We usedmore » fracture mechanics approaches to study the degradation modes including: the adhesion between the encapsulant and the cell or secondary optical element; and the cohesion of the encapsulant itself. Understanding the underlying mechanisms of materials degradation under elevated stress conditions is critical for commercialization of CPV technology and can offer unique insights into degradation modes in similar encapsulants used in other photovoltaic modules.« less

Degradation of Silicone Encapsulants in CPV Optics: Preprint

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

Miller, David C.; Tappan, Ian A.; Cai, Can

High efficiency multijunction solar cells in terrestrial concentrator photovoltaic (CPV) modules are becoming an increasingly cost effective and viable option in utility scale power generation. As with other utility scale photovoltaics, CPV modules need to guarantee operational lifetimes of at least 25 years. The reliability of optical elements in CPV modules poses a unique materials challenge due to the increased UV irradiance and enhanced temperature cycling associated with concentrated solar flux. The polymeric and thin film materials used in the optical elements are especially susceptible to UV damage, diurnal temperature cycling and active chemical species from the environment. We usedmore » fracture mechanics approaches to study the degradation modes including: the adhesion between the encapsulant and the cell or secondary optical element; and the cohesion of the encapsulant itself. Understanding the underlying mechanisms of materials degradation under elevated stress conditions is critical for commercialization of CPV technology and can offer unique insights into degradation modes in similar encapsulants used in other photovoltaic modules.« less

Laser-zone growth in a Ribbon-To-Ribbon (RTR) process silicon sheet growth development for the large area silicon sheet task of the low cost silicon solar array project

NASA Technical Reports Server (NTRS)

Gurtler, R. W.; Baghdadi, A.; Wise, J.; Ellis, R. J.

1977-01-01

The Ribbon-to-Ribbon (RTR) approach to silicon ribbon growth was investigated. An existing RTR apparatus, RTR#1, was upgraded to allow for 5 cm wide ribbon growth with a finite stroke length of at least 15 cm. A second RTR apparatus, RTR#2, was designed, built, and operated which utilizes continuous feed mechanisms and allows continuous growth of 7.5 cm wide ribbons. RTR#2 includes development and utilization of advanced beam scanning (or shaping), high power lasers, and thermal profile modification elements to attain maximum growth velocities (with a design goal of 18 cm/min). Materials studies, process development, and thermal analyses are also described. Residual stresses and dislocation densities were minimized through theoretical and experimental efforts towards optimization of thermal profiles. Growth runs were performed on RTR#2 and solar cells were fabricated which demonstrated efficiencies greater than 10%.

The power of disruptive technological innovation: Transcatheter aortic valve implantation.

PubMed

Berlin, David B; Davidson, Michael J; Schoen, Frederick J

2015-11-01

We sought to evaluate the principles of disruptive innovation, defined as technology innovation that fundamentally shifts performance and utility metrics, as applied to transcatheter aortic valve implantation (TAVI). In particular, we considered implantation procedure, device design, cost, and patient population. Generally cheaper and lower performing, classical disruptive innovations are first commercialized in insignificant markets, promise lower margins, and often parasitize existing usage, representing unattractive investments for established market participants. However, despite presently high unit cost, TAVI is less invasive, treats a "new," generally high risk, patient population, and is generally done by a multidisciplinary integrated heart team. Moreover, at least in the short-term TAVI has not been lower-performing than open surgical aortic valve replacement in high-risk patients. We conclude that TAVI extends the paradigm of disruptive innovation and represents an attractive commercial opportunity space. Moreover, should the long-term performance and durability of TAVI approach that of conventional prostheses, TAVI will be an increasingly attractive commercial opportunity. © 2014 Wiley Periodicals, Inc.

Undersea line planned to transmit to an island

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

Not Available

The electric utility serving Nantucket Island in Massachusetts, which until now has generated its own power, plans to lay 25 miles of transmission cable to connect with New England's mainland grid. The line will allow the utility to purchase less costly power and retire several old generators, improving both reliability and air quality on the island. Nantucket Electric Co. says the 33-Mw submarine link, costing at least $23 million, probably will connect with a line near the elbow on Cape Cod. The undersea cable will be as deep as 60 ft. Nantucket Electric plans to form a partnership within amore » few months with a mainland utility or private producer that would help finance the project and sell the power. The island utility has preliminary approval by the state Industrial Finance Agency for a tax-exempt bond issue to finance the cable, contingent on its finding a partner.« less

No Cost – Low Cost Compressed Air System Optimization in Industry

NASA Astrophysics Data System (ADS)

Dharma, A.; Budiarsa, N.; Watiniasih, N.; Antara, N. G.

2018-04-01

Energy conservation is a systematic, integrated of effort, in order to preserve energy sources and improve energy utilization efficiency. Utilization of energy in efficient manner without reducing the energy usage it must. Energy conservation efforts are applied at all stages of utilization, from utilization of energy resources to final, using efficient technology, and cultivating an energy-efficient lifestyle. The most common way is to promote energy efficiency in the industry on end use and overcome barriers to achieve such efficiency by using system energy optimization programs. The facts show that energy saving efforts in the process usually only focus on replacing tools and not an overall system improvement effort. In this research, a framework of sustainable energy reduction work in companies that have or have not implemented energy management system (EnMS) will be conducted a systematic technical approach in evaluating accurately a compressed-air system and potential optimization through observation, measurement and verification environmental conditions and processes, then processing the physical quantities of systems such as air flow, pressure and electrical power energy at any given time measured using comparative analysis methods in this industry, to provide the potential savings of energy saving is greater than the component approach, with no cost to the lowest cost (no cost - low cost). The process of evaluating energy utilization and energy saving opportunities will provide recommendations for increasing efficiency in the industry and reducing CO2 emissions and improving environmental quality.

An Australian discrete choice experiment to value eq-5d health states.

PubMed

Viney, Rosalie; Norman, Richard; Brazier, John; Cronin, Paula; King, Madeleine T; Ratcliffe, Julie; Street, Deborah

2014-06-01

Conventionally, generic quality-of-life health states, defined within multi-attribute utility instruments, have been valued using a Standard Gamble or a Time Trade-Off. Both are grounded in expected utility theory but impose strong assumptions about the form of the utility function. Preference elicitation tasks for both are complicated, limiting the number of health states that each respondent can value and, therefore, that can be valued overall. The usual approach has been to value a set of the possible health states and impute values for the remainder. Discrete Choice Experiments (DCEs) offer an attractive alternative, allowing investigation of more flexible specifications of the utility function and greater coverage of the response surface. We designed a DCE to obtain values for EQ-5D health states and implemented it in an Australia-representative online panel (n = 1,031). A range of specifications investigating non-linear preferences with respect to time and interactions between EQ-5D levels were estimated using a random-effects probit model. The results provide empirical support for a flexible utility function, including at least some two-factor interactions. We then constructed a preference index such that full health and death were valued at 1 and 0, respectively, to provide a DCE-based algorithm for Australian cost-utility analyses. Copyright © 2013 John Wiley & Sons, Ltd.

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

Puttagunta, Srikanth

National programs such as Home Performance with ENERGY STAR® and numerous other utility air sealing programs have brought awareness to homeowners of the benefits of energy efficiency retrofits. Yet, these programs tend to focus on the low-hanging fruit: air-sealing the thermal envelope and ductwork where accessible, switch to efficient lighting, and low-flow fixtures. At the other end of the spectrum, deep-energy retrofit programs are also being encouraged by various utilities across the country. While deep energy retrofits typically seek 50% energy savings, they are often quite costly and most applicable to gut-rehab projects. A significant potential for lowering energy usagemore » in existing homes lies between the low hanging fruit and deep energy retrofit approaches - retrofits that save approximately 30% in energy over the existing conditions. A key is to be non-intrusive with the efficiency measures so the retrofit projects can be accomplished in occupied homes. This cold climate retrofit project involved the design and optimization of a home in Connecticut that sought to improve energy savings by at least 30% (excluding solar PV) over the existing home's performance. This report documents the successful implementation of a cost-effective solution package that achieved performance greater than 30% over the pre-retrofit - what worked, what did not, and what improvements could be made.« less

Cost utility analysis of caudal epidural injections in the treatment of lumbar disc herniation, axial or discogenic low back pain, central spinal stenosis, and post lumbar surgery syndrome.

PubMed

Manchikanti, Laxmaiah; Falco, Frank J E; Pampati, Vidyasagar; Cash, Kimberly A; Benyamin, Ramsin M; Hirsch, Joshua A

2013-01-01

In this era of escalating health care costs and the questionable effectiveness of multiple interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine, and has an influence coverage decisions. Even though multiple cost effectiveness analysis studies have been performed over the years, extensive literature is lacking for interventional techniques. Cost utility analysis studies of epidural injections for managing chronic low back pain demonstrated highly variable results including a lack of cost utility in randomized trials and contrasting results in observational studies. There has not been any cost utility analysis studies of epidural injections in large randomized trials performed in interventional pain management settings. To assess the cost utility of caudal epidural injections in managing chronic low back pain secondary to lumbar disc herniation, axial or discogenic low back pain, lumbar central spinal stenosis, and lumbar post surgery syndrome. This analysis is based on 4 previously published randomized trials. A private, specialty referral interventional pain management center in the United States. Four randomized trials were conducted assessing the clinical effectiveness of caudal epidural injections with or without steroids for lumbar disc herniation, lumbar discogenic or axial low back pain, lumbar central spinal stenosis, and post surgery syndrome. A cost utility analysis was performed with direct payment data for a total of 480 patients over a period of 2 years from these 4 trials. Outcome included various measures with significant improvement defined as at least a 50% improvement in pain reduction and disability status. The results of 4 randomized controlled trials of low back pain with 480 patients with a 2 year follow-up with the actual reimbursement data showed cost utility for one year of quality-adjusted life year (QALY) of $2,206 for disc herniation, $2,136 for axial or discogenic pain without disc herniation, $2,155 for central spinal stenosis, and $2,191 for post surgery syndrome. All patients showed significant improvement clinically and showed positive results in the cost utility analysis with an average cost per one year QALY of $2,172.50 for all patients and $1,966.03 for patients judged to be successful. The results of this assessment show a better cost utility or lower cost of managing chronic, intractable low back pain with caudal epidural injections at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, and surgery in most cases. The limitations of this cost utility analysis include that it is a single center evaluation, even though 480 patients were included in the analysis. Further, only the costs of interventional procedures and physician visits were included. The benefits of returning to work were not assessed.   This cost utility analysis of caudal epidural injections in the treatment of disc herniation, axial or discogenic low back pain, central spinal stenosis, and post surgery syndrome in the lumbar spine shows the clinical effectiveness and cost utility of these injections at less than $2,200 per one year of QALY.

Proceedings: 1990 EPRI gas turbine procurement seminar

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

McDonald, B.L.; Miller, M.N.

1991-06-01

This seminar presents information that enables utilities to implement more cost-effective procurements for gas turbine and combined-cycle power generation equipment. A systematic approach to specification and permitting procedures can lower unit life-cycle cost. APPROACH. Thirty-two staff members from 25 utilities met in Danvers, Massachusetts, October 9--11, 1990. Speakers representing utilities, vendors, and EPRI contractors presented material on recent procurement and startup experiences, permitting considerations, specification strategy, bid evaluation techniques, and a vendor's perspective of utility procurements. KEY POINTS. The seminar focused on specification features, procurement procedures, and bid evaluation techniques designed to implement life-cycle cost-effective procurement consistent with the plantmore » mission. Speakers highlighted the following issues: Experiential case histories of recent procurements and startups, emphasizing how to design procurement procedures that improve plant operating economics; Current trends in permitting for NO{sub x} compliance and recent permitting experience; Quantifiable evaluations of vendors' bids for RAM-related characteristics; The means to obtain specifically desired but nonstandard equipment features.« less

Understanding London's Water Supply Tradeoffs When Scheduling Interventions Under Deep Uncertainty

NASA Astrophysics Data System (ADS)

Huskova, I.; Matrosov, E. S.; Harou, J. J.; Kasprzyk, J. R.; Reed, P. M.

2015-12-01

Water supply planning in many major world cities faces several challenges associated with but not limited to climate change, population growth and insufficient land availability for infrastructure development. Long-term plans to maintain supply-demand balance and ecosystem services require careful consideration of uncertainties associated with future conditions. The current approach for London's water supply planning utilizes least cost optimization of future intervention schedules with limited uncertainty consideration. Recently, the focus of the long-term plans has shifted from solely least cost performance to robustness and resilience of the system. Identifying robust scheduling of interventions requires optimizing over a statistically representative sample of stochastic inputs which may be computationally difficult to achieve. In this study we optimize schedules using an ensemble of plausible scenarios and assess how manipulating that ensemble influences the different Pareto-approximate intervention schedules. We investigate how a major stress event's location in time as well as the optimization problem formulation influence the Pareto-approximate schedules. A bootstrapping method that respects the non-stationary trend of climate change scenarios and ensures the even distribution of the major stress event in the scenario ensemble is proposed. Different bootstrapped hydrological scenario ensembles are assessed using many-objective scenario optimization of London's future water supply and demand intervention scheduling. However, such a "fixed" scheduling of interventions approach does not aim to embed flexibility or adapt effectively as the future unfolds. Alternatively, making decisions based on the observations of occurred conditions could help planners who prefer adaptive planning. We will show how rules to guide the implementation of interventions based on observations may result in more flexible strategies.

NALNET book system: Cost benefit study

NASA Technical Reports Server (NTRS)

Dewath, N. V.; Palmour, V. E.; Foley, J. R.; Henderson, M. M.; Shockley, C. W.

1981-01-01

The goals of the NASA's library network system, NALNET, the functions of the current book system, the products and services of a book system required by NASA Center libraries, and the characteristics of a system that would best supply those products and services were assessed. Emphasis was placed on determining the most cost effective means of meeting NASA's requirements for an automated book system. Various operating modes were examined including the current STIMS file, the PUBFILE, developing software improvements for products as appropriate to the Center needs, and obtaining cataloging and products from the bibliographic utilities including at least OCLC, RLIN, BNA, and STIF. It is recommended that NALNET operate under the STIMS file mode and obtain cataloging and products from the bibliographic utilities. The recommendations are based on the premise that given the current state of the art in library automation it is not cost effective for NASA to maintain a full range of cataloging services on its own system. The bibliographic utilities can support higher quality systems with a greater range of services at a lower total cost.

Electric thermal storage demonstration program

NASA Astrophysics Data System (ADS)

In early 1989, MMWEC, a joint action agency comprised of 30 municipal light departments in Massachusetts and on affiliate in Rhode Island, responded to a DOE request to proposal for the Least Cost Utility Planning Program. The MMWEC submission was for the development of a program, focused on small rural electric utilities, to promote the use of electric thermal storage heating systems in residential applications. This report discusses the demonstration of ETS equipment at four member light departments.

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

None

??National programs such as Home Performance with ENERGY STAR(R) and numerous other utility air sealing programs have brought awareness to homeowners of the benefits of energy efficiency retrofits. Yet, these programs tend to focus on the low-hanging fruit: air-sealing the thermal envelope and ductwork where accessible, switch to efficient lighting, and low-flow fixtures. At the other end of the spectrum, deep-energy retrofit programs are also being encouraged by various utilities across the country. While deep energy retrofits typically seek 50% energy savings, they are often quite costly and most applicable to gut-rehab projects. A significant potential for lowering energy usagemore » in existing homes lies between the low hanging fruit and deep energy retrofit approaches - retrofits that save approximately 30% in energy over the existing conditions. A key is to be non-intrusive with the efficiency measures so the retrofit projects can be accomplished in occupied homes. This cold climate retrofit project involved the design and optimization of a home in Connecticut that sought to improve energy savings by at least 30% (excluding solar PV) over the existing home's performance. This report documents the successful implementation of a cost-effective solution package that achieved performance greater than 30% over the pre-retrofit - what worked, what did not, and what improvements could be made. Confirmation of successfully achieving 30% source energy savings over the pre-existing conditions was confirmed through energy modeling and comparison of the utility bills pre- and post- retrofit.« less

A methodology to identify stranded generation facilities and estimate stranded costs for Louisiana's electric utility industry

NASA Astrophysics Data System (ADS)

Cope, Robert Frank, III

1998-12-01

The electric utility industry in the United States is currently experiencing a new and different type of growing pain. It is the pain of having to restructure itself into a competitive business. Many industry experts are trying to explain how the nation as a whole, as well as individual states, will implement restructuring and handle its numerous "transition problems." One significant transition problem for federal and state regulators rests with determining a utility's stranded costs. Stranded generation facilities are assets which would be uneconomic in a competitive environment or costs for assets whose regulated book value is greater than market value. At issue is the methodology which will be used to estimate stranded costs. The two primary methods are known as "Top-Down" and "Bottom-Up." The "Top-Down" approach simply determines the present value of the losses in revenue as the market price for electricity changes over a period of time into the future. The problem with this approach is that it does not take into account technical issues associated with the generation and wheeling of electricity. The "Bottom-Up" approach computes the present value of specific strandable generation facilities and compares the resulting valuations with their historical costs. It is regarded as a detailed and difficult, but more precise, approach to identifying stranded assets and their associated costs. This dissertation develops a "Bottom-Up" quantitative, optimization-based approach to electric power wheeling within the state of Louisiana. It optimally evaluates all production capabilities and coordinates the movement of bulk power through transmission interconnections of competing companies in and around the state. Sensitivity analysis to this approach is performed by varying seasonal consumer demand, electric power imports, and transmission inter-connection cost parameters. Generation facility economic dispatch and transmission interconnection bulk power transfers, specific to each set of parameters, lead to the identification of stranded generation facilities. Stranded costs of non-dispatched and uneconomically dispatched generation facilities can then be estimated to indicate, arguably, the largest portion of restructuring transition costs as the industry is transformed from its present monopolistic structure to a competitive one.

Interactive Visual Least Absolutes Method: Comparison with the Least Squares and the Median Methods

ERIC Educational Resources Information Center

Kim, Myung-Hoon; Kim, Michelle S.

2016-01-01

A visual regression analysis using the least absolutes method (LAB) was developed, utilizing an interactive approach of visually minimizing the sum of the absolute deviations (SAB) using a bar graph in Excel; the results agree very well with those obtained from nonvisual LAB using a numerical Solver in Excel. These LAB results were compared with…

Welfare implications of energy and environmental policies: A general equilibrium approach

NASA Astrophysics Data System (ADS)

Iqbal, Mohammad Qamar

Government intervention and implementation of policies can impose a financial and social cost. To achieve a desired goal there could be several different alternative policies or routes, and government would like to choose the one which imposes the least social costs or/and generates greater social benefits. Therefore, applied welfare economics plays a vital role in public decision making. This paper recasts welfare measure such as equivalent variation, in terms of the prices of factors of production rather than product prices. This is made possible by using duality theory within a general equilibrium framework and by deriving alternative forms of indirect utility functions and expenditure functions in factor prices. Not only we are able to recast existing welfare measures in factor prices, we are able to perform a true cost-benefit analysis of government policies using comparative static analysis of different equilibria and breaking up monetary measure of welfare change such as equivalent variation into its components. A further advantage of our research is demonstrated by incorporating externalities and public goods in the utility function. It is interesting that under a general equilibrium framework optimal income tax tends to reduce inequalities. Results show that imposition of taxes at socially optimal rates brings a net gain to the society. It was also seen that even though a pollution tax may reduce GDP, it leads to an increase in the welfare of the society if it is imposed at an optimal rate.

The business case for payer support of a community-based health information exchange: a humana pilot evaluating its effectiveness in cost control for plan members seeking emergency department care.

PubMed

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R

2011-07-01

As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel. The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Post-propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care.

The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature

PubMed Central

Liu, Xinliang; Kolber, Morey J.

2016-01-01

Background Low back pain (LBP) is common and associated healthcare costs are significant. While clinical practice guidelines have been established in an attempt to reduce costs and healthcare utilization, it is unclear if adherence to physical therapy guidelines for those with LBP is efficacious. Therefore, the purpose of this study was to assess current evidence and evaluate the impact of physical therapy guideline adherence on subsequent healthcare costs and utilization for patients with LBP. Methods An electronic search was conducted in PubMed, CINAHL (EBSCO Host), AMED (Ovid), and PEDro. Studies included in this review were published in peer reviewed journals and the primary mode of treatment was administered by a physical therapist. Also, the definition of adherence was clearly defined based on claims data and at least one measure of cost or utilization reported. Quality assessment was evaluated via a modified Downs and Black checklist. Due to the conceptual heterogeneity in variable measurements, data were qualitatively synthesized and stratified by reported utilization and cost measures. Results A total of 256 results were identified and after omitting duplicates, 4 articles were retained, which were all retrospective in nature. Quality scores ranged between 19 and 21 points out of a possible 26 on the modified Downs and Black checklist. All identified studies used the same definition of guideline adherence, which focused on billing active codes and minimizing use of passive codes. The results demonstrated trends that, with a few exceptions, suggested those patients with LBP that were treated with an adherent guideline program demonstrated decreased healthcare utilization and an overall healthcare savings. Conclusion Preliminary evidence suggests that adherence to established clinical practice guidelines may assist with decreasing healthcare utilization and costs. Additional research based on prospective randomized controlled trials are needed to provide high quality evidence regarding the impact of guideline adherence among patients with LBP. PMID:27285608

Average cost per person victimized by an intimate partner of the opposite gender: a comparison of men and women.

PubMed

Arias, Ileana; Corso, Phaedra

2005-08-01

Differences in prevalence, injury, and utilization of services between female and male victims of intimate partner violence (IPV) have been noted. However, there are no studies indicating approximate costs of men's IPV victimization. This study explored gender differences in service utilization for physical IPV injuries and average cost per person victimized by an intimate partner of the opposite gender. Significantly more women than men reported physical IPV victimization and related injuries. A greater proportion of women than men reported seeking mental health services and reported more visits on average in response to physical IPV victimization. Women were more likely than men to report using emergency department, inpatient hospital, and physician services, and were more likely than men to take time off from work and from childcare or household duties because of their injuries. The total average per person cost for women experiencing at least one physical IPV victimization was more than twice the average per person cost for men.

Planning for a Distributed Disruption: Innovative Practices for Incorporating Distributed Solar into Utility Planning

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

Mills, Andrew D.; Barbose, Galen L.; Seel, Joachim

The rapid growth of distributed solar photovoltaics (DPV) has critical implications for U.S. utility planning processes. This report informs utility planning through a comparative analysis of roughly 30 recent utility integrated resource plans or other generation planning studies, transmission planning studies, and distribution system plans. It reveals a spectrum of approaches to incorporating DPV across nine key planning areas, and it identifies areas where even the best current practices might be enhanced. (1) Forecasting DPV deployment: Because it explicitly captures several predictive factors, customer-adoption modeling is the most comprehensive forecasting approach. It could be combined with other forecasting methods tomore » generate a range of potential futures. (2) Ensuring robustness of decisions to uncertain DPV quantities: using a capacity-expansion model to develop least-cost plans for various scenarios accounts for changes in net load and the generation portfolio; an innovative variation of this approach combines multiple per-scenario plans with trigger events, which indicate when conditions have changed sufficiently from the expected to trigger modifications in resource-acquisition strategy. (3) Characterizing DPV as a resource option: Today's most comprehensive plans account for all of DPV's monetary costs and benefits. An enhanced approach would address non-monetary and societal impacts as well. (4) Incorporating the non-dispatchability of DPV into planning: Rather than having a distinct innovative practice, innovation in this area is represented by evolving methods for capturing this important aspect of DPV. (5) Accounting for DPV's location-specific factors: The innovative propensity-to-adopt method employs several factors to predict future DPV locations. Another emerging utility innovation is locating DPV strategically to enhance its benefits. (6) Estimating DPV's impact on transmission and distribution investments: Innovative practices are being implemented to evaluate system needs, hosting capacities, and system investments needed to accommodate DPV deployment. (7) Estimating avoided losses associated with DPV: A time-differentiated marginal loss rate provides the most comprehensive estimate of avoided losses due to DPV, but no studies appear to use it. (8) Considering changes in DPV's value with higher solar penetration: Innovative methods for addressing the value changes at high solar penetrations are lacking among the studies we evaluate. (9) Integrating DPV in planning across generation, transmission, and distribution: A few states and regions have started to develop more comprehensive processes that link planning forums, but there are still many issues to address.« less

Planning for a Distributed Disruption: Innovative Practices for Incorporating Distributed Solar into Utility Planning

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

Mill, Andrew; Barbose, Galen; Seel, Joachim

The rapid growth of distributed solar photovoltaics (DPV) has critical implications for U.S. utility planning processes. This report informs utility planning through a comparative analysis of roughly 30 recent utility integrated resource plans or other generation planning studies, transmission planning studies, and distribution system plans. It reveals a spectrum of approaches to incorporating DPV across nine key planning areas, and it identifies areas where even the best current practices might be enhanced. 1) Forecasting DPV deployment: Because it explicitly captures several predictive factors, customer-adoption modeling is the most comprehensive forecasting approach. It could be combined with other forecasting methods tomore » generate a range of potential futures. 2) Ensuring robustness of decisions to uncertain DPV quantities: using a capacity-expansion model to develop least-cost plans for various scenarios accounts for changes in net load and the generation portfolio; an innovative variation of this approach combines multiple per-scenario plans with trigger events, which indicate when conditions have changed sufficiently from the expected to trigger modifications in resource-acquisition strategy. 3) Characterizing DPV as a resource option: Today’s most comprehensive plans account for all of DPV’s monetary costs and benefits. An enhanced approach would address non-monetary and societal impacts as well. 4) Incorporating the non-dispatchability of DPV into planning: Rather than having a distinct innovative practice, innovation in this area is represented by evolving methods for capturing this important aspect of DPV. 5) Accounting for DPV’s location-specific factors: The innovative propensity-to-adopt method employs several factors to predict future DPV locations. Another emerging utility innovation is locating DPV strategically to enhance its benefits. 6) Estimating DPV’s impact on transmission and distribution investments: Innovative practices are being implemented to evaluate system needs, hosting capacities, and system investments needed to accommodate DPV deployment. 7) Estimating avoided losses associated with DPV: A time-differentiated marginal loss rate provides the most comprehensive estimate of avoided losses due to DPV, but no studies appear to use it. 8) Considering changes in DPV’s value with higher solar penetration: Innovative methods for addressing the value changes at high solar penetrations are lacking among the studies we evaluate. 9) Integrating DPV in planning across generation, transmission, and distribution: A few states and regions have started to develop more comprehensive processes that link planning forums, but there are still many issues to address.« less

76 FR 49841 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-11

.... Each cost allocation method must satisfy six cost allocation principles. DATES: Effective Date: This... 86 c. Commission Determination 99 3. Regional Transmission Planning Principles........ 118 a.... Principles for Regional and Interregional Cost 585 Allocation 1. Use of a Principles-Based Approach 585 a...

Healthcare resource use and costs of multiple sclerosis patients in Germany before and during fampridine treatment.

PubMed

Ziemssen, Tjalf; Prosser, Christine; Haas, Jennifer Scarlet; Lee, Andrew; Braun, Sebastian; Landsman-Blumberg, Pamela; Kempel, Angela; Gleißner, Erika; Patel, Sarita; Huang, Ming-Yi

2017-03-27

Multiple sclerosis (MS) patients often suffer from gait impairment and fampridine is indicated to medically improve walking ability in this population. Patient characteristics, healthcare resource use, and costs of MS patients on fampridine treatment for 12 months in Germany were analyzed. A retrospective claims database analysis was conducted including MS patients who initiated fampridine treatment (index date) between July 2011 and December 2013. Continuous insurance enrollment during 12 months pre- and post-index date was required, as was at least 1 additional fampridine prescription in the fourth quarter after the index date. Patient characteristics were evaluated and pre- vs post-index MS-related healthcare utilization and costs were compared. A total of 562 patients were included in this study. The mean (standard deviation [SD]) age was 50.5 (9.8) years and 63% were female. In the treatment period, almost every patient had at least 1 MS-related outpatient visit, 24% were hospitalized due to MS, and 79% utilized MS-specific physical therapy in addition to the fampridine treatment. Total MS-related healthcare costs were significantly higher in the fampridine treatment period than in the period prior to fampridine initiation (€17,392 vs €10,960, P < 0.001). While this difference was driven primarily by prescription costs, MS-related inpatient costs were lower during fampridine treatment (€1,333 vs €1,565, P < 0.001). Physical therapy is mainly used concomitant to fampridine treatment. While healthcare costs were higher during fampridine treatment compared to the pre-treatment period, inpatient costs were lower. Further research is necessary to better understand the fampridine influence.

Should Cost-Effectiveness Analysis Include the Cost of Consumption Activities? AN Empirical Investigation.

PubMed

Adarkwah, Charles Christian; Sadoghi, Amirhossein; Gandjour, Afschin

2016-02-01

There has been a debate on whether cost-effectiveness analysis should consider the cost of consumption and leisure time activities when using the quality-adjusted life year as a measure of health outcome under a societal perspective. The purpose of this study was to investigate whether the effects of ill health on consumptive activities are spontaneously considered in a health state valuation exercise and how much this matters. The survey enrolled patients with inflammatory bowel disease in Germany (n = 104). Patients were randomized to explicit and no explicit instruction for the consideration of consumption and leisure effects in a time trade-off (TTO) exercise. Explicit instruction to consider non-health-related utility in TTO exercises did not influence TTO scores. However, spontaneous consideration of non-health-related utility in patients without explicit instruction (60% of respondents) led to significantly lower TTO scores. Results suggest an inclusion of consumption costs in the numerator of the cost-effectiveness ratio, at least for those respondents who spontaneously consider non-health-related utility from treatment. Results also suggest that exercises eliciting health valuations from the general public may include a description of the impact of disease on consumptive activities. Copyright © 2015 John Wiley & Sons, Ltd.

Cost and resource utilization in cervical cancer management: a real-world retrospective cost analysis.

PubMed

Cromwell, I; Ferreira, Z; Smith, L; van der Hoek, K; Ogilvie, G; Coldman, A; Peacock, S J

2016-02-01

We set out to assess the health care resource utilization and cost of cervical cancer from the perspective of a single-payer health care system. Retrospective observational data for women diagnosed with cervical cancer in British Columbia between 2004 and 2009 were analyzed to calculate patient-level resource utilization patterns from diagnosis to death or 5-year discharge. Domains of resource use within the scope of this cost analysis were chemotherapy, radiotherapy, and brachytherapy administered by the BC Cancer Agency; resource utilization related to hospitalization and outpatient visits as recorded by the B.C. Ministry of Health; medically required services billed under the B.C. Medical Services Plan; and prescriptions dispensed under British Columbia's health insurance programs. Unit costs were applied to radiotherapy and brachytherapy, producing per-patient costs. The mean cost per case of treating cervical cancer in British Columbia was $19,153 (standard error: $3,484). Inpatient hospitalizations, at 35%, represented the largest proportion of the total cost (95% confidence interval: 32.9% to 36.9%). Costs were compared for subgroups of the total cohort. As health care systems change the way they manage, screen for, and prevent cervical cancer, cost-effectiveness evaluations of the overall approach will require up-to-date data for resource utilization and costs. We provide information suitable for such a purpose and also identify factors that influence costs.

Utility-scale system preventive and failure-related maintenance

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

Jennings, C.; Hutchinson, P.

1995-11-01

This paper describes the design and performance background on PVUSA utility-scale systems at Davis and Kerman, California, and reports on a preventative and failure-related maintenance approach and costs.

Cost-effectiveness methodology for computer systems selection

NASA Technical Reports Server (NTRS)

Vallone, A.; Bajaj, K. S.

1980-01-01

A new approach to the problem of selecting a computer system design has been developed. The purpose of this methodology is to identify a system design that is capable of fulfilling system objectives in the most economical way. The methodology characterizes each system design by the cost of the system life cycle and by the system's effectiveness in reaching objectives. Cost is measured by a 'system cost index' derived from an analysis of all expenditures and possible revenues over the system life cycle. Effectiveness is measured by a 'system utility index' obtained by combining the impact that each selection factor has on the system objectives and it is assessed through a 'utility curve'. A preestablished algorithm combines cost and utility and provides a ranking of the alternative system designs from which the 'best' design is selected.

Enhancing ultra-high CPV passive cooling using least-material finned heat sinks

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

Micheli, Leonardo, E-mail: lm409@exeter.ac.uk; Mallick, Tapas K., E-mail: T.K.Mallick@exeter.ac.uk; Fernandez, Eduardo F., E-mail: E.Fernandez-Fernandez2@exeter.ac.uk

2015-09-28

Ultra-high concentrating photovoltaic (CPV) systems aim to increase the cost-competiveness of CPV by increasing the concentrations over 2000 suns. In this work, the design of a heat sink for ultra-high concentrating photovoltaic (CPV) applications is presented. For the first time, the least-material approach, widely used in electronics to maximize the thermal dissipation while minimizing the weight of the heat sink, has been applied in CPV. This method has the potential to further decrease the cost of this technology and to keep the multijunction cell within the operative temperature range. The designing procedure is described in the paper and the resultsmore » of a thermal simulation are shown to prove the reliability of the solution. A prediction of the costs is also reported: a cost of 0.151$/W{sub p} is expected for a passive least-material heat sink developed for 4000x applications.« less

Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease.

PubMed

Hibbard, Judith H; Greene, Jessica; Sacks, Rebecca M; Overton, Valerie; Parrotta, Carmen

2017-08-01

To explore using the Patient Activation Measure (PAM) for identifying patients more likely to have ambulatory care-sensitive (ACS) utilization and future increases in chronic disease. Secondary data are extracted from the electronic health record of a large accountable care organization. This is a retrospective cohort design. The key predictor variable, PAM score, is measured in 2011, and is used to predict outcomes in 2012-2014. Outcomes include ACS utilization and the likelihood of a new chronic disease. Our sample of 98,142 adult patients was drawn from primary care clinic users. To be included, patients had to have a PAM score in 2011 and at least one clinic visit in each of the three subsequent years. PAM level is a significant predictor of ACS utilization. Less activated patients had significantly higher odds of ACS utilization compared to those with high PAM scores. Similarly, patients with low PAM scores were more likely to have a new chronic disease diagnosis over each of the years of observation. Assessing patient activation may help to identify patients who could benefit from greater support. Such an approach may help ACOs reach population health management goals. © Health Research and Educational Trust.

Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups.

PubMed

Whitehurst, David G T; Bryan, Stirling; Lewis, Martyn; Hill, Jonathan; Hay, Elaine M

2012-11-01

Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Within a cost-utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups.

Future directions: Integrated resource planning

NASA Astrophysics Data System (ADS)

Bauer, D. C.; Eto, J.

Integrated resource planning or IRP is the process for integrating supply- and demand-side resources to provide energy services at a cost that balances the interests of all stakeholders. It now is the resource planning process used by electric utilities in over 30 states. The goals of IRP have evolved from least cost planning and encouragement of demand-side management to broader, more complex issues including core competitive business activity, risk management and sharing, accounting for externalities, and fuel switching between gas and electricity. IRP processes are being extended to other interior regions of the country, to non-investor owned utilities, and to regional (rather than individual utility) planning bases, and to other fuels (natural gas). The comprehensive, multi-valued, and public reasoning characteristics of IRP could be extended to applications beyond energy, e.g., transportation, surface water management, and health care in ways suggested.

Regression Models of Quarterly Overhead Costs for Six Government Aerospace Contractors.

DTIC Science & Technology

1986-03-01

34 Testing ,, for Serial Correlation After Least Squares %Regression, Econometrica, Vol. 36, No. 1, pp. 133-150, January 1968. Intrili8ator M.D., Econometric ...to be superior. These two estimators are both two-stage estimators that are calculated utilizing Wallis’s test statistic for fourth-order...utilizing Wallis’s test statistic for fourth-order autocorrelation. NTIS C F’,& D tI1C T - .1 I -. . . ..- rJ ,. *p J • - DA 3

Resource modeling: A reality for program cost analysis

NASA Technical Reports Server (NTRS)

Fouts, L. D.; Hurst, R. L. (Principal Investigator)

1979-01-01

The approach, implementation, operation, and utilization of a model to establish capital investment and operational costs for the Program is presented. These are based on their interrelationships, dependencies, and alternative actions.

A benders decomposition approach to multiarea stochastic distributed utility planning

NASA Astrophysics Data System (ADS)

McCusker, Susan Ann

Until recently, small, modular generation and storage options---distributed resources (DRs)---have been installed principally in areas too remote for economic power grid connection and sensitive applications requiring backup capacity. Recent regulatory changes and DR advances, however, have lead utilities to reconsider the role of DRs. To a utility facing distribution capacity bottlenecks or uncertain load growth, DRs can be particularly valuable since they can be dispersed throughout the system and constructed relatively quickly. DR value is determined by comparing its costs to avoided central generation expenses (i.e., marginal costs) and distribution investments. This requires a comprehensive central and local planning and production model, since central system marginal costs result from system interactions over space and time. This dissertation develops and applies an iterative generalized Benders decomposition approach to coordinate models for optimal DR evaluation. Three coordinated models exchange investment, net power demand, and avoided cost information to minimize overall expansion costs. Local investment and production decisions are made by a local mixed integer linear program. Central system investment decisions are made by a LP, and production costs are estimated by a stochastic multi-area production costing model with Kirchhoff's Voltage and Current Law constraints. The nested decomposition is a new and unique method for distributed utility planning that partitions the variables twice to separate local and central investment and production variables, and provides upper and lower bounds on expected expansion costs. Kirchhoff's Voltage Law imposes nonlinear, nonconvex constraints that preclude use of LP if transmission capacity is available in a looped transmission system. This dissertation develops KVL constraint approximations that permit the nested decomposition to consider new transmission resources, while maintaining linearity in the three individual models. These constraints are presented as a heuristic for the given examples; future research will investigate conditions for convergence. A ten-year multi-area example demonstrates the decomposition approach and suggests the ability of DRs and new transmission to modify capacity additions and production costs by changing demand and power flows. Results demonstrate that DR and new transmission options may lead to greater capacity additions, but resulting production cost savings more than offset extra capacity costs.

A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students

PubMed Central

Nicklen, Peter; Rivers, George; Foo, Jonathan; Ooi, Ying Ying; Reeves, Scott; Walsh, Kieran; Ilic, Dragan

2015-01-01

Background Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. Objective This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. Methods The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. Results The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions. Conclusions Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context. PMID:26197801

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

Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy.

PubMed

Smith, William B; Steinberg, Joni; Scholtes, Stefan; Mcnamara, Iain R

2017-03-01

To compare the age-based cost-effectiveness of total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and high tibial osteotomy (HTO) for the treatment of medial compartment knee osteoarthritis (MCOA). A Markov model was used to simulate theoretical cohorts of patients 40, 50, 60, and 70 years of age undergoing primary TKA, UKA, or HTO. Costs and outcomes associated with initial and subsequent interventions were estimated by following these virtual cohorts over a 10-year period. Revision and mortality rates, costs, and functional outcome data were estimated from a systematic review of the literature. Probabilistic analysis was conducted to accommodate these parameters' inherent uncertainty, and both discrete and probabilistic sensitivity analyses were utilized to assess the robustness of the model's outputs to changes in key variables. HTO was most likely to be cost-effective in cohorts under 60, and UKA most likely in those 60 and over. Probabilistic results did not indicate one intervention to be significantly more cost-effective than another. The model was exquisitely sensitive to changes in utility (functional outcome), somewhat sensitive to changes in cost, and least sensitive to changes in 10-year revision risk. HTO may be the most cost-effective option when treating MCOA in younger patients, while UKA may be preferred in older patients. Functional utility is the primary driver of the cost-effectiveness of these interventions. For the clinician, this study supports HTO as a competitive treatment option in young patient populations. It also validates each one of the three interventions considered as potentially optimal, depending heavily on patient preferences and functional utility derived over time.

A non-stationary cost-benefit based bivariate extreme flood estimation approach

NASA Astrophysics Data System (ADS)

Qi, Wei; Liu, Junguo

2018-02-01

Cost-benefit analysis and flood frequency analysis have been integrated into a comprehensive framework to estimate cost effective design values. However, previous cost-benefit based extreme flood estimation is based on stationary assumptions and analyze dependent flood variables separately. A Non-Stationary Cost-Benefit based bivariate design flood estimation (NSCOBE) approach is developed in this study to investigate influence of non-stationarities in both the dependence of flood variables and the marginal distributions on extreme flood estimation. The dependence is modeled utilizing copula functions. Previous design flood selection criteria are not suitable for NSCOBE since they ignore time changing dependence of flood variables. Therefore, a risk calculation approach is proposed based on non-stationarities in both marginal probability distributions and copula functions. A case study with 54-year observed data is utilized to illustrate the application of NSCOBE. Results show NSCOBE can effectively integrate non-stationarities in both copula functions and marginal distributions into cost-benefit based design flood estimation. It is also found that there is a trade-off between maximum probability of exceedance calculated from copula functions and marginal distributions. This study for the first time provides a new approach towards a better understanding of influence of non-stationarities in both copula functions and marginal distributions on extreme flood estimation, and could be beneficial to cost-benefit based non-stationary bivariate design flood estimation across the world.

Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty.

PubMed

Al, Maiwenn J; Feenstra, Talitha L; Hout, Ben A van

2005-07-01

This paper addresses the problem of how to value health care programmes with different ratios of costs to effects, specifically when taking into account that these costs and effects are uncertain. First, the traditional framework of maximising health effects with a given health care budget is extended to a flexible budget using a value function over money and health effects. Second, uncertainty surrounding costs and effects is included in the model using expected utility. Other approaches to uncertainty that do not specify a utility function are discussed and it is argued that these also include implicit notions about risk attitude.

Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care: A Cost-Benefit Analysis.

PubMed

Basu, Sanjay; Jack, Helen E; Arabadjis, Sophia D; Phillips, Russell S

2017-02-01

Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption. To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer's perspective. Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program's expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources. CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4-5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure-approximately 3%-4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings. Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient's primary diagnosis.

Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain

PubMed Central

Manchikanti, Laxmaiah; Pampati, Vidyasagar; Kaye, Alan D.; Hirsch, Joshua A.

2017-01-01

Background:Controlled diagnostic studies have established the prevalence of cervical facet joint pain to range from 36% to 67% based on the criterion standard of ≥ 80% pain relief. Treatment of cervical facet joint pain has been described with Level II evidence of effectiveness for therapeutic facet joint nerve blocks and radiofrequency neurotomy and with no significant evidence for intraarticular injections. However, there have not been any cost effectiveness or cost utility analysis studies performed in managing chronic neck pain with or without headaches with cervical facet joint interventions. Study Design:Cost utility analysis based on the results of a double-blind, randomized, controlled trial of cervical therapeutic medial branch blocks in managing chronic neck pain. Objectives:To assess cost utility of therapeutic cervical medial branch blocks in managing chronic neck pain. Methods: A randomized trial was conducted in a specialty referral private practice interventional pain management center in the United States. This trial assessed the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids for an established diagnosis of cervical facet joint pain by means of controlled diagnostic blocks. Cost utility analysis was performed with direct payment data for the procedures for a total of 120 patients over a period of 2 years from this trial based on reimbursement rates of 2016. The payment data provided direct procedural costs without inclusion of drug treatments. An additional 40% was added to procedural costs with multiplication of a factor of 1.67 to provide estimated total costs including direct and indirect costs, based on highly regarded surgical literature. Outcome measures included significant improvement defined as at least a 50% improvement with reduction in pain and disability status with a combined 50% or more reduction in pain in Neck Disability Index (NDI) scores. Results:The results showed direct procedural costs per one-year improvement in quality adjusted life year (QALY) of United States Dollar (USD) of $2,552, and overall costs of USD $4,261. Overall, each patient on average received 5.7 ± 2.2 procedures over a period of 2 years. Average significant improvement per procedure was 15.6 ± 12.3 weeks and average significant improvement in 2 years per patient was 86.0 ± 24.6 weeks. Limitations:The limitations of this cost utility analysis are that data are based on a single center evaluation. Only costs of therapeutic interventional procedures and physician visits were included, with extrapolation of indirect costs. Conclusion:The cost utility analysis of therapeutic cervical medial branch blocks in the treatment of chronic neck pain non-responsive to conservative management demonstrated clinical effectiveness and cost utility at USD $4,261 per one year of QALY. PMID:29200944

Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain.

PubMed

Manchikanti, Laxmaiah; Pampati, Vidyasagar; Kaye, Alan D; Hirsch, Joshua A

2017-01-01

Background: Controlled diagnostic studies have established the prevalence of cervical facet joint pain to range from 36% to 67% based on the criterion standard of ≥ 80% pain relief. Treatment of cervical facet joint pain has been described with Level II evidence of effectiveness for therapeutic facet joint nerve blocks and radiofrequency neurotomy and with no significant evidence for intraarticular injections. However, there have not been any cost effectiveness or cost utility analysis studies performed in managing chronic neck pain with or without headaches with cervical facet joint interventions. Study Design: Cost utility analysis based on the results of a double-blind, randomized, controlled trial of cervical therapeutic medial branch blocks in managing chronic neck pain. Objectives: To assess cost utility of therapeutic cervical medial branch blocks in managing chronic neck pain. Methods: A randomized trial was conducted in a specialty referral private practice interventional pain management center in the United States. This trial assessed the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids for an established diagnosis of cervical facet joint pain by means of controlled diagnostic blocks. Cost utility analysis was performed with direct payment data for the procedures for a total of 120 patients over a period of 2 years from this trial based on reimbursement rates of 2016. The payment data provided direct procedural costs without inclusion of drug treatments. An additional 40% was added to procedural costs with multiplication of a factor of 1.67 to provide estimated total costs including direct and indirect costs, based on highly regarded surgical literature. Outcome measures included significant improvement defined as at least a 50% improvement with reduction in pain and disability status with a combined 50% or more reduction in pain in Neck Disability Index (NDI) scores. Results: The results showed direct procedural costs per one-year improvement in quality adjusted life year (QALY) of United States Dollar (USD) of $2,552, and overall costs of USD $4,261. Overall, each patient on average received 5.7 ± 2.2 procedures over a period of 2 years. Average significant improvement per procedure was 15.6 ± 12.3 weeks and average significant improvement in 2 years per patient was 86.0 ± 24.6 weeks. Limitations: The limitations of this cost utility analysis are that data are based on a single center evaluation. Only costs of therapeutic interventional procedures and physician visits were included, with extrapolation of indirect costs. Conclusion: The cost utility analysis of therapeutic cervical medial branch blocks in the treatment of chronic neck pain non-responsive to conservative management demonstrated clinical effectiveness and cost utility at USD $4,261 per one year of QALY.

Assessing the Utilization of Total Ankle Replacement in the United States.

PubMed

Reddy, Sudheer; Koenig, Lane; Demiralp, Berna; Nguyen, Jennifer T; Zhang, Qian

2017-06-01

Total ankle arthroplasty (TAR) has been shown to be a cost-effective procedure relative to conservative management and ankle arthrodesis. Although its use has grown considerably over the last 2 decades, it is less common than arthrodesis. The purpose of this investigation was to analyze the cost and utilization of TAR across hospitals. Our analytical sample consisted of Medicare claims data from 2011 and 2012 for Inpatient Prospective Payment System hospitals. Outcome variables of interest were the likelihood of a hospital performing TAR, the volume of TAR cases, TAR hospital costs, and hospital profit margins. Data from the 2010 Cost Report and Medicare inpatient claims were utilized to compute average margins for TAR cases and overall hospital margins. TAR cost was calculated based on the all payer cost-to-charge ratio for each hospital in the Cost Report. Nationwide Inpatient Sample data were used to generate descriptive statistics on all TAR patients across payers. Medicare participants accounted for 47.5% of the overall population of TAR patients. Average implant cost was $13 034, accounting for approximately 70% of the total all-payer cost. Approximately, one-third of hospitals were profitable with respect to primary TAR. Profitable hospitals had lower total costs and higher payments leading to a difference in profit of approximately $11 000 from TAR surgeries between profitable and nonprofitable hospitals. No difference was noted with respect to length of stay or number of cases performed between profitable and nonprofitable hospitals. TAR surgeries were more likely to take place in large and major teaching hospitals. Among hospitals performing at least 1 TAR, the margin on TAR cases was positively associated with the total number of TARs performed by a hospital. There is an overall significant financial burden associated with performing TAR with many health systems failing to demonstrate profitability despite its increased utilization. While additional factors such as improved patient outcomes may be driving utilization of TAR, financial barriers may exist that can affect utilization of TAR across health systems. Level III, comparative study.

Characteristics of High- and Low-Efficiency Hospitals.

PubMed

Rosko, Michael; Wong, Herbert S; Mutter, Ryan

2017-01-01

We compared performance, operating characteristics, and market environments of low- and high-efficiency hospitals in the 37 states that supplied inpatient data to the Healthcare Cost and Utilization Project from 2006 to 2010. Hospital cost-inefficiency estimates using stochastic frontier analysis were generated. Hospitals were then grouped into the 100 most- and 100 least-efficient hospitals for subsequent analysis. Compared with the least efficient hospitals, high-efficiency hospitals tended to have lower average costs, higher labor productivity, and higher profit margins. The most efficient hospitals tended to be nonteaching, investor-owned, and members of multihospital systems. Hospitals in the high-efficiency group were located in areas with lower health maintenance organization penetration and less competition, and they had a higher share of Medicaid and Medicare admissions. Results of the analysis suggest there are opportunities for public policies to support improved efficiency in the hospital sector.

A System for Cost and Reimbursement Control in Hospitals

PubMed Central

Fetter, Robert B.; Thompson, John D.; Mills, Ronald E.

1976-01-01

This paper approaches the design of a regional or statewide hospital rate-setting system as the underpinning of a larger system which permits a regulatory agency to satisfy the requirements of various public laws now on the books or in process. It aims to generate valid interinstitutional monitoring on the three parameters of cost, utilization, and quality review. Such an approach requires the extension of the usual departmental cost and budgeting system to include consideration of the mix of patients treated and the utilization of various resources, including patient days, in the treatment of these patients. A sampling framework for the application of process-based quality studies and the generation of selected performance measurements is also included. PMID:941461

The Potential Economic Value of a Cutaneous Leishmaniasis Vaccine in Seven Endemic Countries in the Americas

PubMed Central

Bacon, Kristina M.; Hotez, Peter J.; Kruchten, Stephanie D.; Kamhawi, Shaden; Bottazzi, Maria Elena; Valenzuela, Jesus G.; Lee, Bruce Y.

2013-01-01

Cutaneous leishmaniasis (CL) and its associated complications, including mucocutaneous leishmaniasis (MCL) and diffuse CL (DCL) have emerged as important neglected tropical diseases in Latin America, especially in areas associated with human migration, conflict, and recent deforestation. Because of the limitations of current chemotherapeutic approaches to CL, MCL, and DCL, several prototype vaccines are in different states of product and clinical development. We constructed and utilized a Markov decision analytic computer model to evaluate the potential economic value of a preventative CL vaccine in seven countries in Latin America: Bolivia, Brazil, Colombia, Ecuador, Mexico, Peru, and Venezuela. The results indicated that even a vaccine with a relative short duration of protection and modest efficacy could be recommended for use in targeted locations, as it could prevent a substantial number of cases at low-cost and potentially even result in cost savings. If the population in the seven countries were vaccinated using a vaccine that provides at least 10 years of protection, an estimated 41,000-144,784 CL cases could be averted, each at a cost less than the cost of current recommended treatments. Further, even a vaccine providing as little as five years duration of protection with as little as 50% efficacy remains cost-effective compared with chemotherapy; additional scenarios resembling epidemic settings such as the one that occurred in Chaparral, Colombia in 2004 demonstrates important economic benefits. PMID:23176979

Initiatives toward effective decision making and laboratory use.

PubMed

Benson, E S

1980-09-01

Escalating health care costs constitute a public issue of paramount importance today, Among the leading growth factors in this rise is the cost of hospital services, notably laboratory services. With respect to the clinical laboratory, rising costs appear to be almost entirely attributable to expanding utilization and introduction of new services. The clinical laboratory has gone through a technological revolution in two decades that has changed it from a largely manual to a highly automated system of great speed and capacity. This change had produced a change in the style of providing services, a change that includes the provision of quantities of unsolicited data. A parallel change in the style of use of the laboratory has taken place on the part of patient care physicians from a relatively sparing, problem oriented use pattern to a relatively lavish, data oriented one. These reciprocal changes have transformed medicine, in the United States, at least, into a relatively high laboratory use culture. Abandonment of the new technology and return to a simpler, more primitive laboratory world would be a drastic and most inappropriate response to the new situation. Furthermore, arbitrary measures such as rationing, quotas, and tariffs are, if enacted, almost certain to fail. The most effective long term strategies, though more demanding of time and effort, lie through modification of physician behavior through the pathways of education and research. Education and research initiatives now in progress can in time influence laboratory use patterns of physicians at all career levels, improving the logic of test use and providing more strategic, prudent, and cost effective overall laboratory utilization practices. These approaches will require much improved communication between laboratory and bedside and a new intense involvement of laboratory physicians and scientists in the tasks of helping to improve the use of laboratory tests and laboratory data.

Cost-utility of cognitive behavioral therapy for low back pain from the commercial payer perspective.

PubMed

Norton, Giulia; McDonough, Christine M; Cabral, Howard; Shwartz, Michael; Burgess, James F

2015-05-15

Markov cost-utility model. To evaluate the cost-utility of cognitive behavioral therapy (CBT) for the treatment of persistent nonspecific low back pain (LBP) from the perspective of US commercial payers. CBT is widely deemed clinically effective for LBP treatment. The evidence is suggestive of cost-effectiveness. We constructed and validated a Markov intention-to-treat model to estimate the cost-utility of CBT, with 1-year and 10-year time horizons. We applied likelihood of improvement and utilities from a randomized controlled trial assessing CBT to treat LBP. The trial randomized subjects to treatment but subjects freely sought health care services. We derived the cost of equivalent rates and types of services from US commercial claims for LBP for a similar population. For the 10-year estimates, we derived recurrence rates from the literature. The base case included medical and pharmaceutical services and assumed gradual loss of skill in applying CBT techniques. Sensitivity analyses assessed the distribution of service utilization, utility values, and rate of LBP recurrence. We compared health plan designs. Results are based on 5000 iterations of each model and expressed as an incremental cost per quality-adjusted life-year. The incremental cost-utility of CBT was $7197 per quality-adjusted life-year in the first year and $5855 per quality-adjusted life-year over 10 years. The results are robust across numerous sensitivity analyses. No change of parameter estimate resulted in a difference of more than 7% from the base case for either time horizon. Including chiropractic and/or acupuncture care did not substantively affect cost-effectiveness. The model with medical but no pharmaceutical costs was more cost-effective ($5238 for 1 yr and $3849 for 10 yr). CBT is a cost-effective approach to manage chronic LBP among commercial health plans members. Cost-effectiveness is demonstrated for multiple plan designs. 2.

Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients.

PubMed

de Oliveira, Claire; Cheng, Joyce; Vigod, Simone; Rehm, Jürgen; Kurdyak, Paul

2016-01-01

A small proportion of health care users, called high-cost patients, account for a disproportionately large share of health care costs. Most literature on these patients has focused on the entire population. However, high-cost patients whose use of mental health care services is substantial are likely to differ from other members of the population. We defined a mental health high-cost patient as someone for whom mental health-related services accounted for at least 50 percent of total health care costs. We examined these patients' health care utilization and costs in Ontario, Canada. We found that their average cost for health care, in 2012 Canadian dollars, was $31,611. In contrast, the cost was $23,681 for other high-cost patients. Mental health high-cost patients were younger, lived in poorer neighborhoods, and had different health care utilization patterns, compared to other high-cost patients. These findings should be considered when implementing policies or interventions to address quality of care for mental health patients so as to ensure that mental health high-cost patients receive appropriate care in a cost-effective manner. Furthermore, efforts to manage mental health patients' health care use should address their complex profile through integrated multidisciplinary health care delivery. Project HOPE—The People-to-People Health Foundation, Inc.

Access to space study

NASA Technical Reports Server (NTRS)

1994-01-01

This report summarizes the results of a comprehensive NASA in-house study to identify and assess alternate approaches to access to space through the year 2030, and to select and recommend a preferred cause of action. The goals of the study were to identify the best vehicles and transportation architectures to make major reductions in the cost of space transportation (at least 50%), while at the same time increasing safety for flight crews by at least an order of magnitude. In addition, vehicle reliability was to exceed 0.98 percent, and, as important, the robustness, pad time, turnaround time, and other aspects of operability were to be vastly improved. This study examined three major optional architectures: (1) retain and upgrade the Space Shuttle and expendable launch vehicles; (2) develop new expendable vehicles using conventional technologies and transition from current vehicles beginning in 2005; and (3) develop new reusable vehicles using advanced technology, and transition from current vehicles beginning in 2008. The launch-needs, mission model utilized for for the study was based upon today's projection of civil, defense, and commercial mission payload requirements.

Suppression cost forecasts in advance of wildfire seasons

Treesearch

Jeffrey P. Prestemon; Karen Abt; Krista Gebert

2008-01-01

Approaches for forecasting wildfire suppression costs in advance of a wildfire season are demonstrated for two lead times: fall and spring of the current fiscal year (Oct. 1–Sept. 30). Model functional forms are derived from aggregate expressions of a least cost plus net value change model. Empirical estimates of these models are used to generate advance-of-season...

State Performance-Based Regulation Using Multiyear Rate Plans for U.S. Electric Utilities

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

Lowry, Mark Newton; Makos, Matt; Deason, Jeff

Electric utilities today must contain costs at a time when many need to modernize aging systems and all face major changes in technologies, customer preferences and competitive pressures.Most U.S. electric utility facilities are investor-owned, subject to rate and service regulation by state public utility commissions. Regulatory systems under which these utilities operate affect their performance and ability to meet these challenges. In this business environment, multiyear rate plans have some advantages over traditional rate regulation.The report focuses on key design issues and provides case studies of the multiyear rate plan approach, applicable to both vertically integrated and restructured states. Markmore » Newton Lowry and Matt Makos of Pacific Energy Group Research and Jeff Deason of Berkeley Lab authored the report; Lisa Schwartz, Berkeley Lab, was project manager and technical editor.The report is aimed primarily at state utility regulators and stakeholders in the state regulatory process. The multiyear rate approach also provides ideas on how to streamline oversight of public power utilities and rural electric cooperatives for their governing boards.Two key provisions of multiyear rate plans strengthen cost containment incentives and streamline regulation: 1. Reducing frequency of rate cases, typically to every four or five years 2. Using an attrition relief mechanism to escalate rates or revenue between rate cases to address cost pressures such as inflation and growth in number of customers, independently of the utility’s own cost Better utility performance can be achieved under well-designed multiyear rate plans while achieving lower regulatory costs. Benefits can be shared between utilities and their customers. But plans can be complex and involve significant changes in the regulatory system. Designing plans that stimulate utility performance without undue risk and share benefits fairly can be challenging.This report discusses the rationale for multiyear rate plans and their usefulness under modern business conditions. It then explains critical plan design issues and challenges and presents results from numerical research that considers the extra incentive power achieved under different plan provisions. Next, the report presents several case studies of utilities that have operated under formal multiyear rate plans or, for various reasons, have stayed out of rate cases for more than a decade. These studies consider the effect of multiyear rate plans and rate case frequency on utility cost, reliability and other performance dimensions.« less

Technology requirements for GaAs photovoltaic arrays

NASA Technical Reports Server (NTRS)

Scott-Monck, J.; Rockey, D.

1981-01-01

An analysis based on percent GaAs solar cell weight and cost is performed to assess the utility of this cell for future space missions. It is shown that the GaAs substrate cost and the end-of-life (EOL) advantage the cell can provide over the space qualified silicon solar cell are the dominant factors determining potential use. Examples are presented to show that system level advantages resulting from reduction in solar panel area may warrant the use of GaAs at its current weight and projected initial cost provided the EOL advantage over silicon is at least 20 percent.

Solar energy research and utilization

NASA Technical Reports Server (NTRS)

Cherry, W. R.

1974-01-01

The role of solar energy is visualized in the heating and cooling of buildings, in the production of renewable gaseous, liquid and solid fuels, and in the production of electric power over the next 45 years. Potential impacts of solar energy on various energy markets, and estimated costs of such solar energy systems are discussed. Some typical solar energy utilization processes are described in detail. It is expected that at least 20% of the U.S. total energy requirements by 2020 will be delivered from solar energy.

Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials

PubMed Central

Oppong, Raymond; Nicholls, Elaine; Whitehurst, David G. T.; Hill, Susan; Hammond, Alison; Hay, Elaine M.; Dziedzic, Krysia

2015-01-01

Objectives. Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand OA is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytical methodologies. Methods. A trial-based economic evaluation to assess the cost-utility of joint protection only, hand exercises only and joint protection plus hand exercises compared with leaflet and advice was undertaken over a 12 month period from a UK National Health Service perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves were constructed. The base case analysis used a within-the-table analysis methodology. Two further methods were explored: the at-the-margins approach and a regression-based approach with or without an interaction term. Results. Mean costs (QALYs) were £58.46 (s.d. 0.662) for leaflet and advice, £92.12 (s.d. 0.659) for joint protection, £64.51 (s.d. 0.681) for hand exercises and £112.38 (s.d. 0.658) for joint protection plus hand exercises. In the base case, hand exercises were the cost-effective option, with an ICER of £318 per QALY gained. Hand exercises remained the most cost-effective management strategy when adopting alternative methodological approaches. Conclusion. This is the first trial evaluating the cost-effectiveness of occupational therapy-supported approaches to self-management for hand OA. Our findings showed that hand exercises were the most cost-effective option. PMID:25339642

The Impact of Utility Tariff Evolution on Behind-the-Meter PV Adoption

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

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

This analysis uses a new method to link the NREL Regional Energy Deployment System (ReEDS) capacity expansion model with the NREL distributed generation market demand model (dGen) to explore the impact that the evolution of retail electricity tariffs can have on the adoption of distributed photovoltaics (DPV). The evolution most notably takes the form of decreased mid-day electricity costs, as low-cost PV reduces the marginal cost of electricity during those hours and the changes are subsequently communicated to electricity consumers through tariffs. We find that even under the low PV prices of the new SunShot targets the financial performance ofmore » DPV under evolved tariffs still motivates behind-the-meter adoption, despite significant reduction in the costs of electricity during afternoon periods driven by deployment of cheap utility-scale PV. The amount of DPV in 2050 in these low-cost futures ranged from 206 GW to 263 GW, a 13-fold and 16-fold increase over 2016 adoption levels respectively. From a utility planner's perspective, the representation of tariff evolution has noteworthy impacts on forecasted DPV adoption in scenarios with widespread time-of-use tariffs. Scenarios that projected adoption under a portfolio of time-of-use tariffs, but did not represent the evolution of those tariffs, predicted up to 36 percent more DPV in 2050, compared to scenarios that did not represent that evolution. Lastly, we find that a reduction in DPV deployment resulting from evolved tariffs had a negligible impact on the total generation from PV - both utility-scale and distributed - in the scenarios we examined. Any reduction in DPV generation was replaced with utility-scale PV generation, to arrive at the quantity that makes up the least-cost portfolio.« less

Elastic Model Transitions: a Hybrid Approach Utilizing Quadratic Inequality Constrained Least Squares (LSQI) and Direct Shape Mapping (DSM)

NASA Technical Reports Server (NTRS)

Jurenko, Robert J.; Bush, T. Jason; Ottander, John A.

2014-01-01

A method for transitioning linear time invariant (LTI) models in time varying simulation is proposed that utilizes both quadratically constrained least squares (LSQI) and Direct Shape Mapping (DSM) algorithms to determine physical displacements. This approach is applicable to the simulation of the elastic behavior of launch vehicles and other structures that utilize multiple LTI finite element model (FEM) derived mode sets that are propagated throughout time. The time invariant nature of the elastic data for discrete segments of the launch vehicle trajectory presents a problem of how to properly transition between models while preserving motion across the transition. In addition, energy may vary between flex models when using a truncated mode set. The LSQI-DSM algorithm can accommodate significant changes in energy between FEM models and carries elastic motion across FEM model transitions. Compared with previous approaches, the LSQI-DSM algorithm shows improvements ranging from a significant reduction to a complete removal of transients across FEM model transitions as well as maintaining elastic motion from the prior state.

Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

PubMed Central

Knight, Tyler; Schaefer, Caroline; Krasa, Holly; Oberdhan, Dorothee; Chapman, Arlene; Perrone, Ronald D

2015-01-01

Background Autosomal dominant polycystic kidney disease (ADPKD) results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD) leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU) and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13). ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years) and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860), dialysis (n=586), and post-transplant (n=615). Mean ages did not differ across CKD stages (range 43–56 years). Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant). The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons). Conclusion ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system relative to the general population. Any treatments that delay progression to later stages of CKD may provide potential health care cost offsets. PMID:25759590

Chemical Microsensor Development for Aerospace Applications

NASA Technical Reports Server (NTRS)

Xu, Jennifer C.; Hunter, Gary W.; Lukco, Dorothy; Chen, Liangyu; Biaggi-Labiosa, Azlin M.

2013-01-01

Numerous aerospace applications, including low-false-alarm fire detection, environmental monitoring, fuel leak detection, and engine emission monitoring, would benefit greatly from robust and low weight, cost, and power consumption chemical microsensors. NASA Glenn Research Center has been working to develop a variety of chemical microsensors with these attributes to address the aforementioned applications. Chemical microsensors using different material platforms and sensing mechanisms have been produced. Approaches using electrochemical cells, resistors, and Schottky diode platforms, combined with nano-based materials, high temperature solid electrolytes, and room temperature polymer electrolytes have been realized to enable different types of microsensors. By understanding the application needs and chemical gas species to be detected, sensing materials and unique microfabrication processes were selected and applied. The chemical microsensors were designed utilizing simple structures and the least number of microfabrication processes possible, while maintaining high yield and low cost. In this presentation, an overview of carbon dioxide (CO2), oxygen (O2), and hydrogen/hydrocarbons (H2/CxHy) microsensors and their fabrication, testing results, and applications will be described. Particular challenges associated with improving the H2/CxHy microsensor contact wire-bonding pad will be discussed. These microsensors represent our research approach and serve as major tools as we expand our sensor development toolbox. Our ultimate goal is to develop robust chemical microsensor systems for aerospace and commercial applications.

Management of Newer Medications for Attention-Deficit Hyperactivity Disorder In Commercial Health Plans

PubMed Central

Hodgkin, Dominic; Horgan, Constance M.; Quinn, Amity E.; Merrick, Elizabeth; Stewart, Maureen T.; Leslie, Laurel K.

2014-01-01

Purpose In the US, many individuals with attention deficit hyperactivity disorder (ADHD) pay for their medications using private health insurance coverage. As in other drug classes, private insurers are actively seeking to influence utilization and costs, particularly for newer and costlier medications. The approaches that insurers use may have important effects on patients’ access to medications. This paper examines approaches (e.g., copayments, prior authorization, and step therapy) that commercial health plans are employing to manage newer medications used to treat ADHD and changes in approaches since 2003. Methods Data are from a nationally representative survey of commercial health plans in 60 market areas regarding alcohol, drug abuse and mental health services in 2010. Responses were obtained from 389 plans (89% response rate), reporting on 925 insurance products. For each of six branded ADHD medications, respondents were asked whether the plan covered the medication and if so, on what copayment tier each medication was placed, and whether it was subject to prior authorization or step therapy. Measures of management approach were constructed for each medication and for the group of medications. Bivariate and multivariate analyses were used to test for association of the management approach with various health plan characteristics. Findings There was considerable variation across these 6 medications in how tightly they were managed by health plans, with newer medications being subject to more stringent management. The proportion of insurance products relying solely on copay tiering to manage novel ADHD medications appears to have decreased since 2003. Less than half of insurance products (43%) managed these 6 medications solely by use of Tier 3/4 placement, and most of the remainder (48%) used other restrictions (with or without Tier 3/4 placement). The average insurance product restricted access to at least 3 of the 6 brand-only medications examined, whether through copayment tier placement or other approaches. More ADHD medications were left unrestricted in HMO products than in PPO ones; products with internal or hybrid-internal contracts for behavioral health; those not contracting with pharmacy benefits managers; and those with for-profit ownership. Implications Many plans have supplemented copayment tiering with other approaches such as prior authorization and step therapy to influence utilization and decrease costs. It may be that plans have found copayments to be less effective in redirecting utilization in this medication class. The impact on clinical outcomes was not examined in this study but should be prioritized using other data sources. PMID:25450473

Costs, Productivity, and the Utilization of Physicians’s Extenders in Air Force Primary Medicine Clinics.

DTIC Science & Technology

1983-06-01

to physicians.7 Using the actual casemix and attitudes toward extenders prevailing at each demonstra- tion base and applying this least constraining...Fairchild, 17 percent; Nellis, 16 percent. The Chanute estimate is lower because its large student population presents a simple casemix , and its patients

An Integrated Design Approach for Evaluating the Utility and Cost of a Fleet

DTIC Science & Technology

2015-04-29

biodiesel vehicles. Again the variety of vehicles was small, and the cost was restricted to only operational cost (maintenance, repair and fuel). Fu and...and cost metrics associated with a diesel to biodiesel fleet transition”. Energy Policy, 38(11, SI), NOV, pp. 7451–7456. [15] Fu, L., and Ishkhanov, G

Diagnosis isn't enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults.

PubMed

Reichard, Amanda; Gulley, Stephen P; Rasch, Elizabeth K; Chan, Leighton

2015-10-01

Under the ACA, new programs are being developed to enhance care coordination and reduce health care costs among people with chronic conditions, disabilities, and high utilization of health care. However, the relationships between these groups are not well understood. Our aims were to (1) identify high utilizers of health care in the U.S. working age (18-64) population, (2) examine the overlap between this group and people with chronic conditions and/or disabilities, (3) identify predictors of high service use or cost among these subpopulations, and (4) recommend approaches for stratification of individuals with high health care utilization. Using pooled national data from the Medical Expenditure Panel Survey (2006-2008), we created indices to identify elevated or high utilization and cost groups. We performed descriptive analyses, bivariate comparisons and multivariate analyses to examine the relations between these populations and individuals with chronic conditions and/or disabilities. While the large majority of persons with high use/cost had chronic conditions, the minority of persons with chronic conditions had high health care utilization. However, among persons with chronic conditions, disability was a significant predictor of high utilization. Annual expenditures were significantly elevated among people with disabilities, particularly when activities of daily living were limited. We conclude that medical diagnosis alone is insufficient for the development of eligibility criteria for, or the evaluation of, programs intended to better the delivery or coordination of services for high utilizers of health care services. New approaches are needed to assess functional limitations and identify ongoing needs for services and supports. Published by Elsevier Inc.

Does Accumulated Knowledge Impact Academic Performance in Cost Accounting?

ERIC Educational Resources Information Center

Alanzi, Khalid A.; Alfraih, Mishari M.

2017-01-01

Purpose: This quantitative study aims to examine the impact of accumulated knowledge of accounting on the academic performance of Cost Accounting students. Design/methodology/approach The sample consisted of 89 students enrolled in the Accounting program run by a business college in Kuwait during 2015. Correlation and linear least squares…

Time--It's Not Always Money

ERIC Educational Resources Information Center

Gabrieli, Chris

2012-01-01

In a time of resource challenges, many educators see the cost of expanding learning time as a barrier. However, with at least 1,000 schools across the United States currently expanding learning time, data show that schools can implement the approach cost effectively. Expanded learning time schools manage three levers that both build quality…

Photovoltaic-system evaluation at the Northeast Residential Experiment Station

NASA Astrophysics Data System (ADS)

Russell, M. C.

1983-01-01

Five residential photovoltaic systems were tested and the systems' performance and cost was evaluated. The five systems each consist of an unoccupied structure employing a roof mounted photovoltaic array and a utility connected power inverter capable of sending excess PV generated energy to the local utility system. The photovoltaic systems are designed to meet at least 50% of the total annual electrical demand of residences in the cold climate regions of the country. The following specific issues were investigated: photovoltaic array and inverter system power rating and performance characterization, system energy production, reliability and system cost/worth. Summary load data from five houses in the vicinity of the Northeast Residential Experiment Station, and meteorological data from the station's weather station are also presented.

Economic burden of cardiovascular events and fractures among patients with end-stage renal disease.

PubMed

Doan, Quan V; Gleeson, Michelle; Kim, John; Borker, Rohit; Griffiths, Robert; Dubois, Robert W

2007-07-01

To quantify direct medical costs of fractures and cardiovascular diseases among end-stage renal disease (ESRD) patients. Medicare claims data from year 2001 of the United States Renal Data System were used to quantify direct medical costs of acute episodic events (acute myocardial infarction (MI), stroke, heart valve repair, heart valve replacement, fractures) and chronic conditions (arrhythmia, peripheral vascular disease (PVD), heart valve disease (HVD), congestive heart failure (CHF), coronary heart disease, and non-acute stroke). Costs of hospitalized episodes of arrhythmia, PVD, CHF, and angina were also quantified. For acute events, costs were quantified using an episode-of-care approach. For chronic conditions, annualized costs were reported. Only costs specific to the events or conditions of interest were included and reported, in 2006 US dollars. Drug and dialysis-related costs were excluded. Diagnosis and procedure codes were used to identify these events and conditions. Among acute events analyzed as clinical episodes, PVD ($358 million) was associated with the greatest economic burden, followed by CHF, arrhythmia, angina, acute MI, heart valve replacement, hip fracture, acute stroke, heart valve repair, vertebral fracture, and pelvic fracture ($8.6 million). The cost per episode ranged from approximately $12,000 to 104,000. Among chronic conditions, CHF ($681 million) contributed the greatest economic burden; HVD ($100 million) contributed the least. The costs per patient-year ranged from $23,000 to 45,000 among chronic conditions. The costing methodology utilized could contribute to an underestimate of the economic impact of each condition; therefore these results are considered conservative. The economic burden of these selected conditions was substantial to health services payers who finance ESRD patient care. Episodic costs were high for most acute events.

Early Treatment in HCV: Is it a Cost-Utility Option from the Italian Perspective?

PubMed

Marcellusi, Andrea; Viti, Raffaella; Damele, Francesco; Cammà, Calogero; Taliani, Gloria; Mennini, Francesco Saverio

2016-08-01

In Italy, the Italian Pharmaceutical Agency (AIFA) criteria used F3-F4 fibrosis stages as the threshold to prioritise the treatment with interferon (IFN)-free regimens, while in genotype 1 chronic hepatitis C (G1 CHC) patients with fibrosis of liver stage 2, an approach with pegylated interferon (PEG-IFN)-based triple therapy with simeprevir was suggested. The key clinical question is whether, in an era of financial constraints, the application of a universal IFN-free strategy in naïve G1 CHC patients is feasible within a short time horizon. The aim of this study is to perform an economic analysis to estimate the cost-utility of the early innovative therapy in Italy for managing hepatitis C virus (HCV)-infected patients. The incremental cost-utility analysis was carried out to quantify the benefits of the early treatment approach in HCV subjects. A Markov simulation model including direct and indirect costs and health outcomes was developed from an Italian National Healthcare Service and societal perspective. A total of 5000 Monte Carlo simulations were performed on two distinct scenarios: standard of care (SoC) which includes 14,000 genotype 1 patients in Italy treated with innovative interferon-free regimens in the fibrosis of liver stages 3 and 4 (F3-F4) versus early-treatment scenario (ETS) where 2000 patients were additionally treated with simeprevir plus PEG-IFN and ribavirin in the fibrosis stage 2 (F2) (based on Italian Medicines Agency AIFA reimbursement criteria). A systematic literature review was carried out to identify epidemiological and economic data, which were subsequently used to inform the model. Furthermore, a one-way probabilistic sensitivity was performed to measure the relationship between the main parameters of the model and the cost-utility results. The model shows that, in terms of incremental cost-effectiveness ratio (ICER) per quality adjusted life year (QALY) gained, ETS appeared to be the most cost-utility option compared with both perspective societal (ICER = EUR11,396) and NHS (ICER = EUR14,733) over a time period of 10 years. The cost-utility of ETS is more sustainable as it extends the time period analysis [ICER = EUR 6778 per QALY to 20 years and EUR4474 per QALY to 30 years]. From the societal perspective, the ETS represents the dominant option at a time horizon of 30 years. If we consider the sub-group population of treated patients [16,000 patients of which 2000 not treated in the SoC, the ETS scenario was dominant after only 5 years and the cost-utility at 2 years of simulation. The one-way sensitivity analysis on the main variables confirmed the robustness of the model for the early-treatment approach. Our model represents a tool for policy makers and health-care professionals, and provided information on the cost-utility of the early-treatment approach in HCV-infected patients in Italy. Starting innovative treatment regimens earlier keeps HCV-infected patients in better health and reduces the incidence of HCV-related events; generating a gain both in terms of health of the patients and correct resource allocation.

Area-Specific Marginal Costing for Electric Utilities: a Case Study of Transmission and Distribution Costs

NASA Astrophysics Data System (ADS)

Orans, Ren

1990-10-01

Existing procedures used to develop marginal costs for electric utilities were not designed for applications in an increasingly competitive market for electric power. The utility's value of receiving power, or the costs of selling power, however, depend on the exact location of the buyer or seller, the magnitude of the power and the period of time over which the power is used. Yet no electric utility in the United States has disaggregate marginal costs that reflect differences in costs due to the time, size or location of the load associated with their power or energy transactions. The existing marginal costing methods used by electric utilities were developed in response to the Public Utilities Regulatory Policy Act (PURPA) in 1978. The "ratemaking standards" (Title 1) established by PURPA were primarily concerned with the appropriate segmentation of total revenues to various classes-of-service, designing time-of-use rating periods, and the promotion of efficient long-term resource planning. By design, the methods were very simple and inexpensive to implement. Now, more than a decade later, the costing issues facing electric utilities are becoming increasingly complex, and the benefits of developing more specific marginal costs will outweigh the costs of developing this information in many cases. This research develops a framework for estimating total marginal costs that vary by the size, timing, and the location of changes in loads within an electric distribution system. To complement the existing work at the Electric Power Research Institute (EPRI) and Pacific Gas and Electric Company (PGandE) on estimating disaggregate generation and transmission capacity costs, this dissertation focuses on the estimation of distribution capacity costs. While the costing procedure is suitable for the estimation of total (generation, transmission and distribution) marginal costs, the empirical work focuses on the geographic disaggregation of marginal costs related to electric utility distribution investment. The study makes use of data from an actual distribution planning area, located within PGandE's service territory, to demonstrate the important characteristics of this new costing approach. The most significant result of this empirical work is that geographic differences in the cost of capacity in distribution systems can be as much as four times larger than the current system average utility estimates. Furthermore, lumpy capital investment patterns can lead to significant cost differences over time.

Development of a Portfolio Management Approach with Case Study of the NASA Airspace Systems Program

NASA Technical Reports Server (NTRS)

Neitzke, Kurt W.; Hartman, Christopher L.

2012-01-01

A portfolio management approach was developed for the National Aeronautics and Space Administration s (NASA s) Airspace Systems Program (ASP). The purpose was to help inform ASP leadership regarding future investment decisions related to its existing portfolio of advanced technology concepts and capabilities (C/Cs) currently under development and to potentially identify new opportunities. The portfolio management approach is general in form and is extensible to other advanced technology development programs. It focuses on individual C/Cs and consists of three parts: 1) concept of operations (con-ops) development, 2) safety impact assessment, and 3) benefit-cost-risk (B-C-R) assessment. The first two parts are recommendations to ASP leaders and will be discussed only briefly, while the B-C-R part relates to the development of an assessment capability and will be discussed in greater detail. The B-C-R assessment capability enables estimation of the relative value of each C/C as compared with all other C/Cs in the ASP portfolio. Value is expressed in terms of a composite weighted utility function (WUF) rating, based on estimated benefits, costs, and risks. Benefit utility is estimated relative to achieving key NAS performance objectives, which are outlined in the ASP Strategic Plan.1 Risk utility focuses on C/C development and implementation risk, while cost utility focuses on the development and implementation portions of overall C/C life-cycle costs. Initial composite ratings of the ASP C/Cs were successfully generated; however, the limited availability of B-C-R information, which is used as inputs to the WUF model, reduced the meaningfulness of these initial investment ratings. Development of this approach, however, defined specific information-generation requirements for ASP C/C developers that will increase the meaningfulness of future B-C-R ratings.

Study of Lyndon B. Johnson Space Center utility systems

NASA Technical Reports Server (NTRS)

Redding, T. E.; Huber, W. C.

1977-01-01

The results of an engineering study of potential energy saving utility system modifications for the NASA Lyndon B. Johnson Space Center are presented. The objective of the study was to define and analyze utility options that would provide facility energy savings in addition to the approximately 25 percent already achieved through an energy loads reduction program. A systems engineering approach was used to determine total system energy and cost savings resulting from each of the ten major options investigated. The results reported include detailed cost analyses and cost comparisons of various options. Cost are projected to the year 2000. Also included are a brief description of a mathematical model used for the analysis and the rationale used for a site survey to select buildings suitable for analysis.

Cultural Identity and Regional Security in the Western Balkans

DTIC Science & Technology

2013-06-13

possible. Case Study as Qualitative Approach Creswell and other experts of the social research methodology suggest at least five forms of...descriptive research approach, and the main method is case study of the Western Balkans. This thesis utilizes the analytical frameworks of securitization

Mental Health Needs and Service Utilization by Hispanic Immigrants Residing in Mid-Southern United States

PubMed Central

Bridges, Ana J.; Andrews, Arthur R.; Deen, Tisha L.

2014-01-01

Purpose This study assessed mental health needs and service utilization patterns in a convenience sample of Hispanic immigrants. Design and Method A total of 84 adult Hispanic participants completed a structured diagnostic interview and a semistructured service utilization interview with trained bilingual research assistants. Results In the sample, 36% met diagnostic criteria for at least one mental disorder. Although 42% of the sample saw a physician in the prior year, mental health services were being rendered primarily by religious leaders. The most common barriers to service utilization were cost (59%), lack of health insurance (35%), and language (31%). Although more women than men met criteria for a disorder, service utilization rates were comparable. Participants with a mental disorder were significantly more likely to have sought medical, but not psychiatric, services in the prior year and faced significantly more cost barriers than participants without a mental disorder. Conclusions Findings suggest that Hispanic immigrants, particularly those with a mental illness, need to access services but face numerous systemic barriers. The authors recommend specific ways to make services more affordable and linguistically accessible. PMID:22802297

Health care resource utilization and direct medical costs for patients with schizophrenia initiating treatment with atypical versus typical antipsychotics in Tianjin, China.

PubMed

He, Xiaoning; Wu, Jing; Jiang, Yawen; Liu, Li; Ye, Wenyu; Xue, Haibo; Montgomery, William

2015-04-09

It is uncertain whether the extra acquisition costs of atypical antipsychotics over typical antipsychotics are offset by their other reduced resource use especially in hospital services in China. This study compared the psychiatric-related health care resource utilization and direct medical costs for patients with schizophrenia initiating atypical or typical antipsychotics in Tianjin, China. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2008-2010). Adult patients with schizophrenia with ≥1 prescription for antipsychotics after ≥90-day washout and 12-month continuous enrollment after first prescription was included. Psychiatric-related resource utilization and direct medical costs of the atypical and typical cohorts were estimated during the 12-month follow-up period. Logistic regressions, ordinary least square (OLS), and generalized linear models (GLM) were employed to estimate differences of resource utilization and costs between the two cohorts. One-to-one propensity score matching was conducted as a sensitivity analysis. 1131 patients initiating either atypical (N = 648) or typical antipsychotics (N = 483) were identified. Compared with the typical cohort, the atypical cohort had a lower likelihood of hospitalization (45.8% vs. 56.7%, P < 0.001; adjusted OR: 0.58, P < 0.001) over the follow-up period. Medication costs for the atypical cohort were higher than the typical cohort ($438 vs. $187, P < 0.001); however, their non-medication medical costs were significantly lower ($1223 vs. $1704, P < 0.001). The total direct medical costs were similar between the atypical and typical cohorts before ($1661 vs. $1892, P = 0.100) and after matching ($1711 vs. 1868, P = 0.341), consistent with the results from OLS and GLM models for matched cohorts. The atypical cohort had similar total direct medical costs compared to the typical cohort. Higher medication costs associated with atypical antipsychotics were offset by a reduction in non-medication medical costs, driven by fewer hospitalizations.

Financial and clinical characteristics of fibromyalgia: a case-control comparison.

PubMed

Palacio, Ana; Uribe, Claudia L; Li, Hua; Hanna, John; Deminski, Michael; Alvir, Jose; Chandran, Arthi; Sanchez, Robert

2010-05-01

To compare healthcare utilization and costs between subjects with and without fibromyalgia (FM) using claims data from a large health benefits company in the United States. Retrospective cohort. We analyzed 24 months of medical and pharmacy claims data comparing healthcare utilization and costs among Humana members diagnosed with FM to a propensity score matched control group without a diagnosis for FM. FM cases were identified as members aged 18 years and older, with at least 2 medical claims for International Classification of Diseases, Ninth Revision, Clinical Modification codes 729.0 and/or 729.1. The first medical claim for FM was utilized as the index date. A total of 9988 FM cases and 9988 controls were included in the analysis. Compared with controls, the use of pain-related medications by FM cases was approximately 2 times higher with opioids being used most commonly. FM cases utilized a mean (SD) of 22.5 (23.9) and 31.1 (26.6) outpatient services per year in the prediagnosis and postdiagnosis periods, respectively, compared with 14.8 (20.5) and 16.3 (24.5) among controls (P <.01). Office visits, tests, and procedures represented the majority of utilization. During the postdiagnosis period, the mean per-patient per-month costs for outpatient services among FM cases was $377 ($760) and $217 ($740.87) among controls (P <.01). FM cases had significantly higher utilization and costs compared with controls. Office visits, tests and procedures, and the use of pain-related medications accounted for the largest absolute differences between the 2 groups.

Utility of Policy Capturing as an Approach to Graduate Admissions Decision Making.

ERIC Educational Resources Information Center

Schmidt, Frank L.; And Others

1978-01-01

The present study examined and evaluated the application of linear policy-capturing models to the real-world decision task of graduate admissions. Utility of the policy-capturing models was great enough to be of practical significance, and least-squares weights showed no predictive advantage over equal weights. (Author/CTM)

The BOS-X approach: achieving drastic cost reduction in CPV through holistic power plant level innovation

NASA Astrophysics Data System (ADS)

Plesniak, A.; Garboushian, V.

2012-10-01

In 2011, the Amonix Advanced Technology Group was awarded DOE SunShot funding in the amount of 4.5M to design a new Balance of System (BOS) architecture utilizing Amonix MegaModules™ focused on reaching the SunShot goal of 0.06-$0.08/kWhr LCOE. The project proposal presented a comprehensive re-evaluation of the cost components of a utility scale CPV plant and identified critical areas of focus where innovation is needed to achieve cost reduction. As the world's premier manufacturer and most experienced installer of CPV power plants, Amonix is uniquely qualified to lead a rethinking of BOS architecture for CPV. The presentation will focus on the structure of the BOS-X approach, which looks for the next wave of cost reduction in CPV through evaluation of non-module subsystems and the interaction between subsystems during the lifecycle of a solar power plant. Innovation around nonmodule components is minimal to date because CPV companies are just now getting enough practice through completion of large projects to create ideas and tests on how to improve baseline designs and processes. As CPV companies increase their installed capacity, they can utilize an approach similar to the methodology of BOS-X to increase the competitiveness of their product. Through partnership with DOE, this holistic approach is expected to define a path for CPV well aligned with the goals of the SunShot Initiative.

Optimizing high performance computing workflow for protein functional annotation.

PubMed

Stanberry, Larissa; Rekepalli, Bhanu; Liu, Yuan; Giblock, Paul; Higdon, Roger; Montague, Elizabeth; Broomall, William; Kolker, Natali; Kolker, Eugene

2014-09-10

Functional annotation of newly sequenced genomes is one of the major challenges in modern biology. With modern sequencing technologies, the protein sequence universe is rapidly expanding. Newly sequenced bacterial genomes alone contain over 7.5 million proteins. The rate of data generation has far surpassed that of protein annotation. The volume of protein data makes manual curation infeasible, whereas a high compute cost limits the utility of existing automated approaches. In this work, we present an improved and optmized automated workflow to enable large-scale protein annotation. The workflow uses high performance computing architectures and a low complexity classification algorithm to assign proteins into existing clusters of orthologous groups of proteins. On the basis of the Position-Specific Iterative Basic Local Alignment Search Tool the algorithm ensures at least 80% specificity and sensitivity of the resulting classifications. The workflow utilizes highly scalable parallel applications for classification and sequence alignment. Using Extreme Science and Engineering Discovery Environment supercomputers, the workflow processed 1,200,000 newly sequenced bacterial proteins. With the rapid expansion of the protein sequence universe, the proposed workflow will enable scientists to annotate big genome data.

Optimizing high performance computing workflow for protein functional annotation

PubMed Central

Stanberry, Larissa; Rekepalli, Bhanu; Liu, Yuan; Giblock, Paul; Higdon, Roger; Montague, Elizabeth; Broomall, William; Kolker, Natali; Kolker, Eugene

2014-01-01

Functional annotation of newly sequenced genomes is one of the major challenges in modern biology. With modern sequencing technologies, the protein sequence universe is rapidly expanding. Newly sequenced bacterial genomes alone contain over 7.5 million proteins. The rate of data generation has far surpassed that of protein annotation. The volume of protein data makes manual curation infeasible, whereas a high compute cost limits the utility of existing automated approaches. In this work, we present an improved and optmized automated workflow to enable large-scale protein annotation. The workflow uses high performance computing architectures and a low complexity classification algorithm to assign proteins into existing clusters of orthologous groups of proteins. On the basis of the Position-Specific Iterative Basic Local Alignment Search Tool the algorithm ensures at least 80% specificity and sensitivity of the resulting classifications. The workflow utilizes highly scalable parallel applications for classification and sequence alignment. Using Extreme Science and Engineering Discovery Environment supercomputers, the workflow processed 1,200,000 newly sequenced bacterial proteins. With the rapid expansion of the protein sequence universe, the proposed workflow will enable scientists to annotate big genome data. PMID:25313296

Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People's Republic of China.

PubMed

Wu, Jing; He, Xiaoning; Liu, Li; Ye, Wenyu; Montgomery, William; Xue, Haibo; McCombs, Jeffery S

2015-01-01

Information concerning the treatment costs of schizophrenia is scarce in People's Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People's Republic of China. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated. A total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median) length of stay of 112.1 (71) days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median) number of visits of 6.2 (4) and a mean cost of $42 per visit during the 12-month follow-up period. Non-medication treatment costs were the most important element (45.7%) of schizophrenia-related costs, followed by laboratory and diagnostic costs (19.9%), medication costs (15.4%), and bed fees (13.3%). The costs related to the treatment of patients with schizophrenia were considerable in Tianjin, People's Republic of China, driven mainly by schizophrenia-related hospitalizations. Efforts focusing on community-based treatment programs and appropriate choice of drug treatment have the potential to reduce the use of inpatient services and may lead to better clinical and economic outcomes in the management of patients with schizophrenia in People's Republic of China.

A Project Management Approach to Using Simulation for Cost Estimation on Large, Complex Software Development Projects

NASA Technical Reports Server (NTRS)

Mizell, Carolyn; Malone, Linda

2007-01-01

It is very difficult for project managers to develop accurate cost and schedule estimates for large, complex software development projects. None of the approaches or tools available today can estimate the true cost of software with any high degree of accuracy early in a project. This paper provides an approach that utilizes a software development process simulation model that considers and conveys the level of uncertainty that exists when developing an initial estimate. A NASA project will be analyzed using simulation and data from the Software Engineering Laboratory to show the benefits of such an approach.

Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants.

PubMed

Tsiachristas, Apostolos; Cramm, Jane Murray; Nieboer, Anna P; Rutten-van Mölken, Maureen Pmh

2014-01-01

The aim of the study was to investigate the changes in costs and outcomes after the implementation of various disease management programs (DMPs), to identify their potential determinants, and to compare the costs and outcomes of different DMPs. We investigated the 1-year changes in costs and effects of 1,322 patients in 16 DMPs for cardiovascular risk (CVR), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DMII) in the Netherlands. We also explored the within-DMP predictors of these changes. Finally, a cost-utility analysis was performed from the healthcare and societal perspective comparing the most and the least effective DMP within each disease category. This study showed wide variation in development and implementation costs between DMPs (range:€16;€1,709) and highlighted the importance of economies of scale. Changes in health care utilization costs were not statistically significant. DMPs were associated with improvements in integration of CVR care (0.10 PACIC units), physical activity (+0.34 week-days) and smoking cessation (8% less smokers) in all diseases. Since an increase in physical activity and in self-efficacy were predictive of an improvement in quality-of-life, DMPs that aim to improve these are more likely to be effective. When comparing the most with the least effective DMP in a disease category, the vast majority of bootstrap replications (range:73%;97) pointed to cost savings, except for COPD (21%). QALY gains were small (range:0.003;+0.013) and surrounded by great uncertainty. After one year we have found indications of improvements in level of integrated care for CVR patients and lifestyle indicators for all diseases, but in none of the diseases we have found indications of cost savings due to DMPs. However, it is likely that it takes more time before the improvements in care lead to reductions in complications and hospitalizations.

Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants

PubMed Central

2014-01-01

Objectives The aim of the study was to investigate the changes in costs and outcomes after the implementation of various disease management programs (DMPs), to identify their potential determinants, and to compare the costs and outcomes of different DMPs. Methods We investigated the 1-year changes in costs and effects of 1,322 patients in 16 DMPs for cardiovascular risk (CVR), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DMII) in the Netherlands. We also explored the within-DMP predictors of these changes. Finally, a cost-utility analysis was performed from the healthcare and societal perspective comparing the most and the least effective DMP within each disease category. Results This study showed wide variation in development and implementation costs between DMPs (range:€16;€1,709) and highlighted the importance of economies of scale. Changes in health care utilization costs were not statistically significant. DMPs were associated with improvements in integration of CVR care (0.10 PACIC units), physical activity (+0.34 week-days) and smoking cessation (8% less smokers) in all diseases. Since an increase in physical activity and in self-efficacy were predictive of an improvement in quality-of-life, DMPs that aim to improve these are more likely to be effective. When comparing the most with the least effective DMP in a disease category, the vast majority of bootstrap replications (range:73%;97) pointed to cost savings, except for COPD (21%). QALY gains were small (range:0.003;+0.013) and surrounded by great uncertainty. Conclusions After one year we have found indications of improvements in level of integrated care for CVR patients and lifestyle indicators for all diseases, but in none of the diseases we have found indications of cost savings due to DMPs. However, it is likely that it takes more time before the improvements in care lead to reductions in complications and hospitalizations. PMID:25089122

A non-stationary cost-benefit analysis approach for extreme flood estimation to explore the nexus of 'Risk, Cost and Non-stationarity'

NASA Astrophysics Data System (ADS)

Qi, Wei

2017-11-01

Cost-benefit analysis is commonly used for engineering planning and design problems in practice. However, previous cost-benefit based design flood estimation is based on stationary assumption. This study develops a non-stationary cost-benefit based design flood estimation approach. This approach integrates a non-stationary probability distribution function into cost-benefit analysis, and influence of non-stationarity on expected total cost (including flood damage and construction costs) and design flood estimation can be quantified. To facilitate design flood selections, a 'Risk-Cost' analysis approach is developed, which reveals the nexus of extreme flood risk, expected total cost and design life periods. Two basins, with 54-year and 104-year flood data respectively, are utilized to illustrate the application. It is found that the developed approach can effectively reveal changes of expected total cost and extreme floods in different design life periods. In addition, trade-offs are found between extreme flood risk and expected total cost, which reflect increases in cost to mitigate risk. Comparing with stationary approaches which generate only one expected total cost curve and therefore only one design flood estimation, the proposed new approach generate design flood estimation intervals and the 'Risk-Cost' approach selects a design flood value from the intervals based on the trade-offs between extreme flood risk and expected total cost. This study provides a new approach towards a better understanding of the influence of non-stationarity on expected total cost and design floods, and could be beneficial to cost-benefit based non-stationary design flood estimation across the world.

Hierarchy of adhesion forces in patterns of photoreactive surface layers

NASA Astrophysics Data System (ADS)

Hlawacek, Gregor; Shen, Quan; Teichert, Christian; Lex, Alexandra; Trimmel, Gregor; Kern, Wolfgang

2009-01-01

Precise control of surface properties including electrical characteristics, wettability, and friction is a prerequisite for manufacturing modern organic electronic devices. The successful combination of bottom up approaches for aligning and orienting the molecules and top down techniques to structure the substrate on the nano- and micrometer scale allows the cost efficient fabrication and integration of future organic light emitting diodes and organic thin film transistors. One possibility for the top down patterning of a surface is to utilize different surface free energies or wetting properties of a functional group. Here, we used friction force microscopy (FFM) to reveal chemical patterns inscribed by a photolithographic process into a photosensitive surface layer. FFM allowed the simultaneous visualization of at least three different chemical surface terminations. The underlying mechanism is related to changes in the chemical interaction between probe and film surface.

Cost-effectiveness analysis of collaborative care management of major depression among low-income, predominantly Hispanics with diabetes.

PubMed

Hay, Joel W; Katon, Wayne J; Ell, Kathleen; Lee, Pey-Jiuan; Guterman, Jeffrey J

2012-01-01

To evaluate the cost-effectiveness of a socioculturally adapted collaborative depression care program among low-income Hispanics with diabetes. A randomized controlled trial of 387 patients with diabetes (96.5% Hispanic) with clinically significant depression followed over 18 months evaluated the cost-effectiveness of the Multifaceted Diabetes and Depression Program aimed at increasing patient exposure to evidence-based depression psychotherapy and/or pharmacotherapy in two public safety net clinics. Patient medical care costs and utilization were captured from Los Angeles County Department of Health Services claims records. Patient-reported outcomes included Short-Form Health Survey-12 and Patient Health Questionnaire-9-calculated depression-free days. Intervention patients had significantly greater Short-Form Health Survey-12 utility improvement from baseline compared with controls over the 18-month evaluation period (4.8%; P < 0.001) and a corresponding significant improvement in depression-free days (43.0; P < 0.001). Medical cost differences were not statistically significant in ordinary least squares and log-transformed cost regressions. The average costs of the Multifaceted Diabetes and Depression Program study intervention were $515 per patient. The program's cost-effectiveness averaged $4053 per quality-adjusted life-year per MDDP recipient and was more than 90% likely to fall below $12,000 per quality-adjusted life-year. Socioculturally adapted collaborative depression care improved utility and quality of life in predominantly low-income Hispanic patients with diabetes and was highly cost-effective. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Management of Malignant Pleural Effusion: A Cost-Utility Analysis.

PubMed

Shafiq, Majid; Frick, Kevin D; Lee, Hans; Yarmus, Lonny; Feller-Kopman, David J

2015-07-01

Malignant pleural effusion (MPE) is associated with a significant impact on health-related quality of life. Palliative interventions abound, with varying costs and degrees of invasiveness. We examined the relative cost-utility of 5 therapeutic alternatives for MPE among adults. Original studies investigating the management of MPE were extensively researched, and the most robust and current data particularly those from the TIME2 trial were chosen to estimate event probabilities. Medicare data were used for cost estimation. Utility estimates were adapted from 2 original studies and kept consistent with prior estimations. The decision tree model was based on clinical guidelines and authors' consensus opinion. Primary outcome of interest was the incremental cost-effectiveness ratio for each intervention over a less effective alternative over an analytical horizon of 6 months. Given the paucity of data on rapid pleurodesis protocol, a sensitivity analysis was conducted to address the uncertainty surrounding its efficacy in terms of achieving long-term pleurodesis. Except for repeated thoracentesis (RT; least effective), all interventions had similar effectiveness. Tunneled pleural catheter was the most cost-effective option with an incremental cost-effectiveness ratio of $45,747 per QALY gained over RT, assuming a willingness-to-pay threshold of $100,000/QALY. Multivariate sensitivity analysis showed that rapid pleurodesis protocol remained cost-ineffective even with an estimated probability of lasting pleurodesis up to 85%. Tunneled pleural catheter is the most cost-effective therapeutic alternative to RT. This, together with its relative convenience (requiring neither hospitalization nor thoracoscopic procedural skills), makes it an intervention of choice for MPE.

"Fibromyalgia and quality of life: mapping the revised fibromyalgia impact questionnaire to the preference-based instruments".

PubMed

Collado-Mateo, Daniel; Chen, Gang; Garcia-Gordillo, Miguel A; Iezzi, Angelo; Adsuar, José C; Olivares, Pedro R; Gusi, Narcis

2017-05-30

The revised version of the Fibromyalgia Impact Questionnaire (FIQR) is one of the most widely used specific questionnaires in FM studies. However, this questionnaire does not allow calculation of QALYs as it is not a preference-based measure. The aim of this study was to develop mapping algorithm which enable FIQR scores to be transformed into utility scores that can be used in the cost utility analyses. A cross-sectional survey was conducted. One hundred and 92 Spanish women with Fibromyalgia were asked to complete four general quality of life questionnaires, i.e. EQ-5D-5 L, 15D, AQoL-8D and SF-12, and one specific disease instrument, the FIQR. A direct mapping approach was adopted to derive mapping algorithms between the FIQR and each of the four multi-attribute utility (MAU) instruments. Health state utility was treated as the dependent variable in the regression analysis, whilst the FIQR score and age were predictors. The mean utility scores ranged from 0.47 (AQoL-8D) to 0.69 (15D). All correlations between the FIQR total score and MAU instruments utility scores were highly significant (p < 0.0001) with magnitudes larger than 0.5. Although very slight differences in the mean absolute error were found between ordinary least squares (OLS) estimator and generalized linear model (GLM), models based on GLM were better for EQ-5D-5 L, AQoL-8D and 15D. Mapping algorithms developed in this study enable the estimation of utility values from scores in a fibromyalgia specific questionnaire.

The Business Case for Payer Support of a Community-Based Health Information Exchange: A Humana Pilot Evaluating Its Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care

PubMed Central

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R.

2011-01-01

Background As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. Objective To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel Methods The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Results Post–propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. Conclusions When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care. PMID:25126351

Systematic Approach to Better Understanding Integration Costs

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

Stark, Gregory B.

2015-09-01

This research presents a systematic approach to evaluating the costs of integrating new generation and operational procedures into an existing power system, and the methodology is independent of the type of change or nature of the generation. The work was commissioned by the U.S. Department of Energy and performed by the National Renewable Energy Laboratory to investigate three integration cost-related questions: (1) How does the addition of new generation affect a system's operational costs, (2) How do generation mix and operating parameters and procedures affect costs, and (3) How does the amount of variable generation (non-dispatchable wind and solar) impactmore » the accuracy of natural gas orders? A detailed operational analysis was performed for seven sets of experiments: variable generation, large conventional generation, generation mix, gas prices, fast-start generation, self-scheduling, and gas supply constraints. For each experiment, four components of integration costs were examined: cycling costs, non-cycling VO&M costs, fuel costs, and reserves provisioning costs. The investigation was conducted with PLEXOS production cost modeling software utilizing an updated version of the Institute of Electrical and Electronics Engineers 118-bus test system overlaid with projected operating loads from the Western Electricity Coordinating Council for the Sacramento Municipal Utility District, Puget Sound Energy, and Public Service Colorado in the year 2020. The test system was selected in consultation with an industry-based technical review committee to be a reasonable approximation of an interconnection yet small enough to allow the research team to investigate a large number of scenarios and sensitivity combinations. The research should prove useful to market designers, regulators, utilities, and others who want to better understand how system changes can affect production costs.« less

Impact of glycemic control on healthcare resource utilization and costs of type 2 diabetes: current and future pharmacologic approaches to improving outcomes.

PubMed

Banerji, Mary Ann; Dunn, Jeffrey D

2013-09-01

The incidence and prevalence of type 2 diabetes continue to grow in the United States and worldwide, along with the growing prevalence of obesity. Patients with type 2 diabetes are at greater risk for comorbid cardiovascular (CV) disease (CVD), which dramatically affects overall healthcare costs. To review the impact of glycemic control and medication adherence on morbidity, mortality, and healthcare costs of patients with type 2 diabetes, and to highlight the need for new drug therapies to improve outcomes in this patient population. This comprehensive literature search was conducted for the period between 2000 and 2013, using MEDLINE, to identify published articles that report the associations between glycemic control, medication adherence, CV morbidity and mortality, and healthcare utilization and costs. Search terms included "type 2 diabetes," "adherence," "compliance," "nonadherence," "drug therapy," "resource use," "cost," and "cost-effectiveness." Despite improvements in the management of CV risk factors in patients with type 2 diabetes, outcomes remain poor. The costs associated with the management of type 2 diabetes are increasing dramatically as the prevalence of the disease increases. Medication adherence to long-term drug therapy remains poor in patients with type 2 diabetes and contributes to poor glycemic control in this patient population, increased healthcare resource utilization and increased costs, as well as increased rates of comorbid CVD and mortality. Furthermore, poor adherence to established evidence-based guidelines for type 2 diabetes, including underdiagnosis and undertreatment, contributes to poor outcomes. New approaches to the treatment of patients with type 2 diabetes currently in development have the potential to improve medication adherence and consequently glycemic control, which in turn will help to reduce associated costs and healthcare utilization. As the prevalence of type 2 diabetes and its associated comorbidities grows, healthcare costs will continue to increase, indicating a need for better approaches to achieve glycemic control and manage comorbid conditions. Drug therapies are needed that enhance patient adherence and persistence levels far above levels reported with currently available drugs. Improvements in adherence to treatment guidelines and greater rates of lifestyle modifications also are needed. A serious unmet need exists for greatly improved patient outcomes, more effective and more tolerable drugs, as well as marked improvements in adherence to treatment guidelines and drug therapy to positively impact healthcare costs and resource use.

a Unified Matrix Polynomial Approach to Modal Identification

NASA Astrophysics Data System (ADS)

Allemang, R. J.; Brown, D. L.

1998-04-01

One important current focus of modal identification is a reformulation of modal parameter estimation algorithms into a single, consistent mathematical formulation with a corresponding set of definitions and unifying concepts. Particularly, a matrix polynomial approach is used to unify the presentation with respect to current algorithms such as the least-squares complex exponential (LSCE), the polyreference time domain (PTD), Ibrahim time domain (ITD), eigensystem realization algorithm (ERA), rational fraction polynomial (RFP), polyreference frequency domain (PFD) and the complex mode indication function (CMIF) methods. Using this unified matrix polynomial approach (UMPA) allows a discussion of the similarities and differences of the commonly used methods. the use of least squares (LS), total least squares (TLS), double least squares (DLS) and singular value decomposition (SVD) methods is discussed in order to take advantage of redundant measurement data. Eigenvalue and SVD transformation methods are utilized to reduce the effective size of the resulting eigenvalue-eigenvector problem as well.

ParkinsonNet: A Low-Cost Health Care Innovation With A Systems Approach From The Netherlands.

PubMed

Bloem, Bas R; Rompen, Lonneke; Vries, Nienke M de; Klink, Ab; Munneke, Marten; Jeurissen, Patrick

2017-11-01

ParkinsonNet, a low-cost innovation to optimize care for patients with Parkinson disease, was developed in 2004 as a network of physical therapists in several regions in the Netherlands. Since that time, the network has achieved full national reach, with 70 regional networks and around 3,000 specifically trained professionals from 12 disciplines. Key elements include the empowerment of professionals who are highly trained and specialized in Parkinson disease, the empowerment of patients by education and consultation, and the empowerment of integrated multidisciplinary teams to better address and manage the disease. Studies have found that the ParkinsonNet approach leads to outcomes that are at least as good as, if not better than, outcomes from usual care. One study found a 50 percent reduction in hip fractures and fewer inpatient admissions. Other studies suggest that ParkinsonNet leads to modest but important cost savings (at least US$439 per patient annually). These cost savings outweigh the costs of building and maintaining the network. Because of ParkinsonNet's success, the program has now spread to several other countries and serves as a model of a successful and scalable frugal innovation.

Costing the Morbidity and Mortality Consequences of Zoonoses Using Health-Adjusted Life Years.

PubMed

Jordan, H; Dunt, D; Hollingsworth, B; Firestone, S M; Burgman, M

2016-10-01

Governments are routinely involved in the biosecurity of agricultural and food imports and exports. This involves controlling the complex ongoing threat of the broad range of zoonoses: endemic, exotic and newly emerging. Policy-related decision-making in these areas requires accurate information and predictions concerning the effects and potential impacts of zoonotic diseases. The aim of this article was to provide information concerning the development and use of utility-based tools, specifically disability-adjusted life years (DALYs), for measuring the burden on human disease (morbidity and mortality) as a consequence of zoonotic infections. Issues and challenges to their use are also considered. Non-monetary utility approaches that are reviewed in this paper form one of a number of tools that can be used to estimate the monetary and non-monetary 'cost' of morbidity- and mortality-related consequences. Other tools derive from cost-of-illness, willingness-to-pay and multicriteria approaches. Utility-based approaches are specifically designed to capture the pain, suffering and loss of functioning associated with diseases, zoonotic and otherwise. These effects are typically complicated to define, measure and subsequently 'cost'. Utility-based measures will not be able to capture all of the effects, especially those that extend beyond the health sector. These will more normally be captured in financial terms. Along with other uncommon diseases, the quality of the relevant epidemiological data may not be adequate to support the estimation of losses in utility as a result of zoonoses. Other issues in their use have been identified. New empirical studies have shown some success in addressing these issues. Other issues await further study. It is concluded that, bearing in mind all caveats, utility-based methods are important tools in assessing the magnitude of the impacts of zoonoses in human disease. They make an important contribution to decision-making and priority setting across all sectors. In doing so, they highlight the relative importance of the burden of zoonotic disease globally. © 2014 Blackwell Verlag GmbH.

Simulated ward round: reducing costs, not outcomes.

PubMed

Ford, Helen; Cleland, Jennifer; Thomas, Ian

2017-02-01

Distractions and interruptions on the ward pose substantial patient safety risks, but medical students receive little training on their management. Although there is some evidence that medical students can be taught how to manage distractions and interruptions in a simulated ward environment, the only model to date is based on individual feedback, which is resource-expensive, mitigating curricular integration. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round. Twenty-three of 55 final-year medical students took part in a cost-reduced simulated ward round. Costs were minimised by providing group rather than individualised feedback, thereby shortening the duration of each simulation and reducing the number of interruptions. The utility of the simulation was assessed via student evaluation and performance on a patient safety station of an objective structured clinical examination (OSCE). The direct costs of the simulation were more than 50 per cent lower per student compared with the original study, mostly as a result of a reduction in the time that faculty members took to give feedback. Students managed distractions better and received higher scores in the OSCE station than those who had not undergone the ward round. Group feedback was evaluated positively by most participants: 94 per cent of those who provided feedback agreed or strongly agreed that the simulation would make them a safer doctor and would improve their handling of distractions. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round DISCUSSION: The costs of a simulated ward round can be significantly reduced whilst maintaining educational utility. These findings should encourage medical schools to integrate ward simulation into curricula. © 2016 John Wiley & Sons Ltd.

Benefits and Costs of Aggressive Energy Efficiency Programs and the Impacts of Alternative Sources of Funding: Case Study of Massachusetts

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

Cappers, Peter; Satchwell, Andrew; Goldman, Charles

2010-08-06

Increased interest by state (and federal) policymakers and regulatory agencies in pursuing aggressive energy efficiency efforts could deliver significant utility bill savings for customers while having long-term implications for ratepayers (e.g. potential rate impacts). Equity and distributional concerns associated with the authorized recovery of energy efficiency program costs may necessitate the pursuit of alternative program funding approaches. In 2008, Massachusetts passed the Green Communities Act which directed its energy efficiency (EE) program administrators to obtain all cost-effective EE resources. This goal has translated into achieving annual electric energy savings equivalent to a 2.4% reduction in retail sales from energy efficiencymore » programs in 2012. Representatives of electricity consumer groups supported the new portfolio of EE programs (and the projected bill savings) but raised concerns about the potential rate impacts associated with achieving such aggressive EE goals, leading policymakers to seek out alternative funding sources which can potentially mitigate these effects. Utility administrators have also raised concerns about under-recovery of fixed costs when aggressive energy efficiency programs are pursued and have proposed ratemaking policies (e.g. decoupling) and business models that better align the utility's financial interests with the state's energy efficiency public policy goals. Quantifying these concerns and identifying ways they can be addressed are crucial steps in gaining the support of major stakeholder groups - lessons that can apply to other states looking to significantly increase savings targets that can be achieved from their own ratepayer-funded energy efficiency programs. We use a pro-forma utility financial model to quantify the bill and rate impacts on electricity customers when very aggressive annual energy efficiency savings goals ({approx}2.4%) are achieved over the long-term and also assess the impact of different cost recovery approaches that integrate alternative revenue sources. We also analyze alternative lost fixed cost recovery approaches to better understand how to mitigate the erosion of utility shareholder returns in states that have adopted (and achieved) very aggressive savings targets.« less

Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial.

PubMed

Jansons, Paul; Robins, Lauren; O'Brien, Lisa; Haines, Terry

2018-01-01

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program? A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon. People with chronic health conditions who had completed a 6-week exercise program at a community health service. One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks. Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L). Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach. The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently. ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2018) Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial. Journal of Physiotherapy 64: 48-54]. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

USE OF EXPERT RATINGS AS SAMPLING STRATA FOR A MORE COST-EFFECTIVE PROBABILITY SAMPLE OF A RARE POPULATION

PubMed Central

McCaffrey, Daniel; Perlman, Judith; Marshall, Grant N.; Hambarsoomians, Katrin

2010-01-01

We consider situations in which externally observable characteristics allow experts to quickly categorize individual households as likely or unlikely to contain a member of a rare target population. This classification can form the basis of disproportionate stratified sampling such that households classified as “unlikely” are sampled at a lower rate than those classified as “likely,” thereby reducing screening costs. Design weights account for this approach and allow unbiased estimates for the target population. We demonstrate that with sensitivity and specificity of expert classification at least 70%, and ideally at least 80%, our approach can economically increase effective sample size for a rare population. We develop heuristics for implementing this approach and demonstrate that sensitivity drives design effects and screening costs whereas specificity only drives the latter. We demonstrate that the potential gains from this approach increase as the target population becomes rarer. We further show that for most applications, unlikely strata should be sampled at 1/6 to ½ the rate of likely strata. This approach was applied to a survey of Cambodian immigrants in which the 82% of households rated “unlikely” were sampled at ¼ the rate as “likely” households, reducing screening from 9.4 to 4.0 approaches per complete. Sensitivity and specificity were 86% and 91% respectively. Weighted estimation had a design effect of 1.26 so screening costs per effective sample size were reduced 47%. We also note that in this instance, expert classification appeared to be uncorrelated with survey outcomes of interest among eligibles. PMID:20936050

The Role of Theory in Practice.

ERIC Educational Resources Information Center

Pyfer, Jean L.

There are at least three ways in which educational theory can be used in practice: (1) to reexamine our traditional approaches, (2) to provide direction in future practice, and (3) to generate research. Reexamination of traditional approaches through analysis and utilization of theoretical methods is one means of promoting constant growth and…

Benchmarking: applications to transfusion medicine.

PubMed

Apelseth, Torunn Oveland; Molnar, Laura; Arnold, Emmy; Heddle, Nancy M

2012-10-01

Benchmarking is as a structured continuous collaborative process in which comparisons for selected indicators are used to identify factors that, when implemented, will improve transfusion practices. This study aimed to identify transfusion medicine studies reporting on benchmarking, summarize the benchmarking approaches used, and identify important considerations to move the concept of benchmarking forward in the field of transfusion medicine. A systematic review of published literature was performed to identify transfusion medicine-related studies that compared at least 2 separate institutions or regions with the intention of benchmarking focusing on 4 areas: blood utilization, safety, operational aspects, and blood donation. Forty-five studies were included: blood utilization (n = 35), safety (n = 5), operational aspects of transfusion medicine (n = 5), and blood donation (n = 0). Based on predefined criteria, 7 publications were classified as benchmarking, 2 as trending, and 36 as single-event studies. Three models of benchmarking are described: (1) a regional benchmarking program that collects and links relevant data from existing electronic sources, (2) a sentinel site model where data from a limited number of sites are collected, and (3) an institutional-initiated model where a site identifies indicators of interest and approaches other institutions. Benchmarking approaches are needed in the field of transfusion medicine. Major challenges include defining best practices and developing cost-effective methods of data collection. For those interested in initiating a benchmarking program, the sentinel site model may be most effective and sustainable as a starting point, although the regional model would be the ideal goal. Copyright © 2012 Elsevier Inc. All rights reserved.

Economic Value of Greater Access to Bariatric Procedures for Patients With Severe Obesity and Diabetes.

PubMed

Kim, David D; Arterburn, David E; Sullivan, Sean D; Basu, Anirban

2018-05-12

Designing optimal insurance is important to ensure access to care for individuals that are most likely to benefit. We examined the potential impact of lowering patient cost-sharing for bariatric procedures. After defining 10 subgroups by body mass index (BMI) and type 2 diabetes mellitus (T2DM), we analyzed the National Health and Nutrition Examination Survey datasets to estimate the prevalence of each subgroup. The MarketScan claims database provided utilization rates and costs of bariatric procedures. Using an existing cost-effectiveness model, we estimated the economic value of bariatric procedures under various cost-sharing levels (0%-25%) with 2 frameworks: (1) a traditional cost-effectiveness analysis and (2) a new approach that incorporates utilization effects across subgroups. The utilization rate was higher among individuals with T2DM than those without T2DM (90.4 vs. 59.1 cases per 100,000) for bariatric procedures, which were more cost-effective for those with T2DM and a higher BMI. After accounting for utilization effects, the economic value of bariatric surgery was $177 and $63 per individual from a lifetime and a 5-year time horizon, respectively. Under no patient cost-sharing for individuals with BMI≥40 and T2DM, utilization rates were expected to increase by 21 cases per 100,000, resulting in additional $2 realized value per patient and $7.07 million in returns at the US population level. Cost-sharing is a barrier to uptake of a clinical and cost-effective treatment for severe obesity. Reducing cost-sharing for patients with severe obesity and T2DM could potentially increase the utilization of bariatric procedures and result in greater economic value to payers.

A cost-utility analysis of the use of preoperative computed tomographic angiography in abdomen-based perforator flap breast reconstruction.

PubMed

Offodile, Anaeze C; Chatterjee, Abhishek; Vallejo, Sergio; Fisher, Carla S; Tchou, Julia C; Guo, Lifei

2015-04-01

Computed tomographic angiography is a diagnostic tool increasingly used for preoperative vascular mapping in abdomen-based perforator flap breast reconstruction. This study compared the use of computed tomographic angiography and the conventional practice of Doppler ultrasonography only in postmastectomy reconstruction using a cost-utility model. Following a comprehensive literature review, a decision analytic model was created using the three most clinically relevant health outcomes in free autologous breast reconstruction with computed tomographic angiography versus Doppler ultrasonography only. Cost and utility estimates for each health outcome were used to derive the quality-adjusted life-years and incremental cost-utility ratio. One-way sensitivity analysis was performed to scrutinize the robustness of the authors' results. Six studies and 782 patients were identified. Cost-utility analysis revealed a baseline cost savings of $3179, a gain in quality-adjusted life-years of 0.25. This yielded an incremental cost-utility ratio of -$12,716, implying a dominant choice favoring preoperative computed tomographic angiography. Sensitivity analysis revealed that computed tomographic angiography was costlier when the operative time difference between the two techniques was less than 21.3 minutes. However, the clinical advantage of computed tomographic angiography over Doppler ultrasonography only showed that computed tomographic angiography would still remain the cost-effective option even if it offered no additional operating time advantage. The authors' results show that computed tomographic angiography is a cost-effective technology for identifying lower abdominal perforators for autologous breast reconstruction. Although the perfect study would be a randomized controlled trial of the two approaches with true cost accrual, the authors' results represent the best available evidence.

Climate change and peak demand for electricity: Evaluating policies for reducing peak demand under different climate change scenarios

NASA Astrophysics Data System (ADS)

Anthony, Abigail Walker

This research focuses on the relative advantages and disadvantages of using price-based and quantity-based controls for electricity markets. It also presents a detailed analysis of one specific approach to quantity based controls: the SmartAC program implemented in Stockton, California. Finally, the research forecasts electricity demand under various climate scenarios, and estimates potential cost savings that could result from a direct quantity control program over the next 50 years in each scenario. The traditional approach to dealing with the problem of peak demand for electricity is to invest in a large stock of excess capital that is rarely used, thereby greatly increasing production costs. Because this approach has proved so expensive, there has been a focus on identifying alternative approaches for dealing with peak demand problems. This research focuses on two approaches: price based approaches, such as real time pricing, and quantity based approaches, whereby the utility directly controls at least some elements of electricity used by consumers. This research suggests that well-designed policies for reducing peak demand might include both price and quantity controls. In theory, sufficiently high peak prices occurring during periods of peak demand and/or low supply can cause the quantity of electricity demanded to decline until demand is in balance with system capacity, potentially reducing the total amount of generation capacity needed to meet demand and helping meet electricity demand at the lowest cost. However, consumers need to be well informed about real-time prices for the pricing strategy to work as well as theory suggests. While this might be an appropriate assumption for large industrial and commercial users who have potentially large economic incentives, there is not yet enough research on whether households will fully understand and respond to real-time prices. Thus, while real-time pricing can be an effective tool for addressing the peak load problems, pricing approaches are not well suited to ensure system reliability. This research shows that direct quantity controls are better suited for avoiding catastrophic failure that results when demand exceeds supply capacity.

Fishing decisions under uncertainty

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

Harrison, C.G.

1982-02-01

The drilling manager often is forced by an extended fishing operation to choose between the known costs incurred with abandonment of retrieval attempts and the unknown costs of continuing fishing operations. The successful manager makes the decision that costs the company the least money. Continuing fishing operations beyond some economic limit is failure, even if the fish is retrieved and that portion of the hole saved, because more money has been spent in the fishing attempt than would have been spent by not fishing. The strategy is to minimize losses. This analysis closely follows the theory of utility developed bymore » J. von Neuman and O. Morgenstern. 1 ref.« less

A cost effectiveness study of eribulin versus standard single-agent cytotoxic chemotherapy for women with previously treated metastatic breast cancer.

PubMed

Lopes, Gilberto; Glück, Stefan; Avancha, Kiran; Montero, Alberto J

2013-01-01

Eribulin was FDA approved in 2012 as a treatment for patients with MBC who have previously received at least two prior chemotherapy regimens. The aim of this analysis was to assess the cost effectiveness of eribulin versus the three most commonly utilized drugs (TPC) in the EMBRACE trial: vinorelbine, gemcitabine, and capecitabine (X); and to other branded FDA approved drugs: ixabepilone (I), liposomal-doxorubicin (D), and nab-paclitaxel. We created a decision-analytical and a Markov model using clinical data from the EMBRACE trial. Health utilities were derived from the published literature. Costs for drug acquisition, physician visits, and laboratory tests were obtained from Medicare Services Drug Payment Table and Physician Fee Schedule and are represented in 2012 USD. Life-years saved (LY), quality-adjusted life years (QALY), and incremental cost effectiveness ratio (ICER) were calculated. Eribulin added 0.208 LY and 0.119 QALY with an incremental cost over TPC of $25,458, and therefore an ICER of $213,742 per QALY. The main drivers of the model were drug cost, PFS, OS, and health utility values. The results of the model were robust in sensitivity analyses. Relative to I, D, A, and X, the ICER for eribulin was $76,823, $109,283, $129,773, and $167,267, respectively. Even with a more contemporary willingness-to-pay threshold of approximately $120,000 per QALY, eribulin was not found to be cost effective in the treatment of MBC relative to TPC; relative to some more expensive branded drugs, eribulin appears to be cost effective.

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

PubMed

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

2014-02-01

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

Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis.

PubMed

Noben, Cindy; Vilsteren, Myrthe van; Boot, Cécile; Steenbeek, Romy; Schaardenburg, Dirkjan van; Anema, Johannes R; Evers, Silvia; Nijhuis, Frans; Rijk, Angelique de

2017-05-25

Evaluating the cost effectiveness and cost utility of an integrated care intervention and participatory workplace intervention for workers with rheumatoid arthritis (RA) to improve their work productivity. Twelve month follow-up economic evaluation alongside a randomized controlled trial (RCT) within specialized rheumatology treatment centers. Adults diagnosed with RA between 18-64 years, in a paid job for at least eight hours per week, experiencing minor difficulties in work functioning were randomized to the intervention (n = 75) or the care-as-usual (CAU) group (n = 75). Effect outcomes were productivity and quality of life (QALYs). Costs associated with healthcare, patient and family, productivity, and intervention were calculated from a societal perspective. Cost effectiveness and cost utility were assessed to indicate the incremental costs and benefits per additional unit of effect. Subgroup and sensitivity analyses evaluated the robustness of the findings. At-work productivity loss was about 4.6 hours in the intervention group and 3.5 hours in the care as usual (CAU) group per two weeks. Differences in QALY were negligible; 0.77 for the CAU group and 0.74 for the intervention group. In total, average costs after twelve months follow-up were highest in the intervention group (€7,437.76) compared to the CAU group (€5,758.23). The cost-effectiveness and cost-utility analyses show that the intervention was less effective and (often) more expensive when compared to CAU. Sensitivity analyses supported these findings. The integrated care intervention and participatory workplace intervention for workers with RA provides gains neither in productivity at the workplace nor in quality of life. These results do not justify the additional costs.

Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis

PubMed Central

Noben, Cindy; van Vilsteren, Myrthe; Boot, Cécile; Steenbeek, Romy; van Schaardenburg, Dirkjan; Anema, Johannes R.; Evers, Silvia; Nijhuis, Frans; de Rijk, Angelique

2017-01-01

Objectives: Evaluating the cost effectiveness and cost utility of an integrated care intervention and participatory workplace intervention for workers with rheumatoid arthritis (RA) to improve their work productivity. Methods: Twelve month follow-up economic evaluation alongside a randomized controlled trial (RCT) within specialized rheumatology treatment centers. Adults diagnosed with RA between 18-64 years, in a paid job for at least eight hours per week, experiencing minor difficulties in work functioning were randomized to the intervention (n = 75) or the care-as-usual (CAU) group (n = 75). Effect outcomes were productivity and quality of life (QALYs). Costs associated with healthcare, patient and family, productivity, and intervention were calculated from a societal perspective. Cost effectiveness and cost utility were assessed to indicate the incremental costs and benefits per additional unit of effect. Subgroup and sensitivity analyses evaluated the robustness of the findings. Results: At-work productivity loss was about 4.6 hours in the intervention group and 3.5 hours in the care as usual (CAU) group per two weeks. Differences in QALY were negligible; 0.77 for the CAU group and 0.74 for the intervention group. In total, average costs after twelve months follow-up were highest in the intervention group (€7,437.76) compared to the CAU group (€5,758.23). The cost-effectiveness and cost-utility analyses show that the intervention was less effective and (often) more expensive when compared to CAU. Sensitivity analyses supported these findings. Discussion: The integrated care intervention and participatory workplace intervention for workers with RA provides gains neither in productivity at the workplace nor in quality of life. These results do not justify the additional costs. PMID:28381814

Changing resident test ordering behavior: a multilevel intervention to decrease laboratory utilization at an academic medical center.

PubMed

Vidyarthi, Arpana R; Hamill, Timothy; Green, Adrienne L; Rosenbluth, Glenn; Baron, Robert B

2015-01-01

Hospital laboratory test volume is increasing, and overutilization contributes to errors and costs. Efforts to reduce laboratory utilization have targeted aspects of ordering behavior, but few have utilized a multilevel collaborative approach. The study team partnered with residents to reduce unnecessary laboratory tests and associated costs through multilevel interventions across the academic medical center. The study team selected laboratory tests for intervention based on cost, volume, and ordering frequency (complete blood count [CBC] and CBC with differential, common electrolytes, blood enzymes, and liver function tests). Interventions were designed collaboratively with residents and targeted components of ordering behavior, including system changes, teaching, social marketing, academic detailing, financial incentives, and audit/feedback. Laboratory ordering was reduced by 8% cumulatively over 3 years, saving $2 019 000. By involving residents at every stage of the intervention and targeting multiple levels simultaneously, laboratory utilization was reduced and cost savings were sustained over 3 years. © 2014 by the American College of Medical Quality.

Comparison of escitalopram versus citalopram for the treatment of major depressive disorder in a geriatric population.

PubMed

Wu, Eric; Greenberg, Paul E; Yang, Elaine; Yu, Andrew; Erder, M Haim

2008-09-01

To compare escitalopram versus citalopram for the treatment of major depressive disorder (MDD) in geriatric patients. Administrative claims data (2003-2005) were analyzed for patients aged > or =65 years with at least one inpatient claim or two independent medical claims associated with MDD diagnosis. Patients were continuously enrolled for at least 12 months, filled at least one prescription for citalopram or escitalopram and had no second generation antidepressant use during the 6-month pre-index date. Contingency table analysis and survival analysis were used to compare outcomes between the two treatment groups. Treatment persistence, hospitalization utilization, and prescription drug, medical, and total healthcare costs were analyzed. Outcomes were compared between patients initiated on escitalopram and those initiated on citalopram both descriptively and using multivariate analysis adjusting for baseline characteristics. Among 691 geriatric patients, escitalopram-treated patients (n=459) were less likely to discontinue treatment (hazard ratio [HR]=0.83, p=0.049) or switch to another second generation antidepressant (HR=0.62, p=0.001) compared to patients treated with citalopram (n=232). Patients treated with escitalopram had a significantly lower hospitalization rate (31.2% vs. 38.8%, p=0.045) and 66% fewer hospitalization days based on negative binomial regression (p<0.001). While escitalopram patients had comparable prescription drug costs, they had lower total medical service costs (regression: $9748 vs. $19,208, p<0.001) and lower total healthcare costs (regression: $11,434 vs. $20,601, p<0.001). This study's limitations include its small sample size, short observational periods and exclusivity of indirect costs. Geriatric patients treated with escitalopram had better treatment persistence, fewer hospitalizations, and lower medical and total healthcare costs than patients treated with citalopram. Most of the cost reduction was attributable to significantly lower hospitalizations and total medical costs.

The potential economic value of a cutaneous leishmaniasis vaccine in seven endemic countries in the Americas.

PubMed

Bacon, Kristina M; Hotez, Peter J; Kruchten, Stephanie D; Kamhawi, Shaden; Bottazzi, Maria Elena; Valenzuela, Jesus G; Lee, Bruce Y

2013-01-07

Cutaneous leishmaniasis (CL) and its associated complications, including mucocutaneous leishmaniasis (MCL) and diffuse CL (DCL) have emerged as important neglected tropical diseases in Latin America, especially in areas associated with human migration, conflict, and recent deforestation. Because of the limitations of current chemotherapeutic approaches to CL, MCL, and DCL, several prototype vaccines are in different states of product and clinical development. We constructed and utilized a Markov decision analytic computer model to evaluate the potential economic value of a preventative CL vaccine in seven countries in Latin America: Bolivia, Brazil, Colombia, Ecuador, Mexico, Peru, and Venezuela. The results indicated that even a vaccine with a relatively short duration of protection and modest efficacy could be recommended for use in targeted locations, as it could prevent a substantial number of cases at low-cost and potentially even result in cost savings. If the population in the seven countries were vaccinated using a vaccine that provides at least 10 years of protection, an estimated 41,000-144,784 CL cases could be averted, each at a cost less than the cost of current recommended treatments. Further, even a vaccine providing as little as five years duration of protection with as little as 50% efficacy remains cost-effective compared with chemotherapy; additional scenarios resembling epidemic settings such as the one that occurred in Chaparral, Colombia in 2004 demonstrate important economic benefits. Copyright © 2012 Elsevier Ltd. All rights reserved.

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.

Uncertainty analysis of least-cost modeling for designing wildlife linkages.

PubMed

Beier, Paul; Majka, Daniel R; Newell, Shawn L

2009-12-01

Least-cost models for focal species are widely used to design wildlife corridors. To evaluate the least-cost modeling approach used to develop 15 linkage designs in southern California, USA, we assessed robustness of the largest and least constrained linkage. Species experts parameterized models for eight species with weights for four habitat factors (land cover, topographic position, elevation, road density) and resistance values for each class within a factor (e.g., each class of land cover). Each model produced a proposed corridor for that species. We examined the extent to which uncertainty in factor weights and class resistance values affected two key conservation-relevant outputs, namely, the location and modeled resistance to movement of each proposed corridor. To do so, we compared the proposed corridor to 13 alternative corridors created with parameter sets that spanned the plausible ranges of biological uncertainty in these parameters. Models for five species were highly robust (mean overlap 88%, little or no increase in resistance). Although the proposed corridors for the other three focal species overlapped as little as 0% (mean 58%) of the alternative corridors, resistance in the proposed corridors for these three species was rarely higher than resistance in the alternative corridors (mean difference was 0.025 on a scale of 1 10; worst difference was 0.39). As long as the model had the correct rank order of resistance values and factor weights, our results suggest that the predicted corridor is robust to uncertainty. The three carnivore focal species, alone or in combination, were not effective umbrellas for the other focal species. The carnivore corridors failed to overlap the predicted corridors of most other focal species and provided relatively high resistance for the other focal species (mean increase of 2.7 resistance units). Least-cost modelers should conduct uncertainty analysis so that decision-makers can appreciate the potential impact of model uncertainty on conservation decisions. Our approach to uncertainty analysis (which can be called a worst-case scenario approach) is appropriate for complex models in which distribution of the input parameters cannot be specified.

Stranded cost securitization: Analytical considerations

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

Abbott, S.

1997-10-01

Securitization is a promising financing approach by which utilities may recover their stranded costs while lowering their cost of capital, permitting them to offer rate reductions to customers. However, there are important issues to analyze before determining that securitization will be an attractive option for bondholders. To facilitate the transition to a competitive electric market, numerous state legislatures have passed or are considering legislation that, while mandating competition, allows utilities to recover their stranded costs through the imposition of a competitive transition fee. To accommodate securitization of revenues from the fees, statutes typically designate as a property right the futuremore » revenues from these fees and the utility may sell, assign, or transfer the rights to a financing vehicle. Securities may be issued by a trust or other special purpose vehicle supported by future revenues from these fees. Because of the unique characteristics of the highly regulated utility industry and the {open_quotes}asset{close_quotes} that is securitized, the credit analysis of stranded cost securities differs from that of most other assets. For example, underwriting and servicing issues, which are key items of interest in other segments of the ABS market, are less of a concern in a stranded cost context.« less

Low-cost interferometric TDM technology for dynamic sensing applications

NASA Astrophysics Data System (ADS)

Bush, Jeff; Cekorich, Allen

2004-12-01

A low-cost design approach for Time Division Multiplexed (TDM) fiber-optic interferometric interrogation of multi-channel sensor arrays is presented. This paper describes the evolutionary design process of the subject design. First, the requisite elements of interferometric interrogation are defined for a single channel sensor. The concept is then extended to multi-channel sensor interrogation implementing a TDM multiplex scheme where "traditional" design elements are utilized. The cost of the traditional TDM interrogator is investigated and concluded to be too high for entry into many markets. A new design approach is presented which significantly reduces the cost for TDM interrogation. This new approach, in accordance with the cost objectives, shows promise to bring this technology to within the threshold of commercial acceptance for a wide range of distributed fiber sensing applications.

A Mathematical Model for Allocation of School Resources to Optimize a Selected Output.

ERIC Educational Resources Information Center

McAfee, Jackson K.

The methodology of costing an education program by identifying the resources it utilizes places all costs within the framework of staff, equipment, materials, facilities, and services. This paper suggests that this methodology is much stronger than the more traditional budgetary and cost per pupil approach. The techniques of data collection are…

What is heartburn worth? A cost-utility analysis of management strategies.

PubMed

Heudebert, G R; Centor, R M; Klapow, J C; Marks, R; Johnson, L; Wilcox, C M

2000-03-01

To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2 receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life.

Risk aversion and uncertainty in cost-effectiveness analysis: the expected-utility, moment-generating function approach.

PubMed

Elbasha, Elamin H

2005-05-01

The availability of patient-level data from clinical trials has spurred a lot of interest in developing methods for quantifying and presenting uncertainty in cost-effectiveness analysis (CEA). Although the majority has focused on developing methods for using sample data to estimate a confidence interval for an incremental cost-effectiveness ratio (ICER), a small strand of the literature has emphasized the importance of incorporating risk preferences and the trade-off between the mean and the variance of returns to investment in health and medicine (mean-variance analysis). This paper shows how the exponential utility-moment-generating function approach is a natural extension to this branch of the literature for modelling choices from healthcare interventions with uncertain costs and effects. The paper assumes an exponential utility function, which implies constant absolute risk aversion, and is based on the fact that the expected value of this function results in a convenient expression that depends only on the moment-generating function of the random variables. The mean-variance approach is shown to be a special case of this more general framework. The paper characterizes the solution to the resource allocation problem using standard optimization techniques and derives the summary measure researchers need to estimate for each programme, when the assumption of risk neutrality does not hold, and compares it to the standard incremental cost-effectiveness ratio. The importance of choosing the correct distribution of costs and effects and the issues related to estimation of the parameters of the distribution are also discussed. An empirical example to illustrate the methods and concepts is provided. Copyright 2004 John Wiley & Sons, Ltd

Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers.

PubMed

Villamere, James; Gebhart, Alana; Vu, Stephen; Nguyen, Ninh T

2015-07-01

Robotic-assisted general and bariatric surgery is gaining popularity among surgeons. The aim of this study was to analyze the utilization and outcome of laparoscopic versus robotic-assisted laparoscopic techniques for common elective general and bariatric surgical procedures performed at Academic Medical Centers. We analyzed data from University HealthSystem Consortium clinical database from October 2010 to February 2014 for all patients who underwent laparoscopic versus robotic techniques for eight common elective general and bariatric surgical procedures: gastric bypass, sleeve gastrectomy, gastric band, antireflux surgery, Heller myotomy (HM), cholecystectomy (LC), colectomy, rectal resection (RR). Utilization and outcome measures including demographics, in-hospital mortality, major complications, 30-day readmission, length of stay (LOS), and costs were compared between techniques. 96,694 laparoscopic and robotic procedures were analyzed. Utilization of the robotic approach was the highest for RR (21.4%), followed by HM (9.1%). There was no significant difference in in-hospital mortality or major complications between laparoscopic versus robotic techniques for all procedures. Only two procedures had improved outcome associated with the robotic approach: robotic HM and robotic LC had a shorter LOS compared to the laparoscopic approach (2.8 ± 3.6 vs. 2.3 ± 2.1; respectively, p < 0.05 for HM and 2.9 ± 2.4 vs. 2.3 ± 1.7; respectively, p < 0.05 for LC). Costs were significantly higher (21%) in the robotic group for all procedures. A subset analysis of patients with minor/moderate severity of illness showed similar results. This national analysis of academic centers showed a low utilization of robotic-assisted laparoscopic elective general and bariatric surgical procedures with the highest utilization for rectal resection. Compared to conventional laparoscopy, there were no observed clinical benefits associated with the robotic approach, but there was a consistently higher cost.

The association between hospital outcomes and diagnostic imaging: early findings.

PubMed

Lee, David W; Foster, David A

2009-11-01

Resource use variation across the United States prompts the important question of whether "more is better" when it comes to health care services. The aim of this study was to examine correlations between the use of 4 common imaging modalities (CT, MR, ultrasound, and radiography) and in-hospital mortality and costs. Using clinical and utilization data for 1.1 million inpatient admissions at 102 US hospitals during 2007, two hospital-specific, risk-adjusted imaging utilization measures for each modality were constructed that controlled for patients' demographic and clinical characteristics and for hospital characteristics were constructed for each modality. First, logistic regression was used to estimate the odds that each type of imaging service would be provided during an admission. Second, the mean number of services per admission was estimated using output from a two-part ordinary least squares model. Hospital-specific, risk-adjusted inpatient mortality and total hospital costs were also computed, and correlations between the imaging utilization measures and the mortality and cost outcome measures were then assessed using Pearson's correlation coefficients (P < .05). The correlation analyses were weighted by hospital admission volume. Hospitals in which patients were more likely to receive imaging services during admissions had lower mortality, even after controlling for potential confounders. Correlation coefficients were -0.2 for all modalities (P = .02-.05). Weaker correlations existed between mean services per admission and mortality, while costs trended insignificantly higher with greater utilization. This study lays the foundation for further exploration of the relationship between resource use and the clinical and economic outcomes associated with imaging utilization.

Identifying alternatives to old age psychiatry inpatient admission: an application of the balance of care approach to health and social care planning.

PubMed

Tucker, Sue; Brand, Christian; Wilberforce, Mark; Abendstern, Michele; Challis, David

2015-07-17

Mental health problems in older people are common and costly, posing multiple challenges for commissioners. Against this backdrop, a series of initiatives have sought to shift resources from institutional to community care in the belief that this will save money and concurs with user preferences. However, most of this work has focused on the use of care home beds and general hospital admissions, and relatively little attention has been given to reducing the use of mental health inpatient beds, despite their very high cost. The study employed a 'Balance of Care approach' in three areas of North-West England. This long-standing strategic planning framework identifies people whose needs can be met in more than one setting, and compares the costs and consequences of the possible alternatives in a simulation modelling exercise. Information was collected about a six-month cohort of admissions in 2010/11 (n = 216). The sample was divided into groups of people with similar needs for care, and vignettes were formulated to represent the most prevalent groups. A range of key staff judged the appropriateness of these admissions and suggested alternative care for those considered least appropriate for hospital. A public sector costing approach was used to compare the estimated costs of the recommended care with that people currently receive. The findings suggest that more than a sixth of old age psychiatry inpatient admissions could be more appropriately supported in other settings if enhanced community services were available. Such restructuring could involve the provision of intensive support from Care Home Outreach and Community Mental Health Teams, rather than the development of crisis intervention and home treatment teams as currently advocated. Estimated savings were considerable, suggesting local agencies might release up to £1,300,000 per annum. No obvious trade-off between health and social care costs was predicted. There is considerable potential to change the mix of institutional and community services provided for older people with mental health problems. The conclusions would be strengthened by further studies and the incorporation of evidence about relative outcomes. However, the utility of the approach in challenging established patterns of resource allocation and building local ownership for change is apparent.

Cross-Sector Service Use Among High Health Care Utilizers In Minnesota After Medicaid Expansion.

PubMed

Vickery, Katherine Diaz; Bodurtha, Peter; Winkelman, Tyler N A; Hougham, Courtney; Owen, Ross; Legler, Mark S; Erickson, Erik; Davis, Matthew M

2018-01-01

Childless adults in the Medicaid expansion population have complex social and behavioral needs. This study compared the cross-sector involvement of Medicaid expansion enrollees who were high health care utilizers to that of other expansion enrollees in Hennepin County, Minnesota. We examined forty-six months of annualized utilization and cost data for expansion-eligible residents with at least twelve months of enrollment (N = 70,134) across health care, housing, criminal justice, and human service sectors. High health care utilizers, approximately 7 percent of our sample, were disproportionately American Indian, younger, and significantly more likely than other expansion enrollees to have mental health (88.1 percent versus 48.0 percent) or substance use diagnoses (79.2 percent versus 29.6 percent). Total cross-sector public spending was nearly four times higher for high health care users ($25,337 versus $6,786), and their non-health care expenses were 2.4 times higher ($7,476 versus $3,108). High levels of cross-sector service use suggest that there are opportunities for collaboration that may result in cost savings across sectors.

Dementia Care Management in an Underserved Community: The Comparative Effectiveness of Two Different Approaches.

PubMed

Chodosh, Joshua; Colaiaco, Benjamin A; Connor, Karen Ilene; Cope, Dennis Wesley; Liu, Hangsheng; Ganz, David Avram; Richman, Mark Jason; Cherry, Debra Lynn; Blank, Joseph Moshe; Carbone, Raquel Del Pilar; Wolf, Sheldon Mark; Vickrey, Barbara Grace

2015-08-01

To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. We randomized 151 patient-caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient-caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected. © The Author(s) 2015.

Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization.

PubMed

Zuckerberg, Gabriel S; Scott, Andrew V; Wasey, Jack O; Wick, Elizabeth C; Pawlik, Timothy M; Ness, Paul M; Patel, Nishant D; Resar, Linda M S; Frank, Steven M

2015-07-01

Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions. We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center. Three distinct periods were compared: 1) before blood management, 2) education alone, and 3) education plus CPOE. Changes in RBC unit utilization were assessed over the three periods stratified by surgical service. Cost savings were estimated based on RBC acquisition costs. For all surgical services combined, RBC utilization decreased by 16.4% with education alone (p = 0.001) and then changed very little (2.5% increase) after subsequent addition of CPOE (p = 0.64). When we compared the period of education plus CPOE to the pre-blood management period, the overall decrease was 14.3% (p = 0.008; 2102 fewer RBC units/year, or a cost avoidance of $462,440/year). Services with the highest massive transfusion rates (≥10 RBC units) exhibited the least reduction in RBC utilization. Adding CPOE with CDS after a successful education effort to promote evidence-based transfusion practice did not further reduce RBC utilization. These findings suggest that education is an important and effective component of a patient blood management program and that CPOE algorithms may serve to maintain compliance with evidence-based transfusion guidelines. © 2015 AABB.

Enhancing Least-Squares Finite Element Methods Through a Quantity-of-Interest

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

Chaudhry, Jehanzeb Hameed; Cyr, Eric C.; Liu, Kuo

2014-12-18

Here, we introduce an approach that augments least-squares finite element formulations with user-specified quantities-of-interest. The method incorporates the quantity-of-interest into the least-squares functional and inherits the global approximation properties of the standard formulation as well as increased resolution of the quantity-of-interest. We establish theoretical properties such as optimality and enhanced convergence under a set of general assumptions. Central to the approach is that it offers an element-level estimate of the error in the quantity-of-interest. As a result, we introduce an adaptive approach that yields efficient, adaptively refined approximations. Several numerical experiments for a range of situations are presented to supportmore » the theory and highlight the effectiveness of our methodology. Notably, the results show that the new approach is effective at improving the accuracy per total computational cost.« less

High-Cost Patients: Hot-Spotters Don't Explain the Half of It.

PubMed

Lee, Natalie S; Whitman, Noah; Vakharia, Nirav; Taksler, Glen B; Rothberg, Michael B

2017-01-01

Understanding resource utilization patterns among high-cost patients may inform cost reduction strategies. To identify patterns of high-cost healthcare utilization and associated clinical diagnoses and to quantify the significance of hot-spotters among high-cost users. Retrospective analysis of high-cost patients in 2012 using data from electronic medical records, internal cost accounting, and the Centers for Medicare and Medicaid Services. K-medoids cluster analysis was performed on utilization measures of the highest-cost decile of patients. Clusters were compared using clinical diagnoses. We defined "hot-spotters" as those in the highest-cost decile with ≥4 hospitalizations or ED visits during the study period. A total of 14,855 Medicare Fee-for-service beneficiaries identified by the Medicare Quality Resource and Use Report as having received 100 % of inpatient care and ≥90 % of primary care services at Cleveland Clinic Health System (CCHS) in Northeast Ohio. The highest-cost decile was selected from this population. Healthcare utilization and diagnoses. The highest-cost decile of patients (n = 1486) accounted for 60 % of total costs. We identified five patient clusters: "Ambulatory," with 0 admissions; "Surgical," with a median of 2 surgeries; "Critically Ill," with a median of 4 ICU days; "Frequent Care," with a median of 2 admissions, 3 ED visits, and 29 outpatient visits; and "Mixed Utilization," with 1 median admission and 1 ED visit. Cancer diagnoses were prevalent in the Ambulatory group, care complications in the Surgical group, cardiac diseases in the Critically Ill group, and psychiatric disorders in the Frequent Care group. Most hot-spotters (55 %) were in the "frequent care" cluster. Overall, hot-spotters represented 9 % of the high-cost population and accounted for 19 % of their overall costs. High-cost patients are heterogeneous; most are not so-called "hot-spotters" with frequent admissions. Effective interventions to reduce costs will require a more multi-faceted approach to the high-cost population.

Comprehensive assessment of toxic emissions from coal-fired power plants

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

NONE

1996-09-01

The 1990 Clean Air Act Amendments (CAAA) have two primary goals: pollution prevention and a market-based least-cost approach to emission control. To address air quality issues as well as permitting and enforcement, the 1990 CAAA contain 11 sections or titles. The individual amendment titles are as follows: Title I - National Ambient Air Quality Standards Title II - Mobile Sources Title III - Hazardous Air Pollutants Title IV - Acid Deposition Control Title V - Permits Title VI - Stratospheric Ozone Protection Chemicals Title VII - Enforcement Title VIII - Miscellaneous Provisions Title IX - Clean Air Research Title Xmore » - Disadvantaged Business Concerns Title XI - Clean Air Employment Transition Assistance Titles I, III, IV, and V will change or have the potential to change how operators of coal-fired utility boilers control, monitor, and report emissions. For the purpose of this discussion, Title III is the primary focus.« less

Photoactivated and patternable charge transport materials and their use in organic light-emitting devices

NASA Astrophysics Data System (ADS)

Liu, Jie; Lewis, Larry N.; Duggal, Anil R.

2007-06-01

Organic light-emitting devices (OLEDs) usually employ at least one organic semiconductor layer that acts as a hole-injection material. The prototypical example is a conjugated polymer such as poly(3,4-ethylenedioxythiophene) heavily p doped with polystyrene sulfonic acid. Here, the authors describe a chemical doping strategy for hole injection material formulation that enables spatial patterning of the material conductivity through optical activation. The strategy utilizes an organic photoacid generator (PAG) dispersed in a polymeric organic semiconductor host. Upon UV irradiation, the PAG decomposes and generates a strong protonic acid that subsequently p dopes the host. The authors demonstrate an OLED made with such a light-activated hole-injection material and show that arbitrary emission patterning can be accomplished. This approach may provide a simple, low cost path toward specialty lighting and signage applications for OLED technology.

Recruiting Community-Based Dementia Patients and Caregivers in a Nonpharmacologic Randomized Trial: What Works and How Much Does It Cost?

PubMed

Morrison, Karen; Winter, Laraine; Gitlin, Laura N

2016-07-01

The aim of this study was to evaluate the yield and cost of three recruitment strategies-direct mail, newspaper advertisements, and community outreach-for identifying and enrolling dementia caregivers into a randomized trial testing a nonpharmacologic approach to enhancing quality of life of patients and caregivers (dyads). Enrollment occurred between 2006 and 2008. The number of recruitment inquiries, number and race of enrollees, and costs for each recruitment strategy were recorded. Of 284 inquiries, 237 (83%) dyads enrolled. Total cost for recruitment across methodologies was US$154 per dyad. Direct mailings resulted in the most enrollees (n = 135, 57%) and was the least costly method (US$63 per dyad) compared with newspaper ads (US$224 per dyad) and community outreach (US$350 per dyad). Although enrollees were predominately White, mailings yielded the highest number of non-Whites (n = 37). Direct mailings was the most effective and least costly method for enrolling dyads in a nonpharmacologic dementia trial. © The Author(s) 2014.

Economic Evaluation of Complementary and Alternative Medicine in Oncology: Is There a Difference Compared to Conventional Medicine?

PubMed

Huebner, Jutta; Prott, Franz J; Muecke, Ralph; Stoll, Christoph; Buentzel, Jens; Muenstedt, Karsten; Micke, Oliver

2017-01-01

To analyze the financial burden of complementary and alternative medicine (CAM) in cancer treatment. Based on a systematic search of the literature (Medline and the Cochrane Library, combining the MeSH terms 'complementary therapies', 'neoplasms', 'costs', 'cost analysis', and 'cost-benefit analysis'), an expert panel discussed different types of analyses and their significance for CAM in oncology. Of 755 publications, 43 met our criteria. The types of economic analyses and their parameters discussed for CAM in oncology were cost, cost-benefit, cost-effectiveness, and cost-utility analyses. Only a few articles included arguments in favor of or against these different methods, and only a few arguments were specific for CAM because most CAM methods address a broad range of treatment aim parameters to assess effectiveness and are hard to define. Additionally, the choice of comparative treatments is difficult. To evaluate utility, healthy subjects may not be adequate as patients with a life-threatening disease and may be judged differently, especially with respect to a holistic treatment approach. We did not find any arguments in the literature that were directed at the economic analysis of CAM in oncology. Therefore, a comprehensive approach assessment based on criteria from evidence-based medicine evaluating direct and indirect costs is recommended. The usual approaches to conventional medicine to assess costs, benefits, and effectiveness seem adequate in the field of CAM in oncology. Additionally, a thorough deliberation on the comparator, endpoints, and instruments is mandatory for designing studies. © 2016 S. Karger AG, Basel.

Factors contributing to practice variation in post-stroke rehabilitation.

PubMed Central

Lee, A J; Huber, J H; Stason, W B

1997-01-01

OBJECTIVE: To analyze geographic variability in the utilization and cost of post-stroke medical care using multiple linear regression. DATA SOURCES/STUDY SETTING: A 20 percent random sample of Medicare beneficiaries with an admission to an acute care hospital for stroke during the first six months of 1991, supplemented by data from their Medicare claims and beneficiary records, the Medicare Cost Reports for hospitals and nursing homes, and the Area Resource File. STUDY DESIGN: Weighted least squares regression is used to analyze variations in post-stroke practice patterns across 151 MSAs (Metropolitan Statistical Areas). Average post-stroke costs, utilization rates, and facility lengths of stay are regressed on patient and market characteristics. DATA COLLECTION/EXTRACTION METHODS: For a six-month post-stroke interval, beneficiary-level post-stroke costs and service utilization are averaged by MSA. Variables describing market conditions are then added to these MSA-level records. PRINCIPAL FINDINGS: Patient variables rarely explain more than a third of practice variation, and often they explain substantially less than that. Market variables (with some exception) tend to be relatively less important. Finally, one-half to two-thirds of the practice variation across MSAs is unexplained by the patient and market factors measured in our data. CONCLUSIONS: A substantial portion of inter-MSA variability in utilization and intensity of post-stroke rehabilitation services cannot be explained by differences in patient characteristics. Given the large practice differences observed across MSAs, it seems unlikely that unmeasured patient differences can account for much more of the practice differences. PMID:9180616

Causal modeling in international migration research: a methodological prolegomenon.

PubMed

Papademetriou, D G; Hopple, G W

1982-10-01

The authors examine the value of using models to study the migration process. In particular, they demonstrate the potential utility of a partial least squares modeling approach to the causal analysis of international migration.

Systematic analysis of annual health resource utilization and costs in hospitalized patients with inflammatory bowel disease in Switzerland.

PubMed

Schoepfer, Alain; Vavricka, Stephan R; Brüngger, Beat; Reich, Oliver; Blozik, Eva; Bähler, Caroline

2018-05-11

Real-life data on health resource utilization and costs of hospitalized patients with inflammatory bowel disease are lacking in Switzerland. We aimed to assess health resource utilization and costs during a 1-year follow-up period starting with an index hospitalization. On the basis of claims data of the Helsana health insurance group, health resource utilization was assessed and costs reimbursed by mandatory basic health insurance [in Swiss Francs (CHF); 1 CHF=0.991 US$] were calculated during a 1-year follow-up period starting with an index hospitalization in the time period between 1 January 2013 and 31 December 2014. Of 202 002 patients with at least one hospitalization in 2013-2014, a total of 270 (0.13%) patients had inflammatory bowel disease as main diagnosis [112 (41.5%) ulcerative colitis (UC), 158 (58.5%) Crohn's disease (CD), 154/270 (57.0%) females]. In comparison with patients with UC, patients with CD were significantly more frequently treated with biologics (45.6 vs. 20.5%, P<0.001) and more frequently underwent surgery during index hospitalization (27.8 vs. 9.8%, P=0.002). Compared with patients with UC, those with CD had significantly more consultations [odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.12, P=0.016], higher median annual total costs (OR: 1.25, 95% CI: 1.05-1.48, P=0.012), and higher outpatient costs (OR: 1.33, 95% CI: 1.07-1.66, P=0.011). In the bivariate model, median total costs for patients with CD and those with UC were 24 270 and 17 270 CHF, respectively (P=0.032). When compared with patients with UC, hospitalized patients with CD have during a 1-year follow-up a higher rate of outpatient consultations and generate higher costs.

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review.

PubMed

Jack, Helen E; Arabadjis, Sophia D; Sun, Lucy; Sullivan, Erin E; Phillips, Russell S

2017-03-01

As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.

Whole exome sequencing in neurogenetic odysseys: An effective, cost- and time-saving diagnostic approach.

PubMed

Córdoba, Marta; Rodriguez-Quiroga, Sergio Alejandro; Vega, Patricia Analía; Salinas, Valeria; Perez-Maturo, Josefina; Amartino, Hernán; Vásquez-Dusefante, Cecilia; Medina, Nancy; González-Morón, Dolores; Kauffman, Marcelo Andrés

2018-01-01

Diagnostic trajectories for neurogenetic disorders frequently require the use of considerable time and resources, exposing patients and families to so-called "diagnostic odysseys". Previous studies have provided strong evidence for increased diagnostic and clinical utility of whole-exome sequencing in medical genetics. However, specific reports assessing its utility in a setting such as ours- a neurogeneticist led academic group serving in a low-income country-are rare. To assess the diagnostic yield of WES in patients suspected of having a neurogenetic condition and explore the cost-effectiveness of its implementation in a research group located in an Argentinean public hospital. This is a prospective study of the clinical utility of WES in a series of 40 consecutive patients selected from a Neurogenetic Clinic of a tertiary Hospital in Argentina. We evaluated patients retrospectively for previous diagnostic trajectories. Diagnostic yield, clinical impact on management and economic diagnostic burden were evaluated. We demonstrated the clinical utility of Whole Exome Sequencing in our patient cohort, obtaining a diagnostic yield of 40% (95% CI, 24.8%-55.2%) among a diverse group of neurological disorders. The average age at the time of WES was 23 (range 3-70). The mean time elapsed from symptom onset to WES was 11 years (range 3-42). The mean cost of the diagnostic workup prior to WES was USD 1646 (USD 1439 to 1853), which is 60% higher than WES cost in our center. WES for neurogenetics proved to be an effective, cost- and time-saving approach for the molecular diagnosis of this heterogeneous and complex group of patients.

Navigating financial and supply reliability tradeoffs in regional drought management portfolios

NASA Astrophysics Data System (ADS)

Zeff, Harrison B.; Kasprzyk, Joseph R.; Herman, Jonathan D.; Reed, Patrick M.; Characklis, Gregory W.

2014-06-01

Rising development costs and growing concerns over environmental impacts have led many communities to explore more diversified water management strategies. These "portfolio"-style approaches integrate existing supply infrastructure with other options such as conservation measures or water transfers. Diversified water supply portfolios have been shown to reduce the capacity and costs required to meet demand, while also providing greater adaptability to changing hydrologic conditions. However, this additional flexibility can also cause unexpected reductions in revenue (from conservation) or increased costs (from transfers). The resulting financial instability can act as a substantial disincentive to utilities seeking to implement more innovative water management techniques. This study seeks to design portfolios that employ financial tools (e.g., contingency funds and index insurance) to reduce fluctuations in revenues and costs, allowing these strategies to achieve improved performance without sacrificing financial stability. This analysis is applied to the development of coordinated regional supply portfolios in the "Research Triangle" region of North Carolina, an area comprising four rapidly growing municipalities. The actions of each independent utility become interconnected when shared infrastructure is utilized to enable interutility transfers, requiring the evaluation of regional tradeoffs in up to five performance and financial objectives. Diversified strategies introduce significant tradeoffs between achieving reliability goals and introducing burdensome variability in annual revenues and/or costs. Financial mitigation tools can mitigate the impacts of this variability, allowing for an alternative suite of improved solutions. This analysis provides a general template for utilities seeking to navigate the tradeoffs associated with more flexible, portfolio-style management approaches.

On Target Localization Using Combined RSS and AoA Measurements

PubMed Central

Beko, Marko; Dinis, Rui

2018-01-01

This work revises existing solutions for a problem of target localization in wireless sensor networks (WSNs), utilizing integrated measurements, namely received signal strength (RSS) and angle of arrival (AoA). The problem of RSS/AoA-based target localization became very popular in the research community recently, owing to its great applicability potential and relatively low implementation cost. Therefore, here, a comprehensive study of the state-of-the-art (SoA) solutions and their detailed analysis is presented. The beginning of this work starts by considering the SoA approaches based on convex relaxation techniques (more computationally complex in general), and it goes through other (less computationally complex) approaches, as well, such as the ones based on the generalized trust region sub-problems framework and linear least squares. Furthermore, a detailed analysis of the computational complexity of each solution is reviewed. Furthermore, an extensive set of simulation results is presented. Finally, the main conclusions are summarized, and a set of future aspects and trends that might be interesting for future research in this area is identified. PMID:29671832

Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities

PubMed Central

Preussler, Jaime M.; Mau, Lih-Wen; Majhail, Navneet S; Meyer, Christa L.; Denzen, Ellen; Edsall, Kristen C.; Farnia, Stephanie H.; Silver, Alicia; Saber, Wael; Burns, Linda J.; Vanness, David J.

2017-01-01

There is an increasing need for the development of approaches to measure quality, costs and resource utilization patterns among allogeneic hematopoietic cell transplant (HCT) patients. Administrative claims data provide an opportunity to examine service utilization and costs, particularly from the payer’s perspective. However, because administrative claims data are primarily designed for reimbursement purposes, challenges arise when using it for research. We use a case study with data derived from the 2007–2011 Truven Health MarketScan Research database to discuss opportunities and challenges for the use of administrative claims data to examine the costs and service utilization of allogeneic HCT and chemotherapy alone for patients with acute myeloid leukemia (AML). Starting with a cohort of 29,915 potentially eligible patients with a diagnosis of AML, we were able to identify 211 patients treated with HCT and 774 treated with chemotherapy only where we were sufficiently confident of the diagnosis and treatment path to allow analysis. Administrative claims data provide an avenue to meet the need for health care costs, resource utilization, and outcome information. However, when using these data, a balance between clinical knowledge and applied methods is critical to identifying a valid study cohort and accurate measures of costs and resource utilization. PMID:27184624

Approaches to pharmacy benefit management and the impact of consumer cost sharing.

PubMed

Olson, Bridget M

2003-01-01

Numerous mechanisms have been introduced to deliver prescription drug benefits while controlling pharmaceutical costs. An understanding of the most prominent mechanisms of benefit management is an important step in determining the most effective approach to take in future years. The aims of this review were to illustrate the mechanisms by which managed care has attempted to efficiently and equitably deliver pharmacy benefits and to discuss the impact of such programs, including consumer cost sharing. A review of the literature was conducted using the PreMedline and MEDLINE databases from the years 1966 to 2002, reference lists from relevant articles, and online sources, including news releases, conference materials, and pharmacy benefit management reports. Numerous pharmacy benefit management tools and their impact on utilization, expenditures, and health outcomes are reviewed, including disease state management; utilization management (ie, quantity limitations and prior authorization); drug utilization review; formulary management (ie, open and closed); delivery systems (ie, retail and mail order); and mechanisms for implementing consumer cost sharing (ie, generic incentives, multitiered copayments, and co-insurance). Although there is some evidence to suggest that certain benefit management tools have been successful in reducing health plan expenditures, a more thorough investigation of their potential unintended consequences is needed. Implementing adequate levels of consumer cost sharing is necessary if employers and health plans are to continue offering prescription drug benefits. It is important to remember, however, that quality health care cannot be forfeited for the sake of short-term cost savings.

Utilizing Expert Knowledge in Estimating Future STS Costs

NASA Technical Reports Server (NTRS)

Fortner, David B.; Ruiz-Torres, Alex J.

2004-01-01

A method of estimating the costs of future space transportation systems (STSs) involves classical activity-based cost (ABC) modeling combined with systematic utilization of the knowledge and opinions of experts to extend the process-flow knowledge of existing systems to systems that involve new materials and/or new architectures. The expert knowledge is particularly helpful in filling gaps that arise in computational models of processes because of inconsistencies in historical cost data. Heretofore, the costs of planned STSs have been estimated following a "top-down" approach that tends to force the architectures of new systems to incorporate process flows like those of the space shuttles. In this ABC-based method, one makes assumptions about the processes, but otherwise follows a "bottoms up" approach that does not force the new system architecture to incorporate a space-shuttle-like process flow. Prototype software has been developed to implement this method. Through further development of software, it should be possible to extend the method beyond the space program to almost any setting in which there is a need to estimate the costs of a new system and to extend the applicable knowledge base in order to make the estimate.

Impact of Glycemic Control on Healthcare Resource Utilization and Costs of Type 2 Diabetes: Current and Future Pharmacologic Approaches to Improving Outcomes

PubMed Central

Banerji, Mary Ann; Dunn, Jeffrey D.

2013-01-01

Background The incidence and prevalence of type 2 diabetes continue to grow in the United States and worldwide, along with the growing prevalence of obesity. Patients with type 2 diabetes are at greater risk for comorbid cardiovascular (CV) disease (CVD), which dramatically affects overall healthcare costs. Objectives To review the impact of glycemic control and medication adherence on morbidity, mortality, and healthcare costs of patients with type 2 diabetes, and to highlight the need for new drug therapies to improve outcomes in this patient population. Methods This comprehensive literature search was conducted for the period between 2000 and 2013, using MEDLINE, to identify published articles that report the associations between glycemic control, medication adherence, CV morbidity and mortality, and healthcare utilization and costs. Search terms included “type 2 diabetes,” “adherence,” “compliance,” “nonadherence,” “drug therapy,” “resource use,” “cost,” and “cost-effectiveness.” Discussion Despite improvements in the management of CV risk factors in patients with type 2 diabetes, outcomes remain poor. The costs associated with the management of type 2 diabetes are increasing dramatically as the prevalence of the disease increases. Medication adherence to long-term drug therapy remains poor in patients with type 2 diabetes and contributes to poor glycemic control in this patient population, increased healthcare resource utilization and increased costs, as well as increased rates of comorbid CVD and mortality. Furthermore, poor adherence to established evidence-based guidelines for type 2 diabetes, including underdiagnosis and undertreatment, contributes to poor outcomes. New approaches to the treatment of patients with type 2 diabetes currently in development have the potential to improve medication adherence and consequently glycemic control, which in turn will help to reduce associated costs and healthcare utilization. Conclusions As the prevalence of type 2 diabetes and its associated comorbidities grows, healthcare costs will continue to increase, indicating a need for better approaches to achieve glycemic control and manage comorbid conditions. Drug therapies are needed that enhance patient adherence and persistence levels far above levels reported with currently available drugs. Improvements in adherence to treatment guidelines and greater rates of lifestyle modifications also are needed. A serious unmet need exists for greatly improved patient outcomes, more effective and more tolerable drugs, as well as marked improvements in adherence to treatment guidelines and drug therapy to positively impact healthcare costs and resource use. PMID:24991370

Cost-utility analyses of drug therapies in breast cancer: a systematic review.

PubMed

Nerich, Virginie; Saing, Sopany; Gamper, Eva Maria; Kemmler, Georg; Daval, Franck; Pivot, Xavier; Holzner, Bernhard

2016-10-01

The economic evaluation (EE) of health care products has become a necessity. Their quality must be high in order to trust the results and make informed decisions. While cost-utility analyses (CUAs) should be preferred to cost-effectiveness analyses in the oncology area, the quality of breast cancer (BC)-related CUA has been given little attention so far. Thus, firstly, a systematic review of published CUA related to drug therapies for BC, gene expression profiling, and HER2 status testing was performed. Secondly, the quality of selected CUA was assessed and the factors associated with a high-quality CUA identified. The systematic literature search was conducted in PubMed, MEDLINE/EMBASE, and Cochrane to identify published CUA between 2000 and 2014. After screening and data extraction, the quality of each selected CUA was assessed by two independent reviewers, using the checklist proposed by Drummond et al. The analysis of factors associated with a high-quality CUA (defined as a Drummond score ≥7) was performed using a two-step approach. Our systematic review was based on 140 CUAs and showed a wide variety of methodological approaches, including differences in the perspective adopted, the time horizon, measurement of cost and effectiveness, and more specially health-state utility values (HSUVs). The median Drummond score was 7 [range 3-10]. Only one in two of the CUA (n = 74) had a Drummond score ≥7, synonymous of "high quality." The statistically significant predictors of a high-quality CUA were article with "gene expression profiling" topic (p = 0.001), consulting or pharmaceutical company as main location of first author (p = 0.004), and articles with both incremental cost-utility ratio and incremental cost-effectiveness ratio as outcomes of EE (p = 0.02). Our systematic review identified only 140 CUAs published over the past 15 years with one in two of high quality. It showed a wide variety of methodological approaches, especially focused on HSUVs. A critical appraisal of utility values is necessary to better understand one of the main difficulties encountered by authors and propose areas for improvement to increase the quality of CUA. Since the last 5 years, there is a tendency toward an improvement in the quality of these studies, probably coupled with economic context, a better and widely spreading of recommendations and thus appropriation by medical practitioners. That being said, there is an urgent need for mandatory use of European and international recommendations to ensure quality of such approaches and to allow easy comparison.

A class of least-squares filtering and identification algorithms with systolic array architectures

NASA Technical Reports Server (NTRS)

Kalson, Seth Z.; Yao, Kung

1991-01-01

A unified approach is presented for deriving a large class of new and previously known time- and order-recursive least-squares algorithms with systolic array architectures, suitable for high-throughput-rate and VLSI implementations of space-time filtering and system identification problems. The geometrical derivation given is unique in that no assumption is made concerning the rank of the sample data correlation matrix. This method utilizes and extends the concept of oblique projections, as used previously in the derivations of the least-squares lattice algorithms. Exponentially weighted least-squares criteria are considered for both sliding and growing memory.

Life support approaches for Mars missions

NASA Astrophysics Data System (ADS)

Drysdale, A. E.; Ewert, M. K.; Hanford, A. J.

Life support approaches for Mars missions are evaluated using an equivalent system mass (ESM) approach, in which all significant costs are converted into mass units. The best approach, as defined by the lowest mission ESM, depends on several mission parameters, notably duration, environment and consequent infrastructure costs, and crew size, as well as the characteristics of the technologies which are available. Generally, for the missions under consideration, physicochemical regeneration is most cost effective. However, bioregeneration is likely to be of use for producing salad crops for any mission, for producing staple crops for medium duration missions, and for most food, air and water regeneration for long missions (durations of a decade). Potential applications of in situ resource utilization need to be considered further.

The common engine concept for ALS application - A cost reduction approach

NASA Technical Reports Server (NTRS)

Bair, E. K.; Schindler, C. M.

1989-01-01

Future launch systems require the application of propulsion systems which have been designed and developed to meet mission model needs while providing high degrees of reliability and cost effectiveness. Vehicle configurations which utilize different propellant combinations for booster and core stages can benefit from a common engine approach where a single engine design can be configured to operate on either set of propellants and thus serve as either a booster or core engine. Engine design concepts and mission application for a vehicle employing a common engine are discussed. Engine program cost estimates were made and cost savings, over the design and development of two unique engines, estimated.

An effective utilization management strategy by dual approach of influencing physician ordering and gate keeping.

PubMed

Elnenaei, Manal O; Campbell, Samuel G; Thoni, Andrea J; Lou, Amy; Crocker, Bryan D; Nassar, Bassam A

2016-02-01

There is increasing recognition of the importance of appropriate laboratory test utilization. We investigate the effect of a multifaceted educational approach that includes physician feedback on individual test ordering, in conjunction with targeted restriction, on the utilization of selected laboratory tests. Scientific evidence was compiled on the usefulness and limitations of tests suspected of being over utilized in our laboratories. A variety of approaches were used to deliver education on each of the targeted tests, with greater focus on primary care physicians (PCPs). Feedback on requesting behavior of these tests was also communicated to the latter group which included an educational component. Laboratory based restriction of testing was also exercised, including the unbundling of our electrolyte panel. PCP requesting patterns for the selected tests were found to be markedly skewed. The interventions implemented over the study period resulted in a substantial 51% reduction in overall ordering of five of the targeted tests equating to an annual marginal cost saving of $60,124. Unbundling of the electrolyte panel resulted in marginal cost savings that equated annually to $42,500 on chloride and $48,000 on total CO2. A multifaceted educational approach combined with feedback on utilization and laboratory driven gate-keeping significantly reduced the number of laboratory tests suspected of being redundant or unjustifiably requested. Laboratory professionals are well positioned to manage demand on laboratory tests by utilizing evidence base in developing specific test ordering directives and gate-keeping rules. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

High School Students' Accuracy in Estimating the Cost of College: A Proposed Methodological Approach and Differences among Racial/Ethnic Groups and College Financial-Related Factors

ERIC Educational Resources Information Center

Nienhusser, H. Kenny; Oshio, Toko

2017-01-01

High school students' accuracy in estimating the cost of college (AECC) was examined by utilizing a new methodological approach, the absolute-deviation-continuous construct. This study used the High School Longitudinal Study of 2009 (HSLS:09) data and examined 10,530 11th grade students in order to measure their AECC for 4-year public and private…

Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: Adjusting for the burden of ensuing chronic kidney disease

PubMed Central

Klinghoffer, Zachary; Tarride, Jean-Eric; Novara, Giacomo; Ficarra, Vincenzo; Kapoor, Anil; Shayegan, Bobby; Braga, Luis H.

2013-01-01

Objectives: We compare the cost-utility of laparoscopic radical nephrectomy (LRN), laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the management of small renal masses (SRMs) when the impact of ensuing chronic kidney disease (CKD) disease is considered. Methods: We designed a Markov decision analysis model with a 10-year time horizon. Estimates of costs, utilities, complication rates and probabilities of developing CKD were derived from the literature. The base case patient was assumed to be a 65-year-old patient with a <4-cm unilateral renal mass, a normal contralateral kidney and a normal preoperative serum creatinine. Univariate and probabilistic sensitivity analyses were conducted to address the uncertainty associated with the study parameters. Results: OPN was the least costly strategy at $25 941 USD and generated 7.161 quality-adjusted life years (QALYs) over 10 years. LPN yielded 0.098 additional QALYs at an additional cost of $888 for an incremental cost-effectiveness ratio of $9057 per QALY, well below a commonly cited willingness-to-pay threshold of $50 000 per QALY. LRN was more costly and yielded fewer QALYs than OPN and LPN. Sensitivity analyses demonstrated our model to be robust to changes to key parameters. Age had no effect on preferred strategy. Conclusions: Partial nephrectomy (PN) is the preferred treatment strategy for SRMs. In centres where LPN is not available, OPN remains considerably more cost-effective than LRN. Furthermore, our study demonstrates that there is no age at which PN is not preferred to LRN. Our study provides additional evidence to advocate PN for the management of all amenable SRMs. PMID:23671525

A Retrospective Cohort Study of the Incidence, Health Care Resource Utilization and Costs of International Classification of Diseases, Clinical Modification, 9th Revision Diagnosed Influenza and Related Complications in US Children.

PubMed

Buck, Philip O; Smith, David M; Shenolikar, Rahul; Irwin, Debra E

2017-12-01

There is a paucity of data on the clinical and economic impact of seasonal influenza in children. This study estimated the incidence of diagnosed influenza and related complications and associated health care resource utilization and costs in US children. Children ≥6 months and <18 years old diagnosed with influenza using International Classification of Diseases, Clinical Modification, 9th revision codes and enrolled in a health plan during at least one influenza season between 2010 and 2014 were matched to similar patients without diagnosed influenza (GSK study identifier: HO-15-15728). Outcomes included incidence of influenza and complications, health care resource utilization frequency and health care costs during 21 days of follow-up. Adjusted costs were estimated using generalized linear models. Incidence (per 1000) of influenza was 20.3 (commercially insured) and 32.6 (Medicaid), with the highest incidence among 6-35 months old (Commercial: 26.8; Medicaid: 47.9). Approximately 12%-17% of influenza patients experienced complications, with the 6-35 months group having the highest percentage (25%-30%). The 6-35-month-old influenza patients with complications had the highest proportion with hospitalizations (5%-6%) and emergency room visits (Commercial: 19%; Medicaid: 36%). Influenza patients with (vs. without) complications had greater adjusted mean influenza-specific costs (Commercial: $1161 vs. $337; Medicaid: $1199 vs. $354; P<0.05), and influenza cases (vs. controls) had greater adjusted mean all-cause costs (Commercial: $688 vs. $470; Medicaid: $818 vs. $453; P < 0.05). Pediatric patients with influenza incurred higher health care costs compared with matched controls, and influenza-specific costs were greater among those with complications.

Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial.

PubMed

Meeuwsen, E J; German, P; Melis, R J F; Adang, E M; Golüke-Willemse, G A; Krabbe, P F; de Leest, B J; van Raak, F H J M; Schölzel-Dorenbos, C J M; Visser, M C; Wolfs, C A; Vliek, S; Rikkert, M G M Olde

2009-03-01

With the rising number of dementia patients with associated costs and the recognition that there is room for improvement in the provision of dementia care, the question arises on how to efficiently provide high quality dementia care. To describe the design of a study to determine multidisciplinary memory clinics' (MMC) effectiveness and cost-effectiveness in post-diagnosis treatment and care-coordination of dementia patients and their caregivers compared to the post-diagnosis treatment and care-coordination by general practitioners (GP). Next, this article provides the theoretical background of pragmatic trials, often needed in complex interventions, with the AD- Euro study as an example of such a pragmatic approach in a clinical trial. The study is a pragmatic multicentre, randomised clinical trial with an economic evaluation alongside, which aims to recruit 220 independently living patients with a new dementia diagnosis and their informal caregivers. After baseline measurements, patient and caregiver are allocated to the treatment arm MMC or GP and are visited for follow up measurements at 6 and 12 months. Primary outcome measures are Health Related Quality of Life of the patient as rated by the caregiver using the Quality of Life in Alzheimer's Disease instrument (Qol-AD) and self-perceived caregiving burden of the informal caregiver measured using the Sense of Competence Questionnaire (SCQ). To establish cost-effectiveness a cost-utility analysis using utilities generated by the EuroQol instrument (EQ-5D) will be conducted from a societal perspective. Analyses will be done in an intention-to-treat fashion. The inclusion period started in January 2008 and will commence until at least December 2008. After finalising follow up the results of the study are expected to be available halfway through 2010. The study will provide an answer to whether follow-up of dementia patients can best be done in specialised outpatient memory clinics or in primary care settings with regard to quality and costs. It will enable decision making on how to provide good and efficient health care services in dementia. ClinicalTrials.gov Identifier NCT00554047.

A least-squares minimization approach for model parameters estimate by using a new magnetic anomaly formula

NASA Astrophysics Data System (ADS)

Abo-Ezz, E. R.; Essa, K. S.

2016-04-01

A new linear least-squares approach is proposed to interpret magnetic anomalies of the buried structures by using a new magnetic anomaly formula. This approach depends on solving different sets of algebraic linear equations in order to invert the depth ( z), amplitude coefficient ( K), and magnetization angle ( θ) of buried structures using magnetic data. The utility and validity of the new proposed approach has been demonstrated through various reliable synthetic data sets with and without noise. In addition, the method has been applied to field data sets from USA and India. The best-fitted anomaly has been delineated by estimating the root-mean squared (rms). Judging satisfaction of this approach is done by comparing the obtained results with other available geological or geophysical information.

Development of Regional Supply Functions and a Least-Cost Model for Allocating Water Resources in Utah: A Parametric Linear Programming Approach.

DTIC Science & Technology

SYSTEMS ANALYSIS, * WATER SUPPLIES, MATHEMATICAL MODELS, OPTIMIZATION, ECONOMICS, LINEAR PROGRAMMING, HYDROLOGY, REGIONS, ALLOCATIONS, RESTRAINT, RIVERS, EVAPORATION, LAKES, UTAH, SALVAGE, MINES(EXCAVATIONS).

Medicare utilization, screening, and costs among participants in the Southeastern Diabetes Initiative: A population-based evaluation.

PubMed

Van Houtven, Courtney H; Greiner, Melissa A; Heidenfelder, Brooke; Spratt, Susan E; Granger, Bradi B; Dunham, Ashley A; Qualls, Laura G; Curtis, Lesley H

2018-04-01

Type 2 diabetes mellitus imposes significant burdens on patients and health care systems. Population-level interventions are being implemented to reach large numbers of patients at risk of or diagnosed with diabetes. We describe a population-based evaluation of the Southeastern Diabetes Initiative (SEDI) from the perspective of a payer, the Centers for Medicare & Medicaid Services (CMS). The purpose of this paper is to describe the population-based evaluation approach of the SEDI intervention from a Medicare utilization and cost perspective. We measured associations between the SEDI intervention and receipt of diabetes screening (i.e., HbA1c test, eye exam, lipid profile), health care resource use, and costs among intervention enrollees, compared with a control cohort of Medicare beneficiaries in geographically adjacent counties. The intervention cohort had slightly lower 1-year screening in 2 of 3 domains (4% for HbA1c; 9% for lipid profiles) in the post-intervention period, compared with the control cohort. The SEDI intervention cohort did not have different Medicare utilization or total Medicare costs in the post-intervention period from surrounding control counties. Our analytic approach may be useful to others evaluating CMS demonstration projects in which population-level health is targeted for improvement in a well-defined clinical population. Published by Elsevier Ltd.

Cost-effectiveness and cost-utility of beclomethasone/formoterol versus fluticasone propionate/salmeterol in patients with moderate to severe asthma.

PubMed

Gerzeli, Simone; Rognoni, Carla; Quaglini, Silvana; Cavallo, Maria Caterina; Cremonesi, Giovanni; Papi, Alberto

2012-04-01

Asthma is a chronic disease characterized by acute symptomatic episodes with variable severity and duration. Pharmacological asthma management aims to achieve and maintain control without side effects, thus improving quality of life and reducing the economic impact. Recently, a clinical trial showed the non-inferiority of beclomethasone/formoterol (BDP/F) versus fluticasone propionate/salmeterol (FP/S) in adults with moderate to severe persistent asthma. However, this study did not provide evidence on costs and did not quantify quality-of-life parameters. The objective of the present study was to assess the cost effectiveness and cost utility of BDP/F versus FP/S in patients with moderate to severe asthma from the perspective of the Italian National Health Service (NHS). A Markov model (MM) was used, with five health states for the different levels of asthma control: successful control, sub-optimal control, outpatient-managed exacerbation, inpatient-managed exacerbation, and death. Model data were derived from the ICAT SE study and from expert panels. Three outcomes were considered: time spent in successful control state, costs and quality-adjusted life-years (QALYs). The model shows that BDP/F treatment led to a slight increase of weeks in successful control compared with FP/S, with a lower cost. The probabilistic sensitivity analysis highlights that in 64% and 68% of the Monte Carlo simulations, BDP/F outperformed FP/S in terms of weeks in successful control and QALYs. Considering the expected cost of the two strategies, in 90% of simulations BDP/F was the least expensive choice. In particular, BDP/F was cost saving as compared with FP/S in about 63% and 59% of simulations as shown by the cost-utility and cost-effectiveness analysis, respectively. Overall, from the Italian NHS perspective, BDP/F treatment is associated with a reduction in cost and offers a slight increase of effectiveness in terms of weeks spent in successful control and QALYs. © 2012 Adis Data Information BV. All rights reserved.

Cap-and-trade policy: The influence on investments in carbon dioxide reducing technologies in Indiana

NASA Astrophysics Data System (ADS)

Fahie, Monique

With most of the energy produced in the state of Indiana coming from coal, the implementation of policy instruments such as cap-and-trade, which is included in the most recent climate bill, will have significant effects. This thesis provides an analysis of the effects that a cap-and-trade policy might have on the investment decisions for alternative technologies in the power plant sector in Indiana. Two economic models of representative coal-fired power plants, Gallagher (600MW) and Rockport (2600MW), are selected and used to evaluate the repowering decision of a plant for several technologies: integrated gasification combined cycle (IGCC), wind farm combined with natural gas combined cycle (NGCC) and supercritical pulverized coal (SCPC). The firm will make its decisions based on the net present value (NPV) of cost estimates for these CO2 reducing technologies, the cost of purchasing offsets and CO 2 allowances. This model is applied to a base case and three American Clean Energy and Security Act of 2009 cases derived from the Energy Information Administration (EIA, 2009b). A sensitivity analysis is done on the discount rate and capital costs. The results of the study indicate that a SCPC plant without carbon capture and storage (CCS) is the least costly compliance option for both plants under all of the cases while retrofitting the existing plant with CCS is the most expensive. Gallagher's three least expensive options across most scenarios were SCPC without CCS, the operation of the existing plant as is and investment in wind plus NGCC. Rockport's three least expensive compliance options across most scenarios were SCPC without CCS, the operation of the existing plant as is and IGCC without CCS. For both plants, when a 12% discount rate is utilized, NPV of costs are generally lower and the operation of the existing plant technology with the aid of allowances and offsets to be in compliance is the cheapest option. If capital costs were to decrease by 30%, a SCPC without CCS would remain the least costly option to invest in for both plants, but if costs were to increase by 30% operating the existing plant as is becomes the least pricey option.

A Patient-specific Approach to Hospital Cost Accounting

PubMed Central

Macdonald, Larry K.; Reuter, Louis F.

1973-01-01

The hospital facilities and manpower used for the various procedures of a delivery suite are identified and measured as the basis for determining individual patient costs. The method of measuring staff and facility requirements, including the “cost of readiness” and the cost of inherent inefficiencies, generates detailed information that can be used in determining utilization ranges for budgeting decisions, for planning space needs, for personnel scheduling, and for patient billing. PMID:4269322

Cost Effectiveness of Contraceptives in the United States

PubMed Central

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

2013-01-01

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

Learning curve approach to projecting cost and performance for photovoltaic technologies

NASA Astrophysics Data System (ADS)

Cody, George D.; Tiedje, Thomas

1997-10-01

The current cost of electricity generated by PV power is still extremely high with respect to power supplied by the utility grid, and there remain questions as to whether PV power can ever be competitive with electricity generated by fossil fuels. An objective approach to this important question was given in a previous paper by the authors which introduced analytical tools to define and project the technical/economic status of PV power from 1988 through the year 2010. In this paper, we apply these same tools to update the conclusions of our earlier study in the context of recent announcements by Amoco/Enron-Solar of projected sales of PV power at rates significantly less than the U.S. utility average.

A learning curve approach to projecting cost and performance for photovoltaic technologies

NASA Astrophysics Data System (ADS)

Cody, George D.; Tiedje, Thomas

1997-04-01

The current cost of electricity generated by PV power is still extremely high with respect to power supplied by the utility grid, and there remain questions as to whether PV power can ever be competitive with electricity generated by fossil fuels. An objective approach to this important question was given in a previous paper by the authors which introduced analytical tools to define and project the technical/economic status of PV power from 1988 through the year 2010. In this paper, we apply these same tools to update the conclusions of our earlier study in the context of recent announcements by Amoco/Enron-Solarex of projected sales of PV power at rates significantly less than the US utility average.

The transition to fully competitive bulk power markets: Federal regulatory developments in the electric power industry

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

Portasik, L.S.

In recent years, traditional electric utilities have become increasingly dependent upon enhanced competitive conditions in the bulk power market to improve efficiency and secure {open_quotes}least-cost{close_quotes} generation for their franchise and wholesale customers. The industry`s growing reliance on competitive wholesale markets both presaged and overtook the new legislation reflected in the Energy Policy Act of 1992 (EPAct). This article describes the new environment, as revealed in recent Federal Energy Regulatory Commission (FERC) decisions, and discusses its impact on the services and rates of affected utilities.

Decreased Opioid Utilization and Cost at One Year in Chronic Low Back Pain Patients Treated with Transcutaneous Electric Nerve Stimulation (TENS).

PubMed

Pivec, Robert; Minshall, Michael E; Mistry, Jaydev B; Chughtai, Morad; Elmallah, Randa K; Mont, Michael A

2015-11-01

Chronic low back pain (CLBP) may be treated without opioids through the use of transcutaneous electrical nerve stimulation (TENS). However, no study has evaluated its clinical effect and economic impact as measured by opioid utilization and costs. The purpose of this study was to evaluate patients who were given TENS for CLBP compared to a matched group without TENS at one-year follow-up, to determine differences between opioid consumption. Opioid utilization and costs in patients who did and did not receive TENS were extracted from a Medicare supplemental administrative claims database. Patients were selected if they had at least two ICD-9-CM coded claims for low back pain in a three-month period and were then propensity score matched at a 1:1 ratio between patients who received TENS and those who did not. There were 22,913 patients in each group who had a minimum follow-up of one year. There were no significant demographic or comorbidity differences with the exception that TENS patients had more episodes of back pain. Significantly fewer patients in the TENS group required opioids at final follow-up (57.7 vs. 60.3%). TENS patients also had significantly fewer annual per-patient opioid costs compared to non-TENS patients ($169 vs. $192). There were significantly lower event rates in TENS patients compared to non-TENS patients when measured by opioid utilization (characterized by frequency of prescription refills) (3.82 vs. 4.08, respectively) or pharmacy utilization (31.67 vs. 32.25). The TENS group also demonstrated a significantly lower cost of these utilization events ($44 vs. $49) and avoided more opioid events (20.4 events fewer per 100 patients annually). Treatment of CLBP with TENS demonstrated significantly fewer patients requiring opioids, fewer events where a patient required an opioid prescription, and lower per-patient costs. Since TENS is both non-invasive and a non-narcotic, it may potentially allow physicians to be more aggressive in treating CLBP patients.

Valuing a long-term care facility.

PubMed

Mellen, C M

1992-10-01

The business valuation industry generally uses at least one of three basic approaches to value a long-term care facility: the cost approach, sales comparison approach, or income approach. The approach that is chosen and the resulting weight that is applied to it depend largely on the circumstances involved. Because a long-term care facility is a business enterprise, more weight usually is given to the income approach which factors into the estimate of value both the tangible and intangible assets of the facility.

Mapping between 6 Multiattribute Utility Instruments.

PubMed

Chen, Gang; Khan, Munir A; Iezzi, Angelo; Ratcliffe, Julie; Richardson, Jeff

2016-02-01

Cost-utility analyses commonly employ a multiattribute utility (MAU) instrument to estimate the health state utilities, which are needed to calculate quality-adjusted life years. Different MAU instruments predict significantly different utilities, which makes comparison of results from different evaluation studies problematical. This article presents mapping functions ("crosswalks") from 6 MAU instruments (EQ-5D-5L, SF-6D, Health Utilities Index 3 [HUI 3], 15D, Quality of Well-Being [QWB], and Assessment of Quality of Life 8D [AQoL-8D]) to each of the other 5 instruments in the study: a total of 30 mapping functions. Data were obtained from a multi-instrument comparison survey of the public and patients in 7 disease areas conducted in 6 countries (Australia, Canada, Germany, Norway, United Kingdom, and United States). The 8022 respondents were administered each of the 6 study instruments. Mapping equations between each instrument pair were estimated using 4 econometric techniques: ordinary least squares, generalized linear model, censored least absolute deviations, and, for the first time, a robust MM-estimator. Goodness-of-fit indicators for each of the results are within the range of published studies. Transformations reduced discrepancies between predicted utilities. Incremental utilities, which determine the value of quality-related health benefits, are almost perfectly aligned at the sample means. Transformations presented here align the measurement scales of MAU instruments. Their use will increase confidence in the comparability of evaluation studies, which have employed different MAU instruments. © The Author(s) 2015.

Utilization management in anatomic pathology.

PubMed

Lewandrowski, Kent; Black-Schaffer, Steven

2014-01-01

There is relatively little published literature concerning utilization management in anatomic pathology. Nonetheless there are many utilization management opportunities that currently exist and are well recognized. Some of these impact only the cost structure within the pathology department itself whereas others reduce charges for third party payers. Utilization management may result in medical legal liabilities for breaching the standard of care. For this reason it will be important for pathology professional societies to develop national utilization guidelines to assist individual practices in implementing a medically sound approach to utilization management. © 2013.

A survey of personal digital assistant use in a sample of New Zealand doctors.

PubMed

Menzies, Oliver H; Thwaites, John

2012-03-30

To gather information about handheld computing hardware and software usage by hospital based doctors in New Zealand (NZ). An online tool (SurveyMonkey) was used to conduct the survey from 27 June to 10 September 2010. Distribution of the survey was via an email to all NZ District Health Boards (DHBs). There were 850 responses. About half of respondents (52%) used a personal digital assistant (PDA), 90% using it at least once daily. Usage varied greatly between DHBs (27-100%), perhaps related to institutional support. Among PDA users, the most common applications were the non-clinical; Scheduler (95%), Contacts (97%), and Tasks (83%). Users felt PDAs helped considerably with organisation and time saving. For non-users there were a range of barriers to usage, cost being a large factor. Another major barrier identified by both users and non-users was lack of organisational integration and support. Half of survey respondents used a PDA. PDA usage of responders from different DHBs varied considerably. Perceived barriers to PDA use included cost and lack of institutional support. A collaborative approach between clinical leadership and Information Technology teams to address barriers may result in increased utility and usage of PDAs in the NZ health system.

A Framework for Evaluating Economic Impacts of Rooftop PV Systems with or without Energy Storage on Thai Distribution Utilities and Ratepayers

NASA Astrophysics Data System (ADS)

Chaianong, A.; Bangviwat, A.; Menke, C.

2017-07-01

Driven by decreasing PV and energy storage prices, increasing electricity costs and policy supports from Thai government (self-consumption era), rooftop PV and energy storage systems are going to be deployed in the country rapidly that may disrupt existing business models structure of Thai distribution utilities due to revenue erosion and lost earnings opportunities. The retail rates that directly affect ratepayers (non-solar customers) are expected to increase. This paper focuses on a framework for evaluating impacts of PV with and without energy storage systems on Thai distribution utilities and ratepayers by using cost-benefit analysis (CBA). Prior to calculation of cost/benefit components, changes in energy sales need to be addressed. Government policies for the support of PV generation will also help in accelerating the rooftop PV installation. Benefit components include avoided costs due to transmission losses and deferring distribution capacity with appropriate PV penetration level, while cost components consist of losses in revenue, program costs, integration costs and unrecovered fixed costs. It is necessary for Thailand to compare total costs and total benefits of rooftop PV and energy storage systems in order to adopt policy supports and mitigation approaches, such as business model innovation and regulatory reform, effectively.

Cost utility analysis of endoscopic biliary stent in unresectable hilar cholangiocarcinoma: decision analytic modeling approach.

PubMed

Sangchan, Apichat; Chaiyakunapruk, Nathorn; Supakankunti, Siripen; Pugkhem, Ake; Mairiang, Pisaln

2014-01-01

Endoscopic biliary drainage using metal and plastic stent in unresectable hilar cholangiocarcinoma (HCA) is widely used but little is known about their cost-effectiveness. This study evaluated the cost-utility of endoscopic metal and plastic stent drainage in unresectable complex, Bismuth type II-IV, HCA patients. Decision analytic model, Markov model, was used to evaluate cost and quality-adjusted life year (QALY) of endoscopic biliary drainage in unresectable HCA. Costs of treatment and utilities of each Markov state were retrieved from hospital charges and unresectable HCA patients from tertiary care hospital in Thailand, respectively. Transition probabilities were derived from international literature. Base case analyses and sensitivity analyses were performed. Under the base-case analysis, metal stent is more effective but more expensive than plastic stent. An incremental cost per additional QALY gained is 192,650 baht (US$ 6,318). From probabilistic sensitivity analysis, at the willingness to pay threshold of one and three times GDP per capita or 158,000 baht (US$ 5,182) and 474,000 baht (US$ 15,546), the probability of metal stent being cost-effective is 26.4% and 99.8%, respectively. Based on the WHO recommendation regarding the cost-effectiveness threshold criteria, endoscopic metal stent drainage is cost-effective compared to plastic stent in unresectable complex HCA.

Activity-based costing via an information system: an application created for a breast imaging center.

PubMed

Hawkins, H; Langer, J; Padua, E; Reaves, J

2001-06-01

Activity-based costing (ABC) is a process that enables the estimation of the cost of producing a product or service. More accurate than traditional charge-based approaches, it emphasizes analysis of processes, and more specific identification of both direct and indirect costs. This accuracy is essential in today's healthcare environment, in which managed care organizations necessitate responsible and accountable costing. However, to be successfully utilized, it requires time, effort, expertise, and support. Data collection can be tedious and expensive. By integrating ABC with information management (IM) and systems (IS), organizations can take advantage of the process orientation of both, extend and improve ABC, and decrease resource utilization for ABC projects. In our case study, we have examined the process of a multidisciplinary breast center. We have mapped the constituent activities and established cost drivers. This information has been structured and included in our information system database for subsequent analysis.

Least squares restoration of multichannel images

NASA Technical Reports Server (NTRS)

Galatsanos, Nikolas P.; Katsaggelos, Aggelos K.; Chin, Roland T.; Hillery, Allen D.

1991-01-01

Multichannel restoration using both within- and between-channel deterministic information is considered. A multichannel image is a set of image planes that exhibit cross-plane similarity. Existing optimal restoration filters for single-plane images yield suboptimal results when applied to multichannel images, since between-channel information is not utilized. Multichannel least squares restoration filters are developed using the set theoretic and the constrained optimization approaches. A geometric interpretation of the estimates of both filters is given. Color images (three-channel imagery with red, green, and blue components) are considered. Constraints that capture the within- and between-channel properties of color images are developed. Issues associated with the computation of the two estimates are addressed. A spatially adaptive, multichannel least squares filter that utilizes local within- and between-channel image properties is proposed. Experiments using color images are described.

Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs.

PubMed

Frogner, Bianca K; Harwood, Kenneth; Andrilla, C Holly A; Schwartz, Malaika; Pines, Jesse M

2018-05-23

To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all. Commercial health insurance claims data, 2009-2013. Retrospective analyses using two-stage residual inclusion instrumental variable models to estimate rates for opioid prescriptions, imaging services, emergency department visits, hospitalization, and health care costs. Patients aged 18-64 years with a new primary diagnosis of LBP, living in the northwest United States, were observed over a 1-year period. Compared to patients who saw a PT later or never, patients who saw a PT first had lower probability of having an opioid prescription (89.4 percent), any advanced imaging services (27.9 percent), and an Emergency Department visit (14.7 percent), yet 19.3 percent higher probability of hospitalization (all p < .001). These patients also had significantly lower out-of-pocket costs, and costs appeared to shift away from outpatient and pharmacy toward provider settings. When LBP patients saw a PT first, there was lower utilization of high-cost medical services as well as lower opioid use, and cost shifts reflecting the change in utilization. © Health Research and Educational Trust.

Innovative manufacturing and materials for low cost lithium ion batteries

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

Carlson, Steven

2015-12-29

This project demonstrated entirely new manufacturing process options for lithium ion batteries with major potential for improved cost and performance. These new manufacturing approaches are based on the use of the new electrode-coated separators instead of the conventional electrode-coated metal current collector foils. The key enabler to making these electrode-coated separators is a new and unique all-ceramic separator with no conventional porous plastic separator present. A simple, low cost, and high speed manufacturing process of a single coating of a ceramic pigment and polymer binder onto a re-usable release film, followed by a subsequent delamination of the all-ceramic separator andmore » any layers coated over it, such as electrodes and metal current collectors, was utilized. A suitable all-ceramic separator was developed that demonstrated the following required features needed for making electrode-coated separators: (1) no pores greater than 100 nanometer (nm) in diameter to prevent any penetration of the electrode pigments into the separator; (2) no shrinkage of the separator when heated to the high oven heats needed for drying of the electrode layer; and (3) no significant compression of the separator layer by the high pressure calendering step needed to densify the electrodes by about 30%. In addition, this nanoporous all-ceramic separator can be very thin at 8 microns thick for increased energy density, while providing all of the performance features provided by the current ceramic-coated plastic separators used in vehicle batteries: improved safety, longer cycle life, and stability to operate at voltages up to 5.0 V in order to obtain even more energy density. The thin all-ceramic separator provides a cost savings of at least 50% for the separator component and by itself meets the overall goal of this project to reduce the cell inactive component cost by at least 20%. The all-ceramic separator also enables further cost savings by its excellent heat stability with no shrinkage at up to 220oC. This allows vacuum drying of the dry cell just before filling with the electrolyte and thereby can reduce the size of the cell assembly dry room by 50%. Once the electrode-coated separator is produced, there are many different approaches for adding the metal current collector layers and making and connecting the tabs of the cells. These approaches include: (1) laminating the electrode side of the electrode-coated separator to both sides of a metal current collector; and (2) making a full coated electrode stack by coating or depositing a current collector layer on the electrode side and then coating a second electrode layer onto the current collector. Further cost savings are available from using lower cost and/or thinner and lighter current collectors and from using a separator coating manufacturing process at widths of 1.5 meters (m) or more and at high production line speeds of up to 125 meters per minute (mpm), both of which are well above the conventional coating widths and line speeds presently used in manufacturing electrodes for lithium ion batteries.« less

Disaster planning and mitigation technologies, interim technology inventory report: Report {number_sign}2

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

Oggerino, J.; Rabinowitz, M.

1998-06-01

Natural and person-caused disasters are increasing in frequency and magnitude, and these disasters are taking an ever increasing economic and personal toll. This report identifies technologies that can help utilities, their customers, and their communities cope with disasters. Each year, 10,000 violent thunderstorms, 5,000 floods, and 1,000 tornadoes strike the US. These and other natural events have cost at least $8 billion per year over the last 30 years, and the annual costs are increasing rapidly. In 1996, the US experienced twice the yearly average of declared disasters than in the previous twenty years. Damage from Hurricane Andrew and themore » Northridge earthquake resulted in losses of $30 and $25 billion respectively. As a result of these and other costly disasters, utilities are losing business and commercial customers. In response, federal, state, and local organizations have steeped up efforts to deploy mitigation technologies and techniques and business recovery support. A task within the EPRI Disaster Planning and Mitigation Technologies (DP and MT) Target seeks to identify technologies that can help utilities and their customers prepare for and recover from natural disasters. This report provides concise and directed product information that can help member utilities and the communities they serve to plan for, mitigate, and recover quickly from natural and person-caused disasters. This will enable them to retain customers and reduce revenue losses.« less

Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update.

PubMed

Sarnat, Richard L; Winterstein, James; Cambron, Jerrilyn A

2007-05-01

Our initial report analyzed clinical and cost utilization data from the years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 and includes first-time comparisons in data points among PCPs of different licensures who were oriented toward complementary and alternative medicine (CAM). Independent physician association-incurred claims and stratified random patient surveys were descriptively analyzed for clinical utilization, cost offsets, and member satisfaction compared with conventional medical IPA normative values. Comparisons to our original publication's comparative blinded data, using nonrandom matched comparison groups, were descriptively analyzed for differences in age/sex demographics and disease profiles to examine sample bias. Clinical and cost utilization based on 70,274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame. During the past 7 years, and with a larger population than originally reported, the CAM-oriented PCPs using a nonsurgical/nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. Decreased utilization was uniformly achieved by all CAM-oriented PCPs, regardless of their licensure. The validity and generalizability of this observation are guarded given the lack of randomization, lack of statistical analysis possible, and potentially biased data in this population.

Rural energy survey and cost-effectiveness analysis of renewable-energy technologies for a Philippine Island community

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

Manibog, F.R.

1982-01-01

This study presents the methodology and results of: (1) a rural energy survey that was conducted in a Philippine island community; and (2) a cost-effectiveness analysis of selected conventional and renewable-energy technologies. The rural energy survey section compares different survey techniques and analyzes energy utilization by providing: (1) a breakdown of energy flows and use patterns; (2) information on energy prices, ownership patterns, social relations, and their effects in terms of differential access to energy sources; (3) per household and per capita consumption figures; and (4) a village energy-consumption table. Correlation analysis is used to determine if the stratified, independentmore » socio-economic variables are indicators for dependent energy variables. Results of the economic analysis indicate that renewable-energy technologies are already least-cost alternatives to diesel generation in the village case study. The sensitivity analysis also shows that these technologies remain the least-cost options even if their capital costs were underestimated. The findings of the study are useful to the current Philippine renewable-energy program in terms of providing: (1) information essential for determining end-users' priority energy needs and for improving technology choice and project design; and (2) justification for promoting auto-generation based on renewable energy sources as alternatives to diesel fuel.« less

Present-value analysis: A systems approach to public decisionmaking for cost effectiveness

NASA Technical Reports Server (NTRS)

Herbert, T. T.

1971-01-01

Decision makers within Governmental agencies and Congress must evaluate competing (and sometimes conflicting) proposals which seek funding and implementation. Present value analysis can be an effective decision making tool by enabling the formal evaluation of the effects of competing proposals on efficient national resource utilization. A project's costs are not only its direct disbursements, but its social costs as well. How much does it cost to have those funds diverted from their use and economic benefit by the private sector to the public project? Comparisons of competing projects' social costs allow decision makers to expand their decision bases by quantifying the projects' impacts upon the economy and the efficient utilization of the country's limited national resources. A conceptual model is established for the choosing of the appropriate discount rate to be used in evaluation decisions through the technique.

A multilevel modelling approach to analysis of patient costs under managed care.

PubMed

Carey, K

2000-07-01

The growth of the managed care model of health care delivery in the USA has led to broadened interest in the performance of health care providers. This paper uses multilevel modelling to analyse the effects of managed care penetration on patient level costs for a sample of 24 medical centres operated by the Veterans Health Administration (VHA). The appropriateness of a two level approach to this problem over ordinary least squares (OLS) is demonstrated. Results indicate a modicum of difference in institutions' performance after controlling for patient effects. Facilities more heavily penetrated by the managed care model may be more effective at controlling costs of their sicker patients. Copyright 2000 John Wiley & Sons, Ltd.

Utility-Scale Solar 2014. An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

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

Bolinger, Mark; Seel, Joachim

2015-09-01

Other than the nine Solar Energy Generation Systems (“SEGS”) parabolic trough projects built in the 1980s, virtually no large-scale or “utility-scale” solar projects – defined here to include any groundmounted photovoltaic (“PV”), concentrating photovoltaic (“CPV”), or concentrating solar thermal power (“CSP”) project larger than 5 MW AC – existed in the United States prior to 2007. By 2012 – just five years later – utility-scale had become the largest sector of the overall PV market in the United States, a distinction that was repeated in both 2013 and 2014 and that is expected to continue for at least the nextmore » few years. Over this same short period, CSP also experienced a bit of a renaissance in the United States, with a number of large new parabolic trough and power tower systems – some including thermal storage – achieving commercial operation. With this critical mass of new utility-scale projects now online and in some cases having operated for a number of years (generating not only electricity, but also empirical data that can be mined), the rapidly growing utility-scale sector is ripe for analysis. This report, the third edition in an ongoing annual series, meets this need through in-depth, annually updated, data-driven analysis of not just installed project costs or prices – i.e., the traditional realm of solar economics analyses – but also operating costs, capacity factors, and power purchase agreement (“PPA”) prices from a large sample of utility-scale solar projects in the United States. Given its current dominance in the market, utility-scale PV also dominates much of this report, though data from CPV and CSP projects are presented where appropriate.« less

Design-Build in Public School Construction: A Post Hearing Briefing. A Report of the Joint Legislative Audit Committee.

ERIC Educational Resources Information Center

California State Legislature, Sacramento. Joint Legislative Audit Committee.

The California legislature's Joint Legislative Audit Committee has issued a report on the design-build versus the design-bid-build process and offers a hybrid approach combining the two systems as a way of achieving the greatest cost efficiency at the least risk on public agencies. The cost benefits of faster delivery of the design-build method…

Pharmacy accessibility and cost-related underuse of prescription medications in low-income Black and Hispanic urban communities.

PubMed

Qato, Dima Mazen; Wilder, Jocelyn; Zenk, Shannon; Davis, Andrew; Makelarski, Jennifer; Lindau, Stacy Tessler

Policy efforts to reduce the cost of prescription medications in the US have failed to reduce disparities in cost-related underuse. Little is known about the relationships between pharmacy accessibility, utilization, and cost-related underuse of prescription medications among residents of low-income minority communities. The aim of this work was to examine the association between pharmacy accessibility, utilization, and cost-related underuse of prescription medications among residents of predominantly low-income Black and Hispanic urban communities. Data from a population-based probability sample of adults 35 years of age and older residing on the South Side of Chicago in 2012-2013 were linked with the use of geocoded information on the type and location of the primary and the nearest pharmacy. Multivariable regression models were used to examine associations between pharmacy accessibility, utilization of and travel distance to the primary pharmacy, and cost-related underuse overall and by pharmacy type. One-third of South Side residents primarily filled their prescriptions at the pharmacy nearest to their home. Among those who did not use mail order, median distance traveled from home to the primary pharmacy was 1.2 miles. Residents whose primary pharmacy was at a community health center or clinic where they usually received care traveled the farthest but were least likely to report cost-related underuse of their prescription medications. Most residents of minority communities on Chicago's South Side were not using the pharmacies closest to their home to obtain their prescription medications. Efforts to improve access to prescription medications in these communities should focus on improving the accessibility of affordable pharmacies at site of care. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Pharmacy Accessibility and Cost-Related Underuse of Prescription Medications in Low-Income Black and Hispanic Urban Communities

PubMed Central

Qato, Dima Mazen; Wilder, Jocelyn; Zenk, Shannon; Davis, Andrew; Makelarski, Jennifer; Lindau, Stacy Tessler

2016-01-01

Background Policy efforts to reduce the cost of prescription medications in the U.S. have failed to reduce disparities in cost-related underuse. Little is known about the relationships between pharmacy accessibility, utilization and cost-related underuse of prescription medications among residents of low-income minority communities. Objectives To examine the association between pharmacy accessibility, utilization and cost-related underuse of prescription medications among residents of predominantly low-income, Black and Hispanic urban communities. Methods Data from a population-based probability sample of adults 35 years and older residing on the South Side of Chicago in 2012–13 were linked with geocoded information on the type and location of primary and nearest pharmacy. Multivariable regression models were used to examine associations between pharmacy accessibility, utilization of, and travel distance to, primary pharmacy and cost-related underuse overall and by pharmacy type. Results One-third of South Side residents primarily filled their prescriptions at the pharmacy nearest to their home. Among those who did not use mail order, median distance traveled from home to the primary pharmacy was 1.2 miles. Residents whose primary pharmacy was at a community health center or clinic where they usually received care traveled the furthest but were least likely to report cost-related underuse of their prescription medications. Conclusions Most residents of minority communities on Chicago’s South Side were not using pharmacies closest to their home to obtain their prescription medications. Efforts to improve access to prescription medications in these communities should focus on improving the accessibility of affordable pharmacies at site of care. PMID:28153704

Life support approaches for Mars missions

NASA Technical Reports Server (NTRS)

Drysdale, A. E.; Ewert, M. K.; Hanford, A. J.

2003-01-01

Life support approaches for Mars missions are evaluated using an equivalent system mass (ESM) approach, in which all significant costs are converted into mass units. The best approach, as defined by the lowest mission ESM, depends on several mission parameters, notably duration, environment and consequent infrastructure costs, and crew size, as well as the characteristics of the technologies which are available. Generally, for the missions under consideration, physicochemical regeneration is most cost effective. However, bioregeneration is likely to be of use for producing salad crops for any mission, for producing staple crops for medium duration missions, and for most food, air and water regeneration for long missions (durations of a decade). Potential applications of in situ resource utilization need to be considered further. c2002 Published by Elsevier Science Ltd on behalf of COSPAR.

Life support approaches for Mars missions.

PubMed

Drysdale, A E; Ewert, M K; Hanford, A J

2003-01-01

Life support approaches for Mars missions are evaluated using an equivalent system mass (ESM) approach, in which all significant costs are converted into mass units. The best approach, as defined by the lowest mission ESM, depends on several mission parameters, notably duration, environment and consequent infrastructure costs, and crew size, as well as the characteristics of the technologies which are available. Generally, for the missions under consideration, physicochemical regeneration is most cost effective. However, bioregeneration is likely to be of use for producing salad crops for any mission, for producing staple crops for medium duration missions, and for most food, air and water regeneration for long missions (durations of a decade). Potential applications of in situ resource utilization need to be considered further. c2002 Published by Elsevier Science Ltd on behalf of COSPAR.

Whole exome sequencing in neurogenetic odysseys: An effective, cost- and time-saving diagnostic approach

PubMed Central

Córdoba, Marta; Rodriguez-Quiroga, Sergio Alejandro; Vega, Patricia Analía; Salinas, Valeria; Perez-Maturo, Josefina; Amartino, Hernán; Vásquez-Dusefante, Cecilia; Medina, Nancy; González-Morón, Dolores; Kauffman, Marcelo Andrés

2018-01-01

Background Diagnostic trajectories for neurogenetic disorders frequently require the use of considerable time and resources, exposing patients and families to so-called “diagnostic odysseys”. Previous studies have provided strong evidence for increased diagnostic and clinical utility of whole-exome sequencing in medical genetics. However, specific reports assessing its utility in a setting such as ours- a neurogeneticist led academic group serving in a low-income country—are rare. Objectives To assess the diagnostic yield of WES in patients suspected of having a neurogenetic condition and explore the cost-effectiveness of its implementation in a research group located in an Argentinean public hospital. Methods This is a prospective study of the clinical utility of WES in a series of 40 consecutive patients selected from a Neurogenetic Clinic of a tertiary Hospital in Argentina. We evaluated patients retrospectively for previous diagnostic trajectories. Diagnostic yield, clinical impact on management and economic diagnostic burden were evaluated. Results We demonstrated the clinical utility of Whole Exome Sequencing in our patient cohort, obtaining a diagnostic yield of 40% (95% CI, 24.8%-55.2%) among a diverse group of neurological disorders. The average age at the time of WES was 23 (range 3–70). The mean time elapsed from symptom onset to WES was 11 years (range 3–42). The mean cost of the diagnostic workup prior to WES was USD 1646 (USD 1439 to 1853), which is 60% higher than WES cost in our center. Conclusions WES for neurogenetics proved to be an effective, cost- and time-saving approach for the molecular diagnosis of this heterogeneous and complex group of patients. PMID:29389947

Glucose predictability, blood capillary permeability, and glucose utilization rate in subcutaneous, skeletal muscle, and visceral fat tissues.

PubMed

Koutny, Tomas

2013-11-01

This study suggests an approach for the comparison and evaluation of particular compartments with modest experimental setup costs. A glucose level prediction model was used to evaluate the compartment's glucose transport rate across the blood capillary membrane and the glucose utilization rate by the cells. The glucose levels of the blood, subcutaneous tissue, skeletal muscle tissue, and visceral fat were obtained in experiments conducted on hereditary hypertriglyceridemic rats. After the blood glucose level had undergone a rapid change, the experimenter attempted to reach a steady blood glucose level by manually correcting the glucose infusion rate and maintaining a constant insulin infusion rate. The interstitial fluid glucose levels of subcutaneous tissue, skeletal muscle tissue, and visceral fat were evaluated to determine the reaction delay compared with the change in the blood glucose level, the interstitial fluid glucose level predictability, the blood capillary permeability, the effect of the concentration gradient, and the glucose utilization rate. Based on these data, the glucose transport rate across the capillary membrane and the utilization rate in a particular tissue were determined. The rates obtained were successfully verified against positron emission tomography experiments. The subcutaneous tissue exhibits the lowest and the most predictable glucose utilization rate, whereas the skeletal muscle tissue has the greatest glucose utilization rate. In contrast, the visceral fat is the least predictable and has the shortest reaction delay compared with the change in the blood glucose level. The reaction delays obtained for the subcutaneous tissue and skeletal muscle tissue were found to be approximately equal using a metric based on the time required to reach half of the increase in the interstitial fluid glucose level. © 2013 Published by Elsevier Ltd.

Penalized Weighted Least-Squares Approach to Sinogram Noise Reduction and Image Reconstruction for Low-Dose X-Ray Computed Tomography

PubMed Central

Wang, Jing; Li, Tianfang; Lu, Hongbing; Liang, Zhengrong

2006-01-01

Reconstructing low-dose X-ray CT (computed tomography) images is a noise problem. This work investigated a penalized weighted least-squares (PWLS) approach to address this problem in two dimensions, where the WLS considers first- and second-order noise moments and the penalty models signal spatial correlations. Three different implementations were studied for the PWLS minimization. One utilizes a MRF (Markov random field) Gibbs functional to consider spatial correlations among nearby detector bins and projection views in sinogram space and minimizes the PWLS cost function by iterative Gauss-Seidel algorithm. Another employs Karhunen-Loève (KL) transform to de-correlate data signals among nearby views and minimizes the PWLS adaptively to each KL component by analytical calculation, where the spatial correlation among nearby bins is modeled by the same Gibbs functional. The third one models the spatial correlations among image pixels in image domain also by a MRF Gibbs functional and minimizes the PWLS by iterative successive over-relaxation algorithm. In these three implementations, a quadratic functional regularization was chosen for the MRF model. Phantom experiments showed a comparable performance of these three PWLS-based methods in terms of suppressing noise-induced streak artifacts and preserving resolution in the reconstructed images. Computer simulations concurred with the phantom experiments in terms of noise-resolution tradeoff and detectability in low contrast environment. The KL-PWLS implementation may have the advantage in terms of computation for high-resolution dynamic low-dose CT imaging. PMID:17024831

Funding a smoking cessation program for Crohn's disease: an economic evaluation.

PubMed

Coward, Stephanie; Heitman, Steven J; Clement, Fiona; Negron, Maria; Panaccione, Remo; Ghosh, Subrata; Barkema, Herman W; Seow, Cynthia; Leung, Yvette P Y; Kaplan, Gilaad G

2015-03-01

Patients with Crohn's disease (CD) who smoke are at a higher risk of flaring and requiring surgery. Cost-effectiveness studies of funding smoking cessation programs are lacking. Thus, we performed a cost-utility analysis of funding smoking cessation programs for CD. A cost-utility analysis was performed comparing five smoking cessation strategies: No Program, Counseling, Nicotine Replacement Therapy (NRT), NRT+Counseling, and Varenicline. The time horizon for the Markov model was 5 years. The health states included medical remission (azathioprine or antitumor necrosis factor (anti-TNF), dose escalation of an anti-TNF, second anti-TNF, surgery, and death. Probabilities were taken from peer-reviewed literature, and costs (CAN$) for surgery, medications, and smoking cessation programs were estimated locally. The primary outcome was the cost per quality-adjusted life year (QALY) gained associated with each smoking cessation strategy. Threshold, three-way sensitivity, probabilistic sensitivity analysis (PSA), and budget impact analysis (BIA) were carried out. All strategies dominated No Program. Strategies from most to least cost effective were as follows: Varenicline (cost: $55,614, QALY: 3.70), NRT+Counseling (cost: $58,878, QALY: 3.69), NRT (cost: $59,540, QALY: 3.69), Counseling (cost: $61,029, QALY: 3.68), and No Program (cost: $63,601, QALY: 3.67). Three-way sensitivity analysis demonstrated that No Program was only more cost effective when every strategy's cost exceeded approximately 10 times their estimated costs. The PSA showed that No Program was the most cost-effective <1% of the time. The BIA showed that any strategy saved the health-care system money over No Program. Health-care systems should consider funding smoking cessation programs for CD, as they improve health outcomes and reduce costs.

Impact of 2 employer-sponsored population health management programs on medical care cost and utilization.

PubMed

Mattke, Soeren; Serxner, Seth A; Zakowski, Sarah L; Jain, Arvind K; Gold, Daniel B

2009-02-01

Integrated health management programs combining disease prevention and disease management services, although popular with employers, have been insufficiently researched with respect to their effect on costs. To estimate the overall impact of a population health management program and its components on cost and utilization. STUDY DESIGN, SETTING, AND PARTICIPANTS: Observational study of 2 employer-sponsored health management programs involving more than 200,000 health plan members. We used claims data for the first program year and the 2 preceding years to calculate cost and utilization metrics, and program activity data to determine program uptake. Using an intent-to-treat approach and regression-based risk adjustment, we estimated whether the program was associated with changes in cost and utilization. Data on program fees were unavailable. Overall, the program was associated with a nonsignificant cost increase of $13.75 per member per month (PMPM). The wellness component alone was associated with a significant increase of $20.14 PMPM. Case and disease management were associated with a significant decrease in hospital admissions of 4 and 1 per 1000 patient-years, respectively. Our results suggest that the programs did not reduce medical cost in their first year, despite a beneficial effect on hospital admissions. If we had been able to include program fees, it is likely that the overall cost would have increased significantly. Although this study had important limitations, the results suggest that a belief that these programs will save money may be too optimistic and better evaluation is needed.

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

PubMed

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

2010-12-01

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

Cost, healthcare resource utilization, and adherence of individuals with diabetes using U-500 or U-100 insulin: a retrospective database analysis.

PubMed

Eby, Elizabeth L; Wang, Ping; Curtis, Bradley H; Xie, Jin; Haldane, Diane C; Idris, Iskandar; Peters, Anne L; Hood, Robert C; Jackson, Jeffrey A

2013-01-01

To describe costs, healthcare resource utilization, and adherence of US patients receiving human regular U-500 insulin (U-500R), compared to patients receiving high-dose (>200 units/day) U-100 insulins (U-100) by subcutaneous injection for the treatment of diabetes. A retrospective analysis of data from Thomson Reuters MarketScan Research Databases (7/1/2008 to 12/31/2010). Difference-in-differences analyses were conducted on cost (medical, pharmacy, and overall costs) and on healthcare resource utilization variables (overall, diabetes-related, and non-diabetes-related medical visits). Adherence rates to the index insulins were assessed by proportion of days covered (PDC). Seven hundred and eleven (19%) patients in the U-500R cohort and 1508 (6%) patients in the U-100 cohort met selection criteria. Propensity score matching resulted in 684 matched pairs. Mean change in annualized pharmacy costs was in favor of the U-500R vs the U-100 cohort (-$1258 vs $3345, a difference of -$4603, p < 0.0001). Mean overall cost increase in the U-500R vs the U-100 cohort was also lower ($1999 vs $9104, a difference of -$7105, p = 0.005). The proportion of patients with at least one coded hypoglycemic event during the 12-month post-index period was higher in the U-500R vs the U-100 cohort (17.1% vs 11.7%, p < 0.005), but neither hypoglycemia rate (2.73 vs 2.90 events per person) nor hypoglycemia-specific costs (mean $1669 vs $1543) were significantly different. No significant differences were noted between cohorts for change (post-pre) in any resource utilization category. PDC was greater in the U-500R vs the U-100 cohort (65.2% vs 39.5%, p < 0.0001). Claims data are not as accurate as empirical evaluation by a clinician. Glycemic control data were not available for this analysis. In patients requiring high-dose insulin, treatment with U-500R vs high-dose U-100 insulins is associated with significant decreases in pharmacy and overall costs, slightly higher hypoglycemia incidence, no difference in hypoglycemia-specific costs or in resource utilization, and better adherence.

ResStock Analysis Tool | Buildings | NREL

Science.gov Websites

Energy and Cost Savings for U.S. Homes Contact Eric Wilson to learn how ResStock can benefit your approach to large-scale residential energy analysis by combining: Large public and private data sources uncovered $49 billion in potential annual utility bill savings through cost-effective energy efficiency

Burden of a multiple sclerosis relapse: the patient's perspective.

PubMed

Oleen-Burkey, Merrikay; Castelli-Haley, Jane; Lage, Maureen J; Johnson, Kenneth P

2012-01-01

Relapses are a common feature of relapsing-remitting multiple sclerosis (RRMS) and increasing severity has been shown to be associated with higher healthcare costs, and to result in transient increases in disability. Increasing disability likely impacts work and leisure productivity, and lowers quality of life. The objective of this study was to characterize from the patient's perspective the impact of a multiple sclerosis (MS) relapse in terms of the economic cost, work and leisure productivity, functional ability, and health-related quality of life (HR-QOL), for a sample of patients with RRMS in the US treated with immunomodulatory agents. A cross-sectional, web-based, self-report survey was conducted among members of MSWatch.com, a patient support website now known as Copaxone.com. Qualified respondents in the US had been diagnosed with RRMS and were using an immunomodulatory agent. The survey captured costs of RRMS with questions about healthcare resource utilization, use of community services, and purchased alterations and assistive items related to MS. The Work and Leisure Impairment instrument and the EQ-5D were used to measure productivity losses and HR-QOL (health utility), respectively. The Goodin MS neurological impairment questionnaire was used to measure functional disability; questions were added about relapses in the past year. Of 711 qualified respondents, 67% reported having at least one relapse during the last year, with a mean of 2.2 ± 2.3 relapses/year. Respondents who experienced at least one relapse had significantly higher mean annual direct and indirect costs compared with those who did not experience a relapse ($US38 458 vs $US28 669; p = 0.0004) [year 2009 values]. Direct health-related costs accounted for the majority of the increased cost ($US5201; 53%) and were mainly due to increases in hospitalizations, medications, and ambulatory care. Indirect costs, including informal care and productivity loss, accounted for the additional 47% of increased cost ($US4588). Accounting for the mean number of relapses associated with these increased costs, the total economic cost of one relapse episode could be estimated at about $US4449, exclusive of intangible costs. The mean self-reported Expanded Disability Status Scale (EDSS) score, derived from the Goodin MS questionnaire, was significantly higher with relapse than with a clinically stable state (EDSS 4.3 vs 3.7; p < 0.0001), while the mean health utility score was significantly lower with relapse compared with a clinically stable state (0.66 vs 0.75; p = 0.0001). The value of these intangible costs of relapse can be estimated at $US5400. The overall burden (direct, indirect, and intangible costs) of one relapse in patients treated with immunomodulatory agents is therefore estimated conservatively at $US9849. This study shows that from a patient's perspective an MS relapse is associated with a significant increase in the economic costs as well as a decline in HR-QOL and functional ability.

Out-of-Pocket Expenditures on Complementary Health Approaches Associated with Painful Health Conditions in a Nationally Representative Adult Sample

PubMed Central

Nahin, Richard L.; Stussman, Barbara J.; Herman, Patricia M.

2015-01-01

National surveys suggest that millions of adults in the United States use complementary health approaches such as acupuncture, chiropractic manipulation, and herbal medicines to manage painful conditions such as arthritis, back pain and fibromyalgia. Yet, national and per person out-of-pocket (OOP) costs attributable to this condition-specific use are unknown. In the 2007 National Health Interview Survey, use of complementary health approaches, reasons for this use, and associated OOP costs were captured in a nationally representative sample of 5,467 adults. Ordinary least square regression models that controlled for co-morbid conditions were used to estimate aggregate and per person OOP costs associated with 14 painful health conditions. Individuals using complementary approaches spent a total of $14.9 billion (S.E. $0.9 billion) OOP on these approaches to manage these painful conditions. Total OOP expenditures seen in those using complementary approaches for their back pain ($8.7 billion, S.E. $0.8 billion) far outstripped that of any other condition, with the majority of these costs ($4.7 billion, S.E. $0.4 billion) resulting from visits to complementary providers. Annual condition-specific per-person OOP costs varied from a low of $568 (SE $144) for regular headaches, to a high of $895 (SE $163) for fibromyalgia. PMID:26320946

Cost estimate for a proposed GDF Suez LNG testing program

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

Blanchat, Thomas K.; Brady, Patrick Dennis; Jernigan, Dann A.

2014-02-01

At the request of GDF Suez, a Rough Order of Magnitude (ROM) cost estimate was prepared for the design, construction, testing, and data analysis for an experimental series of large-scale (Liquefied Natural Gas) LNG spills on land and water that would result in the largest pool fires and vapor dispersion events ever conducted. Due to the expected cost of this large, multi-year program, the authors utilized Sandia's structured cost estimating methodology. This methodology insures that the efforts identified can be performed for the cost proposed at a plus or minus 30 percent confidence. The scale of the LNG spill, fire,more » and vapor dispersion tests proposed by GDF could produce hazard distances and testing safety issues that need to be fully explored. Based on our evaluations, Sandia can utilize much of our existing fire testing infrastructure for the large fire tests and some small dispersion tests (with some modifications) in Albuquerque, but we propose to develop a new dispersion testing site at our remote test area in Nevada because of the large hazard distances. While this might impact some testing logistics, the safety aspects warrant this approach. In addition, we have included a proposal to study cryogenic liquid spills on water and subsequent vaporization in the presence of waves. Sandia is working with DOE on applications that provide infrastructure pertinent to wave production. We present an approach to conduct repeatable wave/spill interaction testing that could utilize such infrastructure.« less

Quantifying the costs and benefits of privacy-preserving health data publishing.

PubMed

Khokhar, Rashid Hussain; Chen, Rui; Fung, Benjamin C M; Lui, Siu Man

2014-08-01

Cost-benefit analysis is a prerequisite for making good business decisions. In the business environment, companies intend to make profit from maximizing information utility of published data while having an obligation to protect individual privacy. In this paper, we quantify the trade-off between privacy and data utility in health data publishing in terms of monetary value. We propose an analytical cost model that can help health information custodians (HICs) make better decisions about sharing person-specific health data with other parties. We examine relevant cost factors associated with the value of anonymized data and the possible damage cost due to potential privacy breaches. Our model guides an HIC to find the optimal value of publishing health data and could be utilized for both perturbative and non-perturbative anonymization techniques. We show that our approach can identify the optimal value for different privacy models, including K-anonymity, LKC-privacy, and ∊-differential privacy, under various anonymization algorithms and privacy parameters through extensive experiments on real-life data. Copyright © 2014 Elsevier Inc. All rights reserved.

Energetically optimal travel across terrain: visualizations and a new metric of geographic distance with anthropological applications

NASA Astrophysics Data System (ADS)

Wood, Brian M.; Wood, Zoë J.

2006-01-01

We present a visualization and computation tool for modeling the caloric cost of pedestrian travel across three dimensional terrains. This tool is being used in ongoing archaeological research that analyzes how costs of locomotion affect the spatial distribution of trails and artifacts across archaeological landscapes. Throughout human history, traveling by foot has been the most common form of transportation, and therefore analyses of pedestrian travel costs are important for understanding prehistoric patterns of resource acquisition, migration, trade, and political interaction. Traditionally, archaeologists have measured geographic proximity based on "as the crow flies" distance. We propose new methods for terrain visualization and analysis based on measuring paths of least caloric expense, calculated using well established metabolic equations. Our approach provides a human centered metric of geographic closeness, and overcomes significant limitations of available Geographic Information System (GIS) software. We demonstrate such path computations and visualizations applied to archaeological research questions. Our system includes tools to visualize: energetic cost surfaces, comparisons of the elevation profiles of shortest paths versus least cost paths, and the display of paths of least caloric effort on Digital Elevation Models (DEMs). These analysis tools can be applied to calculate and visualize 1) likely locations of prehistoric trails and 2) expected ratios of raw material types to be recovered at archaeological sites.

Preferences and Utilities for Health States after Treatment of Olfactory Groove Meningioma: Endoscopic versus Open.

PubMed

Yao, Christopher M; Kahane, Alyssa; Monteiro, Eric; Gentili, Fred; Zadeh, Gelareh; de Almeida, John R

2017-08-01

Objectives  The purpose of this study is to report health utility scores for patients with olfactory groove meningiomas (OGM) treated with either the standard transcranial approach, or the expanded endonasal endoscopic approach. Design  The time trade-off technique was used to derive health utility scores. Setting  Healthy individuals without skull base tumors were surveyed. Main Outcome Measures  Participants reviewed and rated scenarios describing treatment (endoscopic, open, stereotactic radiation, watchful waiting), remission, recurrence, and complications associated with the management of OGMs. Results  There were 51 participants. The endoscopic approach was associated with higher utility scores compared with an open craniotomy approach (0.88 vs. 0.74; p  < 0.001) and watchful waiting (0.88 vs.0.74; p  = 0.002). If recurrence occurred, revision endoscopic resection continued to have a higher utility score compared with revision open craniotomy (0.68; p  = 0.008). On multivariate analysis, older individuals were more likely to opt for watchful waiting ( p  = 0.001), whereas participants from higher income brackets were more likely to rate stereotactic radiosurgery with higher utility scores ( p  = 0.017). Conclusion  The endoscopic approach was associated with higher utility scores than craniotomy for primary and revision cases. The present utilities can be used for future cost-utility analyses.

Advancements in medicine from aerospace research

NASA Technical Reports Server (NTRS)

Wooten, F. T.

1971-01-01

NASA has taken the lead in implementing the concept of technology utilization, and the Technology Utilization Program is the first vital step in the goal of a technological society to insure maximum benefit from the costs of technology. Experience has shown that the active approach to technology transfer is unique and is well received in the medical profession when appropriate problems are tackled. The problem solving approach is a useful one at the precise time when medicine is recognizing the need for new technology.

Practical considerations in the measurement of the internal relative humidity of pharmaceutical packages with data loggers.

PubMed

Nelson, Eric D; Huang, Henry

2011-03-01

The utility of temperature/humidity data loggers are evaluated as a low-cost approach to enrich practical understanding of the actual time dependent humidity that a pharmaceutical product is exposed to. While this approach is found to have significant utility in general, small systematic biases in the measurements due to the presence of the data logger are observed. Taking these biases into account enables more productive extrapolation of measured time/humidity profiles. © 2011 American Association of Pharmaceutical Scientists

The 30/20 GHz mixed user architecture development study

NASA Technical Reports Server (NTRS)

1979-01-01

A mixed-user system is described which provides cost-effective communications services to a wide range of user terminal classes, ranging from one or two voice channel support in a direct-to-user mode, to multiple 500 mbps trunking channel support. Advanced satellite capabilities are utilized to minimize the cost of small terminals. In a system with thousands of small terminals, this approach results in minimum system cost.

A PARTICIPANT-BASED APPROACH TO INDOOR/OUTDOOR AIR MONITORING IN COMMUNITY HEALTH STUDIES

EPA Science Inventory

Community health studies of traffic-related air pollution have been hampered by the cost and participant burden associated with collecting household-level exposure data. The current study utilized a novel participant-based approach to collect indoor and outdoor air monitoring da...

*A participant-based approach to indoor/outdoor air monitoring in Community Health Studies

EPA Science Inventory

Community health studies of traffic-related air pollution have been hampered by the cost and participant burden associated with collecting household-level exposure data. The current study utilized a participant-based approach to collect indoor and outdoor air monitoring data from...

Issues in formulary management: therapeutic interchange. The value, cost, and quality of therapeutic interchange.

PubMed

Mahoney, C D

1992-10-01

Therapeutic interchange is a process of substituting a prescribed medication with one that offers therapeutic and cost benefits. The practice not only provides short-term savings but also is associated with decreases in lengths of stay in hospitals and total hospital drug expenses. There may be medicolegal implications when FDA-approved indications differ for interchanged drugs. The potential for liability is decreased when a standard of care is met, but since standards can change, guidelines should be reviewed regularly. High-tech, high-cost drugs are sometimes appropriate for therapeutic interchange. Pharmacy and therapeutics committees should assure best value by considering indirect expenses, quality, and therapeutic outcome, as well as product cost. Therapeutic interchange programs enable pharmacy managers to neutralize or at least slow the rate of drug cost increases, ensuring appropriate utilization of resources and more favorable patient outcomes.

A study of the factors that influence consumer attitudes toward beef products using the conjoint market analysis tool.

PubMed

Mennecke, B E; Townsend, A M; Hayes, D J; Lonergan, S M

2007-10-01

This study utilizes an analysis technique commonly used in marketing, the conjoint analysis method, to examine the relative utilities of a set of beef steak characteristics considered by a national sample of 1,432 US consumers, as well as additional localized samples representing undergraduate students at a business college and in an animal science department. The analyses indicate that among all respondents, region of origin is by far the most important characteristic; this is followed by animal breed, traceability, animal feed, and beef quality. Alternatively, the cost of cut, farm ownership, the use (or nonuse) of growth promoters, and whether the product is guaranteed tender were the least important factors. Results for animal science undergraduates are similar to the aggregate results, except that these students emphasized beef quality at the expense of traceability and the nonuse of growth promoters. Business students also emphasized region of origin but then emphasized traceability and cost. The ideal steak for the national sample is from a locally produced, choice Angus fed a mixture of grain and grass that is traceable to the farm of origin. If the product was not produced locally, respondents indicated that their preferred production states are, in order from most to least preferred, Iowa, Texas, Nebraska, and Kansas.

Integrated cost-effectiveness analysis of agri-environmental measures for water quality.

PubMed

Balana, Bedru B; Jackson-Blake, Leah; Martin-Ortega, Julia; Dunn, Sarah

2015-09-15

This paper presents an application of integrated methodological approach for identifying cost-effective combinations of agri-environmental measures to achieve water quality targets. The methodological approach involves linking hydro-chemical modelling with economic costs of mitigation measures. The utility of the approach was explored for the River Dee catchment in North East Scotland, examining the cost-effectiveness of mitigation measures for nitrogen (N) and phosphorus (P) pollutants. In-stream nitrate concentration was modelled using the STREAM-N and phosphorus using INCA-P model. Both models were first run for baseline conditions and then their effectiveness for changes in land management was simulated. Costs were based on farm income foregone, capital and operational expenditures. The costs and effects data were integrated using 'Risk Solver Platform' optimization in excel to produce the most cost-effective combination of measures by which target nutrient reductions could be attained at a minimum economic cost. The analysis identified different combination of measures as most cost-effective for the two pollutants. An important aspect of this paper is integration of model-based effectiveness estimates with economic cost of measures for cost-effectiveness analysis of land and water management options. The methodological approach developed is not limited to the two pollutants and the selected agri-environmental measures considered in the paper; the approach can be adapted to the cost-effectiveness analysis of any catchment-scale environmental management options. Copyright © 2015 Elsevier Ltd. All rights reserved.

Tradeoffs in Risk and Return of Financial Hedging Solutions to Mitigate Drought-Related Financial Risks for Water Utilities

NASA Astrophysics Data System (ADS)

Baum, R.; Characklis, G. W.

2016-12-01

Financial hedging solutions have been examined as tools for effectively mitigating water scarcity related financial risks for water utilities, and have become more prevalent as conservation (resulting in reduced revenues) and water transfers (resulting in increased costs) play larger roles in drought management. Individualized financial contracts (i.e. designed for a single utility) provide evidence of the potential benefits of financial hedging. However, individualized contracts require substantial time and information to develop, limiting their widespread implementation. More generalized contracts have also shown promise, and would allow the benefits of risk pooling to be more effectively realized, resulting in less expensive contracts. Risk pooling reduces the probability of an insurer making payouts that deviate significantly from the mean, but given that the financial risks of drought are spatially correlated amongst utilities, these more extreme "fat tail" risks remain. Any group offering these hedging contracts, whether a third-party insurer or a "mutual" comprised of many utilities, will need to balance the costs (i.e. additional risk) and benefits (i.e. returns) of alternative approaches to managing the extreme risks (e.g. through insurance layers). The balance of these different approaches will vary depending on the risk pool being considered, including the number, size and exposure of the participating utilities. This work first establishes a baseline of the tradeoffs between risk and expected return in insuring against the financial risks of water scarcity without alternative hedging approaches for water utilities across all climate divisions of the United States. Then various scenarios are analyzed to provide insight into how to maximize returns for risk pooling portfolios at various risk levels through balancing different insurance layers and hedging approaches. This analysis will provide valuable information for designing optimal financial risk management strategies for water utilities across the United States.

The Association of Gasoline Prices With Hospital Utilization and Costs for Motorcycle and Nonmotorcycle Motor Vehicle Injuries in the United States.

PubMed

Zhu, He; Wilson, Fernando A; Stimpson, Jim P; Araz, Ozgur M; Kim, Jungyoon; Chen, Baojiang; Wu, Li-Tzy

2016-09-01

This study examined the association between gasoline prices and hospitalizations for motorcycle and nonmotorcycle motor vehicle crash (MVC) injuries. Data on inpatient hospitalizations were obtained from the 2001 to 2010 Nationwide Inpatient Sample. Panel feasible generalized least squares models were used to estimate the effects of monthly inflation-adjusted gasoline prices on hospitalization rates for MVC injuries and to predict the impact of increasing gasoline taxes. On the basis of the available data, a $1.00 increase in the gasoline tax was associated with an estimated 8348 fewer annual hospitalizations for nonmotorcycle MVC injuries, and reduced hospital costs by $143 million. However, the increase in the gasoline tax was also associated with an estimated 3574 more annual hospitalizations for motorcycle crash injuries, and extended hospital costs by $73 million. This analysis of some existing data suggest that the increased utilization and costs of hospitalization from motorcycle crash injuries associated with an increase in the price of gasoline are likely to substantially offset reductions in nonmotorcycle MVC injuries. A policy decision to increase the gasoline tax could improve traffic safety if the increased tax is paired with public health interventions to improve motorcycle safety.

A Novel Approach for a Low-Cost Deployable Antenna

NASA Technical Reports Server (NTRS)

Amend, Chris; Nurnberger, Michael; Oppenheimer, Paul; Koss, Steve; Purdy, Bill

2010-01-01

The Naval Research Laboratory (NRL) has designed, built, and fully qualified a low cost, low Passive Intermodulation (PIM) 12-foot (3.66-m) diameter deployable ultra high frequency (UHF) antenna for the Tacsat-4 program. The design utilized novel approaches in reflector material and capacitive coupling techniques. This paper discusses major design trades, unique design characteristics, and lessons learned from the development of the Tacsat 4 deployable antenna. This antenna development was sponsored by the Office of Naval Research.

A Demonstration System for Capturing Geothermal Energy from Mine Waters beneath Butte, Montana

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

Blackketter, Donald

2015-06-01

Executive Summary An innovative 50-ton ground-source heat pump (GSHP) system was installed to provide space heating and cooling for a 56,000 square foot (5,200 square meter) building in Butte Montana, in conjunction with its heating and chiller systems. Butte is a location with winter conditions much colder than the national average. The GSHP uses flooded mine waters at 78F (25C) as the heat source and heat sink. The heat transfer performance and efficiency of the system were analyzed using data from January through July 2014. This analysis indicated that for typical winter conditions in Butte, Montana, the GSHP could delivermore » about 88% of the building’s annual heating needs. Compared with a baseline natural-gas/electric system, the system demonstrated at least 69% site energy savings, 38% source energy savings, 39% carbon dioxide emissions reduction, and a savings of $17,000 per year (40%) in utility costs. Assuming a $10,000 per ton cost for installing a production system, the payback period at natural gas costs of $9.63/MMBtu and electricity costs of $0.08/kWh would be in the range of 40 to 50 years. At higher utility prices, or lower installation costs, the payback period would obviously be reduced.« less

Utilization of UV Curing Technology to Significantly Reduce the Manufacturing Cost of LIB Electrodes

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

Voelker, Gary; Arnold, John

2015-11-30

Previously identified novel binders and associated UV curing technology have been shown to reduce the time required to apply and finish electrode coatings from tens of minutes to less than one second. This revolutionary approach can result in dramatic increases in process speeds, significantly reduced capital (a factor of 10 to 20) and operating costs, reduced energy requirements, and reduced environmental concerns and costs due to the virtual elimination of harmful volatile organic solvents and associated solvent dryers and recovery systems. The accumulated advantages of higher speed, lower capital and operating costs, reduced footprint, lack of VOC recovery, and reducedmore » energy cost is a reduction of 90% in the manufacturing cost of cathodes. When commercialized, the resulting cost reduction in Lithium batteries will allow storage device manufacturers to expand their sales in the market and thereby accrue the energy savings of broader utilization of HEVs, PHEVs and EVs in the U.S., and a broad technology export market is also envisioned.« less

Highlights of recent balance of system research and evaluation

NASA Astrophysics Data System (ADS)

Thomas, M. G.; Stevens, J. W.

The cost of most photovoltaic (PV) systems is more a function of the balance of system (BOS) components than the collectors. The exception to this rule is the grid-tied system whose cost is related more directly to the collectors, and secondarily to the inverter/controls. In fact, recent procurements throughout the country document that collector costs for roof-mounted, utility-tied systems (Russell, PV Systems Workshop, 7/94) represent 60% to 70% of the system cost. This contrasts with the current market for packaged stand-alone all PV or PV-hybrid systems where collectors represent only 25% to 35% of the total. Not only are the BOS components the cost drivers in the current cost-effective PV system market place, they are also the least reliable components. This paper discusses the impact that BOS issues have on component performance, system performance, and system cost and reliability. We will also look at recent recommended changes in system design based upon performance evaluations of fielded PV systems.

Measuring Resource Utilization: A Systematic Review of Validated Self-Reported Questionnaires.

PubMed

Leggett, Laura E; Khadaroo, Rachel G; Holroyd-Leduc, Jayna; Lorenzetti, Diane L; Hanson, Heather; Wagg, Adrian; Padwal, Raj; Clement, Fiona

2016-03-01

A variety of methods may be used to obtain costing data. Although administrative data are most commonly used, the data available in these datasets are often limited. An alternative method of obtaining costing is through self-reported questionnaires. Currently, there are no systematic reviews that summarize self-reported resource utilization instruments from the published literature.The aim of the study was to identify validated self-report healthcare resource use instruments and to map their attributes.A systematic review was conducted. The search identified articles using terms like "healthcare utilization" and "questionnaire." All abstracts and full texts were considered in duplicate. For inclusion, studies had to assess the validity of a self-reported resource use questionnaire, to report original data, include adult populations, and the questionnaire had to be publically available. Data such as type of resource utilization assessed by each questionnaire, and validation findings were extracted from each study.In all, 2343 unique citations were retrieved; 2297 were excluded during abstract review. Forty-six studies were reviewed in full text, and 15 studies were included in this systematic review. Six assessed resource utilization of patients with chronic conditions; 5 assessed mental health service utilization; 3 assessed resource utilization by a general population; and 1 assessed utilization in older populations. The most frequently measured resources included visits to general practitioners and inpatient stays; nonmedical resources were least frequently measured. Self-reported questionnaires on resource utilization had good agreement with administrative data, although, visits to general practitioners, outpatient days, and nurse visits had poorer agreement.Self-reported questionnaires are a valid method of collecting data on healthcare resource utilization.

Low cost solar silicon production

NASA Astrophysics Data System (ADS)

Mede, Matt

2009-08-01

The worldwide demand for solar grade silicon reached an all time high between 2007 and 2008. Although growth in the solar industry is slowing due to the current economic downturn, demand is expected to rebound in 2011 based on current cost models. However, demand will increase even more than currently anticipated if costs are reduced. This situation creates an opportunity for new and innovative approaches to the production of photovoltaic grade silicon, especially methods which can demonstrate cost reductions over currently utilized processes.

Navigating Financial and Supply Reliability Tradeoffs in Regional Drought Portfolios

NASA Astrophysics Data System (ADS)

Zeff, H. B.; Herman, J. D.; Characklis, G. W.; Reed, P. M.

2013-12-01

Rising development costs and growing concerns over environmental impacts have led many communities to explore more diversified regional portfolio-type approaches to managing their water supplies. These strategies coordinate existing supply infrastructure with other ';assets' such as conservation measures or water transfers, reducing the capacity and costs required to meet demand by providing greater adaptability to changing hydrologic conditions. For many water utilities, however, this additional flexibility can also cause unexpected reductions in revenue (i.e. conservation) or increased costs (i.e. transfers), fluctuations that can be very difficult for a regulated entity to manage. Thus, despite the advantages, concerns over the resulting financial disruptions provide a disincentive for utilities to develop more adaptive methods, potentially limiting the role of some very effective tools. This study seeks to design portfolio strategies that employ financial instruments (e.g. contingency funds, index insurance) to reduce fluctuations in revenues and costs and therefore do not sacrifice financial stability for improved performance (e.g. lower expected costs, high reliability). This work describes the development of regional water supply portfolios in the ';Research Triangle' region of North Carolina, an area comprising four rapidly growing municipalities supplied by nine surface water reservoirs in two separate river basins. Disparities in growth rates and the respective individual storage capacities of the reservoirs provide the region with the opportunity to increase the efficiency of the regional supply infrastructure through inter-utility water transfers, even as each utility engages in its own conservation activities. The interdependence of multiple utilities navigating shared conveyance and treatment infrastructure to engage in transfers forces water managers to consider regional objectives, as the actions of any one utility can affect the others. Results indicate the inclusion of inter-utility water transfers allows the water utilities to improve on regional operational objectives (i.e. higher reliability and lower restriction frequencies) at a lower expected cost, while financial mitigation tools introduce a tradeoff between expected costs and cost variability. Financial mitigation schemes, including both third-party financial insurance contracts and contingency funds (i.e. self-insurance), were able to reduce cost variability at a lower expected cost than mitigation schemes which use self-insurance alone. The dynamics of the Research Triangle scenario (e.g. rapid population growth, constrained supply, and sensitivity to cost/revenue swings) suggest that this work may have the potential to more generally inform utilities on the effects of coordinated regional water supply planning and the resulting financial implications of more flexible, portfolio-type management techniques.

Impact of a comprehensive population health management program on health care costs.

PubMed

Grossmeier, Jessica; Seaverson, Erin L D; Mangen, David J; Wright, Steven; Dalal, Karl; Phalen, Chris; Gold, Daniel B

2013-06-01

Assess the influence of participation in a population health management (PHM) program on health care costs. A quasi-experimental study relied on logistic and ordinary least squares regression models to compare the costs of program participants with those of nonparticipants, while controlling for differences in health care costs and utilization, demographics, and health status. Propensity score models were developed and analyses were weighted by inverse propensity scores to control for selection bias. Study models yielded an estimated savings of $60.65 per wellness participant per month and $214.66 per disease management participant per month. Program savings were combined to yield an integrated return-on-investment of $3 in savings for every dollar invested. A PHM program yielded a positive return on investment after 2 years of wellness program and 1 year of integrated disease management program launch.

The association between physical activity and healthcare costs in children--results from the GINIplus and LISAplus cohort studies.

PubMed

Idler, Nadja; Teuner, Christina M; Hunger, Matthias; Holle, Rolf; Ortlieb, Sandra; Schulz, Holger; Bauer, Carl-Peter; Hoffmann, Ute; Koletzko, Sibylle; Lehmann, Irina; von Berg, Andrea; Berdel, Dietrich; Hoffmann, Barbara; Schaaf, Beate; Heinrich, Joachim; Wolfenstetter, Silke B

2015-04-29

Physical inactivity in children is an important risk factor for the development of various morbidities and mortality in adulthood, physical activity already has preventive effects during childhood. The objective of this study is to estimate the association between physical activity, healthcare utilization and costs in children. Cross-sectional data of 3356 children aged 9 to 12 years were taken from the 10-year follow-up of the birth cohort studies GINIplus and LISAplus, including information on healthcare utilization and physical activity given by parents via self-administered questionnaires. Using a bottom-up approach, direct costs due to healthcare utilization and indirect costs resulting from parental work absence were estimated for the base year 2007. A two-step regression model compared effects on healthcare utilization and costs for a higher (≥ 7 h/week) versus a lower (<7 h/week) level of moderate-to-vigorous physical activity (MVPA) adjusted for age, gender, BMI, education and income of parents, single parenthood and study region. Recycled predictions estimated adjusted mean costs per child and activity group. The analyses for the association between physical activity, healthcare utilization and costs showed no statistically significant results. Different directions of estimates were noticeable throughout cost components in the first step as well as the second step of the regression model. For higher MVPA (≥ 7 h/week) compared with lower MVPA (< 7 h/week) total direct costs accounted for 392 EUR (95% CI: 342-449 EUR) versus 398 EUR (95% CI: 309-480 EUR) and indirect costs accounted for 138 EUR (95% CI: 124-153 EUR) versus 127 EUR (95% CI: 111-146 EUR). The results indicate that childhood might be too early in life, to detect significant preventive effects of physical activity on healthcare utilization and costs, as diseases attributable to lacking physical activity might first occur later in life. This underpins the importance of clarifying the long-term effects of physical activity as it may strengthen the promotion of physical activity in children from a health economic perspective.

Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy.

PubMed

Dandolu, Vani; Pathak, Prathamesh

2018-06-01

To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90 days following surgery. The study used 2008-2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy' and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits, RESULTS: There were 302,923 hysterectomies performed over 5 years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82-0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90 days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period. The study using private insurance data found that robot-assisted hysterectomy was associated with higher health resource utilization and costs than other minimally invasive approaches. Given the high costs associated with robot-assisted hysterectomy, it is important to understand the specific indications for this approach and to identify the patients who may benefit.

Identifying wood utilization options for ecosystem management : summary of a national research project

Treesearch

K. E. Skog; R. J. Barbour; J. E. Baumgras; A. Clark

1997-01-01

Using an ecosystem approach to forest management will change silvicultural practices, thus requiring utilization options to provide revenue and to help offset the costs of the silviculture treatments. The Forest Service, university cooperators, and several industry mills in the southern, western, and northeastern United States have been involved in a national...

Unmanned Maritime Systems Incremental Acquisition Approach

DTIC Science & Technology

2016-12-01

We find that current UMS acquisitions are utilizing previous acquisition reforms, but could benefit from additional contractor peer competition and...peer review. Additional cost and schedule benefits could result from contractor competition during build processes in each incremental process. We...acquisitions are utilizing previous acquisition reforms, but could benefit from additional contractor peer competition and peer review. Additional

Lessons in Commercial PACE Leadership: The Path from Legislation to Launch

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

Leventis, G; Schwartz, LC; Kramer, C

Nonresidential buildings are responsible for over a quarter of primary energy consumption in the United States. Efficiency improvements in these buildings could result in significant energy and utility bill savings. To unlock those potential savings, a number of market barriers to energy efficiency must be addressed. Commercial Property Assessed Clean Energy (C-PACE) financing programs can help overcome several of these barriers with minimal investment from state and local governments. With programs established or under development in 22 states, and at least $521 million in investments so far, other state and local governments are interested in bringing the benefits of C-PACEmore » to their jurisdictions. Lessons in Commercial PACE Leadership: The Path from Legislation to Launch, aims to fast track the set-up of C-PACE programs for state and local governments by capturing the lessons learned from leaders. The report examines the list of potential program design options and important decision points in setting up a C-PACE program, tradeoffs for available options, and experiences of stakeholders that have gone through (or are going through) the process. C-PACE uses a voluntary special property assessment to facilitate energy and other improvements in commercial buildings. For example: - Long financing terms under C-PACE can produce cash flow-positive -- projects to help overcome a focus on short paybacks. - Payment obligations can transfer to subsequent owners, mitigating concern about investing in improvements for a building that may be sold before the return on the investment is fully realized. - 100% of both hard and soft costs can be financed. To capture the benefits of C-PACE financing, state and local governments must navigate numerous decision points and engage with stakeholders to set-up or join a program. Researchers interviewed experts (including state and local sponsors, program administrators, capital providers and industry experts) on their lessons learned and arrived at the following key takeaways for state and local leaders: Enabling legislation: Carefully developed enabling legislation (which includes certain key provisions) and early stakeholder input can greatly improve the chances of program success. Options for program administrative structure: At least four program administrative structures are in use; certain administrative structures inherently result in more standardized product offerings and, potentially, economies of scale. Approaches to program and project capitalization: Two approaches to capitalization have been used. Bonding (project capital is raised through a bond sale) and direct funding (capital providers fund projects directly); programs can rely on one capital provider (a closed market) or allow multiple capital providers to participate (an open market). What and who qualifies for the program: Some programs require a minimum project savings-to-investment ratio; other programs encourage it or are indifferent. Estimating and documenting project energy cost saving: Estimating and documenting energy and cost savings can add costs to projects but also demonstrate C-PACE program value. Stakeholder engagement: Key stakeholder groups to engage include community leaders, local governments, building owners, contractors, utilities, capital providers and mortgage holders; stakeholder engagement should be tailored to each particular group. Start-up and ongoing costs: Understanding set-up and ongoing costs can help program sponsors plan for funding C-PACE programs and projects. The U.S. Department of Energy's Office of Weatherization and Intergovernmental Programs funded the report.« less

An independent assessment of the technical feasibility of the Mars One mission plan - Updated analysis

NASA Astrophysics Data System (ADS)

Do, Sydney; Owens, Andrew; Ho, Koki; Schreiner, Samuel; de Weck, Olivier

2016-03-01

In recent years, the Mars One program has gained significant publicity for its plans to colonize the red planet. Beginning in 2025, the program plans to land four people on Mars every 26 months via a series of one-way missions, using exclusively existing technology. This one-way approach has frequently been cited as a key enabler of accelerating the first crewed landing on Mars. While the Mars One program has received considerable attention, little has been published in the technical literature regarding the formulation of its mission architecture. In light of this, we perform an independent analysis of the technical feasibility of the Mars One mission plan, focusing on the architecture of the life support and in-situ resource utilization (ISRU) systems, and their impact on sparing and space logistics. To perform this analysis, we adopt an iterative analysis approach in which we model and simulate the mission architecture, assess its feasibility, implement any applicable modifications while attempting to remain within the constraints set forth by Mars One, and then resimulate and reanalyze the revised version of the mission architecture. Where required information regarding the Mars One mission architecture is not available, we assume numerical values derived from standard spaceflight design handbooks and documents. Through four iterations of this process, our analysis finds that the Mars One mission plan, as publicly described, is not feasible. This conclusion is obtained from analyses based on mission assumptions derived from and constrained by statements made by Mars One, and is the result of the following findings: (1) several technologies including ISRU, life support, and entry, descent, and landing (EDL) are not currently "existing, validated and available" as claimed by Mars One; (2) the crop growth area described by Mars One is insufficient to feed their crew; (3) increasing the crop growth area to provide sufficient food for the crew leads to atmospheric imbalances that requires a prohibitively large ISRU atmospheric processor or a notably different system architecture to manage; and (4) at least 13 Falcon Heavy launches are needed to deliver a portion of the required equipment to the Martian surface, a value that is at least double that planned by Mars One for the same mission phase. Most importantly, we find that the one-way nature of the Mars One mission, coupled with its plans to increase its crew population every 26 months, causes the operating costs of the program to grow continually over time. This is due to the fact that maintaining a growing colony on the Martian surface incurs increasing equipment and spare parts resupply requirements and hence launch costs over time. Based on published launch vehicle and lander estimates, our analysis finds that by the launch of the fifth crew, the cost associated with launching a portion of all required equipment and spares is approximately equal to half of the total NASA FY2015 budget - and this cost will grow when other critical systems outside the scope of this analysis are included. To mitigate these costs and bring the plan closer towards feasibility, we recommend a number of mission architecture modifications and technology development efforts be implemented before the initiation of any Mars settlement campaign. These include the further development of EDL, life support, and ISRU technologies, as well as additive manufacturing technology that utilizes ISRU-derived Martian feedstock as a potential means to address the growing cost of resupply.

Equalization for a page-oriented optical memory system

NASA Astrophysics Data System (ADS)

Trelewicz, Jennifer Q.; Capone, Jeffrey

1999-11-01

In this work, a method of decision-feedback equalization is developed for a digital holographic channel that experiences moderate-to-severe imaging errors. Decision feedback is utilized, not only where the channel is well-behaved, but also near the edges of the camera grid that are subject to a high degree of imaging error. In addition to these effects, the channel is worsened by typical problems of holographic channels, including non-uniform illumination, dropouts, and stuck bits. The approach described in this paper builds on established methods for performing trained and blind equalization on time-varying channels. The approach is tested on experimental data sets. On most of these data sets, the method of equalization described in this work delivers at least an order of magnitude improvement in bit-error rate (BER) before error-correction coding (ECC). When ECC is introduced, the approach is able to recover stored data with no errors for many of the tested data sets. Furthermore, a low BER was maintained even over a range of small alignment perturbations in the system. It is believed that this equalization method can allow cost reductions to be made in page-memory systems, by allowing for a larger image area per page or less complex imaging components, without sacrificing the low BER required by data storage applications.

Multiscale connectivity and graph theory highlight critical areas for conservation under climate change.

PubMed

Dilt, Thomas E; Weisberg, Peter J; Leitner, Philip; Matocq, Marjorie D; Inman, Richard D; Nussear, Kenneth E; Esque, Todd C

2016-06-01

Conservation planning and biodiversity management require information on landscape connectivity across a range of spatial scales from individual home ranges to large regions. Reduction in landscape connectivity due changes in land use or development is expected to act synergistically with alterations to habitat mosaic configuration arising from climate change. We illustrate a multiscale connectivity framework to aid habitat conservation prioritization in the context of changing land use and climate. Our approach, which builds upon the strengths of multiple landscape connectivity methods, including graph theory, circuit theory, and least-cost path analysis, is here applied to the conservation planning requirements of the Mohave ground squirrel. The distribution of this threatened Californian species, as for numerous other desert species, overlaps with the proposed placement of several utility-scale renewable energy developments in the American southwest. Our approach uses information derived at three spatial scales to forecast potential changes in habitat connectivity under various scenarios of energy development and climate change. By disentangling the potential effects of habitat loss and fragmentation across multiple scales, we identify priority conservation areas for both core habitat and critical corridor or stepping stone habitats. This approach is a first step toward applying graph theory to analyze habitat connectivity for species with continuously distributed habitat and should be applicable across a broad range of taxa.

Substantial sick-leave costs savings due to a graded activity intervention for workers with non-specific sub-acute low back pain.

PubMed

Hlobil, Hynek; Uegaki, Kimi; Staal, J Bart; de Bruyne, Martine C; Smid, Tjabe; van Mechelen, Willem

2007-07-01

The objective of this study is to compare the costs and benefits of a graded activity (GA) intervention to usual care (UC) for sick-listed workers with non-specific low back pain (LBP). The study is a single-blind, randomized controlled trial with 3-year follow-up. A total of 134 (126 men and 8 women) predominantly blue-collar workers, sick-listed due to LBP were recruited and randomly assigned to either GA (N = 67; mean age 39 +/- 9 years) or to UC (N = 67; mean age 37 +/- 8 years). The main outcome measures were the costs of health care utilization during the first follow-up year and the costs of productivity loss during the second and the third follow-up year. At the end of the first follow-up year an average investment for the GA intervention of 475 euros per worker, only 83 euros more than health care utilization costs in UC group, yielded an average savings of at least 999 euros (95% CI: -1,073; 3,115) due to a reduction in productivity loss. The potential cumulative savings were an average of 1,661 euros (95% CI: -4,154; 6,913) per worker over a 3-year follow-up period. It may be concluded that the GA intervention for non-specific LBP is a cost-beneficial return-to-work intervention.

Cost-effectiveness of nivolumab for recurrent or metastatic head and neck cancer☆.

PubMed

Ward, Matthew C; Shah, Chirag; Adelstein, David J; Geiger, Jessica L; Miller, Jacob A; Koyfman, Shlomo A; Singer, Mendel E

2017-11-01

Nivolumab is the first drug to demonstrate a survival benefit for platinum-refractory recurrent or metastatic head and neck cancer. We performed a cost-utility analysis to assess the economic value of nivolumab as compared to alternative standard agents in this context. Using data from the CheckMate 141 trial, we constructed a Markov simulation model from the US payer's perspective to evaluate the cost-effectiveness of nivolumab compared to physician choice of either cetuximab, methotrexate or docetaxel. Alternative strategies considered included: single-agent cetuximab, methotrexate or docetaxel, or first testing for PD-L1 to select for nivolumab. Costs were extracted from Medicare and utilities from the literature and CheckMate. Probabilistic sensitivity analysis (PSA) was used to evaluate parameter uncertainty. $100,000/QALY was the primary threshold for cost-effectiveness. When comparing nivolumab to the standard arm of CheckMate, nivolumab demonstrated an incremental cost-effectiveness ratio (ICER) of $140,672/QALY. When comparing standard therapies, methotrexate was the most cost-effective with similar results for docetaxel. Nivolumab was cost-effective compared to single-agent cetuximab (ICER $89,786/QALY). Treatment selection by PD-L1 immunohistochemistry did not markedly improve the cost-effectiveness of nivolumab. Factors likely to positively impact the cost-effectiveness of nivolumab include better baseline quality-of-life, poor tolerability of standard treatments and/or a lower cost of nivolumab. Nivolumab is preferred to single-agent cetuximab but requires a willingness-to-pay of at least $150,000/QALY to be considered cost-effective when compared to docetaxel or methotrexate. Selection by PD-L1 does not markedly improve the cost-effectiveness of nivolumab. This informs patient selection and clinical care-path development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Real-world resource use and costs of haemophilia A-related bleeding.

PubMed

Shrestha, A; Eldar-Lissai, A; Hou, N; Lakdawalla, D N; Batt, K

2017-07-01

Prophylaxis treatment is recommended for haemophilia patients, but associated real-world economic costs and potential cost-savings associated with improved disease management are not fully known. This study aimed to assess haemophilia A-related resource use and cost by treatment type (prophylaxis versus non-prophylaxis) and any associated cost-savings. Truven MarketScan Commercial claims data (2004-2012) were used to identify haemophilia A-related healthcare utilization, healthcare costs and patterns of prophylaxis and non-prophylaxis treatment among 6- to 64-year-old males. We estimated bleeding-related resource utilization and costs in three age groups (6-18, 19-44, 45-64) by treatment types and assessed the extent to which early initiation of prophylactic treatment can mitigate them. T-tests and ordinary least squares regressions were used to compare unadjusted and demographics-adjusted cost estimates. Among children, overall haemophilia- and bleeding-related non-pharmacy costs were substantially lower for patients receiving prophylaxis (haemophilia-related: $15,864 vs. $53,408; P < 0.001; bleeding-related: $696 vs. $2013, respectively; P = 0.04). Among younger adults (19-44), haemophilia-related non-pharmacy costs were lower for patients receiving prophylaxis ($22,028 vs. $56,311, respectively; P = 0.001). Among children, these savings fully offset the incremental pharmacy cost due to prophylaxis. Among younger adults, the savings offset approximately 34% of the incremental pharmacy cost. No differences were found for older adults (45-64). These results suggest that initiating prophylaxis earlier in life may reduce the healthcare costs of bleeding events and their long-term complications. Future studies should strive to collect more detailed information on disease severity and treatment protocols to improve estimates of disease burden. © 2017 John Wiley & Sons Ltd.

"Factors associated with non-small cell lung cancer treatment costs in a Brazilian public hospital".

PubMed

de Barros Reis, Carla; Knust, Renata Erthal; de Aguiar Pereira, Claudia Cristina; Portela, Margareth Crisóstomo

2018-02-17

The present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time. Estimates were obtained from the survey of direct medical cost per patient from the hospital's perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution. The average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient's survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R 2 of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%. Inequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population's hurdles to accessing cancer care services.

Cost comparisons for the use of nonterrestrial materials in space manufacturing of large structures

NASA Technical Reports Server (NTRS)

Bock, E. H.; Risley, R. C.

1979-01-01

This paper presents results of a study sponsored by NASA to evaluate the relative merits of constructing solar power satellites (SPS) using resources obtained from the earth and from the moon. Three representative lunar resources utilization (LRU) concepts are developed and compared with a previously defined earth baseline concept. Economic assessment of the alternatives includes cost determination, economic threshold sensitivity to manufacturing cost variations, cost uncertainties, program funding schedule, and present value of costs. Results indicate that LRU for space construction is competitive with the earth baseline approach for a program requiring 100,000 metric tons per year of completed satellites. LRU can reduce earth-launched cargo requirements to less than 10% of that needed to build satellites exclusively from earth materials. LRU is potentially more cost-effective than earth-derived material utilization, due to significant reductions in both transportation and manufacturing costs. Because of uncertainties, cost-effectiveness cannot be ascertained with great confidence. The probability of LRU attaining a lower total program cost within the 30-year program appears to range from 57 to 93%.

Defining the value of magnetic resonance imaging in prostate brachytherapy using time-driven activity-based costing.

PubMed

Thaker, Nikhil G; Orio, Peter F; Potters, Louis

Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process. Future initiatives will be required to follow the costs of care over longer periods of time to determine if improvements in outcomes and toxicities with an MRI-based approach lead to lower resource utilization and spending over the long-term. Understanding provider costs will become important as healthcare reform transitions to value-based purchasing and other alternative payment models. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

The social costs of dangerous products: an empirical investigation.

PubMed

Shapiro, Sidney; Ruttenberg, Ruth; Leigh, Paul

2009-01-01

Defective consumer products impose significant costs on consumers and third parties when they cause fatalities and injuries. This Article develops a novel approach to measuring the true extent of such costs, which may not be accurately captured under current methods of estimating the cost of dangerous products. Current analysis rests on a narrowly defined set of costs, excluding certain types of costs. The cost-of-injury estimates utilized in this Article address this omission by quantifying and incorporating these costs to provide a more complete picture of the true impact of defective consumer products. The new estimates help to gauge the true value of the civil liability system.

Coal Utilization in Schools: Issues and Answers.

ERIC Educational Resources Information Center

Pusey, Robert H.

Coal, at one-third the cost of natural gas and one-fifth the cost of oil, is our cheapest source of energy and is also in abundant supply. Because of significant technological advances, coal-fired equipment now approaches the clean and automatic operational characteristics of gas- and oil-fired boilers. For these reasons, and because schools are…

Costs and Trends in Utilization of Low-value Services Among Older Adults With Commercial Insurance or Medicare Advantage.

PubMed

Carter, Elizabeth A; Morin, Pamela E; Lind, Keith D

2017-11-01

Overutilization of low-value services (unnecessary or minimally beneficial tests or procedures) has been cited as a large contributor to the high costs of health care in the United States. To analyze trends in utilization of low-value services from 2009 to 2014 among commercial and Medicare Advantage (MA) enrollees 50 and older. A retrospective analysis of deidentified claims obtained from the OptumLab Data Warehouse. Adults 50 and older enrolled in commercial plans and adults 65 and older enrolled in MA plans between 2009 and 2014. Costs and utilization of 16 low-value services in the following categories: cancer screening, imaging, and invasive procedures. The most commonly performed low-value service was imaging of the head for syncope, at rates of 33%-39% in commercial enrollees and 45% in MA enrollees. The least common service was peripheral artery stenting (<1%) in commercial enrollees, and laminectomy (0.15% in 2009) and renal artery stenting in MA enrollees (0.07% in 2014). Renal artery stenting decreased by roughly 75% over the study period, the largest decrease in utilization, with ∼$30 million and $10 million in reduced spending for commercial and MA plans and enrollees, respectively. Spending on these services in 2014 totaled $317.6 million for commercial and $100.8 million for MA health plans. Clinicians, researchers, and policymakers should strive to reach consensus on methods for more reliably and accurately identifying low-value service utilization. Greater consistency would facilitate monitoring use of low-value services and changing clinical practice patterns over time.

Model-assisted probability of detection of flaws in aluminum blocks using polynomial chaos expansions

NASA Astrophysics Data System (ADS)

Du, Xiaosong; Leifsson, Leifur; Grandin, Robert; Meeker, William; Roberts, Ronald; Song, Jiming

2018-04-01

Probability of detection (POD) is widely used for measuring reliability of nondestructive testing (NDT) systems. Typically, POD is determined experimentally, while it can be enhanced by utilizing physics-based computational models in combination with model-assisted POD (MAPOD) methods. With the development of advanced physics-based methods, such as ultrasonic NDT testing, the empirical information, needed for POD methods, can be reduced. However, performing accurate numerical simulations can be prohibitively time-consuming, especially as part of stochastic analysis. In this work, stochastic surrogate models for computational physics-based measurement simulations are developed for cost savings of MAPOD methods while simultaneously ensuring sufficient accuracy. The stochastic surrogate is used to propagate the random input variables through the physics-based simulation model to obtain the joint probability distribution of the output. The POD curves are then generated based on those results. Here, the stochastic surrogates are constructed using non-intrusive polynomial chaos (NIPC) expansions. In particular, the NIPC methods used are the quadrature, ordinary least-squares (OLS), and least-angle regression sparse (LARS) techniques. The proposed approach is demonstrated on the ultrasonic testing simulation of a flat bottom hole flaw in an aluminum block. The results show that the stochastic surrogates have at least two orders of magnitude faster convergence on the statistics than direct Monte Carlo sampling (MCS). Moreover, the evaluation of the stochastic surrogate models is over three orders of magnitude faster than the underlying simulation model for this case, which is the UTSim2 model.

Enhancing data utilization through adoption of cloud-based data architectures (Invited Paper 211869)

NASA Astrophysics Data System (ADS)

Kearns, E. J.

2017-12-01

A traditional approach to data distribution and utilization of open government data involves continuously moving those data from a central government location to each potential user, who would then utilize them on their local computer systems. An alternate approach would be to bring those users to the open government data, where users would also have access to computing and analytics capabilities that would support data utilization. NOAA's Big Data Project is exploring such an alternate approach through an experimental collaboration with Amazon Web Services, Google Cloud Platform, IBM, Microsoft Azure, and the Open Commons Consortium. As part of this ongoing experiment, NOAA is providing open data of interest which are freely hosted by the Big Data Project Collaborators, who provide a variety of cloud-based services and capabilities to enable utilization by data users. By the terms of the agreement, the Collaborators may charge for those value-added services and processing capacities to recover their costs to freely host the data and to generate profits if so desired. Initial results have shown sustained increases in data utilization from 2 to over 100 times previously-observed access patterns from traditional approaches. Significantly increased utilization speed as compared to the traditional approach has also been observed by NOAA data users who have volunteered their experiences on these cloud-based systems. The potential for implementing and sustaining the alternate cloud-based approach as part of a change in operational data utilization strategies will be discussed.

A hybrid air conditioner driven by a hybrid solar collector

NASA Astrophysics Data System (ADS)

Al-Alili, Ali

The objective of this thesis is to search for an efficient way of utilizing solar energy in air conditioning applications. The current solar Air Conditioners (A/C)s suffer from low Coefficient of Performance (COP) and performance degradation in hot and humid climates. By investigating the possible ways of utilizing solar energy in air conditioning applications, the bottlenecks in these approaches were identified. That resulted in proposing a novel system whose subsystem synergy led to a COP higher than unity. The proposed system was found to maintain indoor comfort at a higher COP compared to the most common solar A/Cs, especially under very hot and humid climate conditions. The novelty of the proposed A/C is to use a concentrating photovoltaic/thermal collector, which outputs thermal and electrical energy simultaneously, to drive a hybrid A/C. The performance of the hybrid A/C, which consists of a desiccant wheel, an enthalpy wheel, and a vapor compression cycle (VCC), was investigated experimentally. This work also explored the use of a new type of desiccant material, which can be regenerated with a low temperature heat source. The experimental results showed that the hybrid A/C is more effective than the standalone VCC in maintaining the indoor conditions within the comfort zone. Using the experimental data, the COP of the hybrid A/C driven by a hybrid solar collector was found to be at least double that of the current solar A/Cs. The innovative integration of its subsystems allows each subsystem to do what it can do best. That leads to lower energy consumption which helps reduce the peak electrical loads on electric utilities and reduces the consumer operating cost since less energy is purchased during the on peak periods and less solar collector area is needed. In order for the proposed A/C to become a real alternative to conventional systems, its performance and total cost were optimized using the experimentally validated model. The results showed that for an electricity price of 0.12 $/kW-hr, the hybrid solar A/C's cumulative total cost will be less than that of a standard VCC after 17.5 years of operation.

Alvimopan, a peripherally acting μ-opioid receptor antagonist, is associated with reduced costs after radical cystectomy: economic analysis of a phase 4 randomized, controlled trial.

PubMed

Kauf, Teresa L; Svatek, Robert S; Amiel, Gilad; Beard, Timothy L; Chang, Sam S; Fergany, Amr; Karnes, R Jeffrey; Koch, Michael; O'Hara, Jerome; Lee, Cheryl T; Sexton, Wade J; Slaton, Joel W; Steinberg, Gary D; Wilson, Shandra S; Techner, Lee; Martin, Carolyn; Moreno, Jessica; Kamat, Ashish M

2014-06-01

We evaluated the effect of alvimopan treatment vs placebo on health care utilization and costs related to gastrointestinal recovery in patients treated with radical cystectomy in a randomized, phase 4 clinical trial. Resource utilization data were prospectively collected and evaluated by cost consequence analysis. Hospital costs were estimated from 2012 Medicare reimbursement rates and medication wholesale acquisition costs. Differences in base case mean costs between the study cohorts for total postoperative ileus related costs (hospital days, study drug, nasogastric tubes, postoperative ileus related concomitant medication and postoperative ileus related readmissions) and total combined costs (postoperative ileus related, laboratory, electrocardiograms, nonpostoperative ileus related concomitant medication and nonpostoperative ileus related readmission) were evaluated by probabilistic sensitivity analysis using a bootstrap approach. Mean hospital stay was 2.63 days shorter for alvimopan than placebo (mean±SD 8.44±3.05 vs 11.07±8.23 days, p=0.005). Use of medications or interventions likely intended to diagnose or manage postoperative ileus was lower for alvimopan than for placebo, eg total parenteral nutrition 10% vs 25% (p=0.001). Postoperative ileus related health care costs were $2,340 lower for alvimopan and mean total combined costs were decreased by $2,640 per patient for alvimopan vs placebo. Analysis using a 10,000-iteration bootstrap approach showed that the mean difference in postoperative ileus related costs (p=0.04) but not total combined costs (p=0.068) was significantly lower for alvimopan than for placebo. In patients treated with radical cystectomy alvimopan decreased hospitalization cost by reducing the health care services associated with postoperative ileus and decreasing the hospital stay. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The potential cost savings of implementing an inter-utility NO{sub x} trading program

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

Siegel, S.; Kalagnanam, J.

1995-12-31

Technology based standards such as RACT, which require the installation of a Reasonably Available Control Technology on a boiler by boiler basis have been the dominant factor driving electric utility NO{sub x} compliance plans. In this paper, the authors examine the cost savings of implementing NO{sub x} trading, an alternative market based strategy for reducing the emissions of nitrogen oxides (NO{sub x}) to achieve NO{sub x} reduction goals set under Title IV of the 1990 Clean Air Act. In order to estimate the potential cost savings of inter-utility NO{sub x} trading, the authors have used a combinatorial optimization approach tomore » identify boiler retrofits and operating parameters which yield efficient (i.e., the most cost effective) NO{sub x} abatement. In the formulation, annual emissions at individual boilers which are expensive to abate may exceed RACT levels by up to a factor of two thus allowing for trades with boilers which can abate in a more cost effective manner. The authors constrain total emissions in a trading region to be at or below the level obtained had all the boilers adopted RACT. Increasing the flexibility with which trades can occur has two main effects: (1) the cost effectiveness of meeting an aggregate reduction goal increases and (2) the spatial distribution of emissions shift relative to what it would have been under a strict RACT based compliance strategy. The authors estimate the magnitude of these effects for two Eastern electric utilities making intra and inter-utility NO{sub x} trades. Results indicate that the cost effectiveness of meeting RACT level reduction can be increased by as much as 38% under certain trading regimes.« less

The potential cost savings of implementing an inter-utility NO{sub x} trading program

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

Siegel, S.; Kalagnanam, J.

1995-10-01

Technology based standards such as RACT, which require the installation of a (R)easonably (A)vailable (C)ontrol (T)echnology on a boiler by boiler basis have been the dominant factor driving electric utility NO{sub x} compliance plans. In this paper, the authors examine the cost savings of implementing NO{sub x} trading, an alternative market based strategy for reducing the emissions of nitrogen oxides (NO{sub x}) to achieve NO{sub x} reduction goals set under Title IV of the 1990 Clean Air Act. In order to estimate the potential cost savings of inter-utility NO{sub x} trading, they use a combinatorial optimization approach to identify boilermore » retrofits and operating parameters which yield efficient (i.e., the most cost effective) NO{sub x} abatement strategies. In their formulation, annual emissions at individual boilers which are expensive to abate may exceed RACT levels by up to a factor of two thus allowing for trades with boilers which can abate in a more cost effective manner. They constrain total emissions in a trading region to be at or below the level obtained had all the boilers adopted RACT. Increasing the flexibility with which trades can occur has two main effects: (1) the cost effectiveness of meeting an aggregate reduction goal increases and (2) the spatial distribution of emissions shift relative to what it would have been under a strict RACT based compliance strategy. They estimate the magnitude of these effects for two Eastern electric utilities making intra- and inter-utility NO{sub x} trades. Results indicate that the cost effectiveness of meeting RACT level reduction can be increased by as much as 38% under certain trading regimes.« less

Utility-Scale Solar 2016: An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

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

Bolinger, Mark; Seel, Joachim; LaCommare, Kristina Hamachi

The utility-scale solar sector has led the overall U.S. solar market in terms of installed capacity since 2012. In 2016, the utility-scale sector installed more than 2.5 times as much new capacity as did the residential and commercial sectors combined, and is expected to maintain its dominant position for at least another five years. This report—the fifth edition in an ongoing annual series—provides data-driven analysis of the utility-scale solar project fleet in the United States. We analyze not just installed project prices, but also operating costs, capacity factors, and power purchase agreement ("PPA") prices from a large sample of utility-scalemore » PV and CSP projects throughout the United States. Highlights from this year's edition include the following: Installation Trends: The use of solar tracking devices dominated 2016 installations, at nearly 80% of all new capacity. In a reflection of the ongoing geographic expansion of the market beyond California and the Southwest, the median long-term average insolation level at newly built project sites declined again in 2016. While new fixed-tilt projects are now seen predominantly in less-sunny regions, tracking projects are increasingly pushing into these same regions. The median inverter loading ratio has stabilized in 2016 at 1.3 for both tracking and fixed-tilt projects. Installed Prices: Median installed PV project prices within a sizable sample have fallen by two-thirds since the 2007-2009 period, to $2.2/WAC (or $1.7/WDC) for projects completed in 2016. The lowest 20th percentile of projects within our 2016 sample were priced at or below $2.0/WAC, with the lowest-priced projects around $1.5/WAC. Overall price dispersion across the entire sample and across geographic regions decreased significantly in 2016. Operation and Maintenance (“O&M”) Costs: What limited empirical O&M cost data are publicly available suggest that PV O&M costs were in the neighborhood of $18/kWAC-year, or $8/MWh, in 2016. These numbers include only those costs incurred to directly operate and maintain the generating plant. Capacity Factors: The cumulative net AC capacity factors of individual PV projects range widely, from 15.4% to 35.5%, with a sample median of 26.3%. This project-level variation is based on a number of factors, including the strength of the solar resource at the project site, whether the array is mounted at a fixed-tilt or on a tracking mechanism, the inverter loading ratio, degradation, and curtailment. Changes in at least the first three of these factors drove mean capacity factors higher from 2010- to 2013-vintage projects, where they’ve remained fairly steady among both 2014- and 2015-vintage projects as an ongoing increase in the prevalence of tracking has been offset by a build-out of lower resource sites. Meanwhile, several of the newer CSP projects in the United States are struggling to match long-term performance expectations. PPA Prices: Driven by lower installed project prices and improving capacity factors, levelized PPA prices for utility-scale PV have fallen dramatically over time. Most recent PPAs in our sample are priced at or below $50/MWh levelized, with a few priced as aggressively as ~$30/MWh. Though impressive in pace and scale, these falling PPA prices have been offset to some degree by declining wholesale market value within high penetration markets like California, where in 2016 a MWh of solar generation was worth just 83% of a MWh of flat, round-the-clock generation. At the end of 2016, there were at least 121.4 GW of utility-scale solar power capacity within the interconnection queues across the nation. The growth within these queues is widely distributed across all regions of the country: California and the Southeast each account for 23% of the 83.3 GW of solar that first entered the queues in 2016, followed by the Northeast (17%), the Southwest (16%), the Central region (12%), Texas (6%) and the Northwest (3%). The widening geographic distribution of solar projects is a clear sign that the utility-scale market is maturing and expanding outside of its traditional high-insolation comfort zones.« less

Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study.

PubMed

Clarke, A E; Zowall, H; Levinton, C; Assimakopoulos, H; Sibley, J T; Haga, M; Shiroky, J; Neville, C; Lubeck, D P; Grover, S A; Esdaile, J M

1997-06-01

To perform the first prospective longitudinal study of direct (health services utilized) and indirect costs (diminished productivity represented by income loss) incurred by patients with rheumatoid arthritis (RA) in Saskatoon and Montreal, followed for up to 12 and 4 years, respectively. 1063 patients reported on health status, health services utilization, and diminished productivity every 6 months. Annual direct costs were $3788 (1994 Canadian dollars) in the late 1980s and $4656 in the early 1990s. Given that the average age exceeded 60 years, few participated in labor force activities or considered themselves disabled from the labor force and their indirect costs were substantially less, $2165 in the late 1980s and $1597 in the early 1990s. Institutional stays and medications made up at least 80% of total direct costs. Lengths of stay in acute care facilities remained constant, but the rate of hospitalization increased in the early 1990s, increasing average hospital costs per patient from $1563 in the late 1980s to $2023 in the early 1990s. For nonacute care facilities, rate of admission as well as length of stay increased over time, increasing costs per patient in Saskatoon 5-fold, from $291 to $1605. Those with greater functional disability incurred substantially higher direct and those under 65 years incurred higher indirect costs. Direct costs are higher than indirect costs. The major component is due to institutional stays that, in contrast to other direct cost components, is increased in the older and more disabled. Measures to reduce longterm disability by earlier, more aggressive intervention have the potential to produce considerable cost savings. However, it is unknown which strategies will have the greatest effect on outcome and accordingly, how resources can be optimally allocated.

Predicting Success in ISCS Level II.

ERIC Educational Resources Information Center

McDuffie, Thomas E., Jr.

1979-01-01

Investigates a method to predict best and least suited students for the ISCS instructional approach. Aptitude-treatment interactions associated with ISCS instruction and a set of aptitude, attitude, and skill factors were utilized to make and verify predictions on two dependent variables--achievement and success. (Author/GA)

Modelling the Cost Effectiveness of Disease-Modifying Treatments for Multiple Sclerosis

PubMed Central

Thompson, Joel P.; Abdolahi, Amir; Noyes, Katia

2013-01-01

Several cost-effectiveness models of disease-modifying treatments (DMTs) for multiple sclerosis (MS) have been developed for different populations and different countries. Vast differences in the approaches and discrepancies in the results give rise to heated discussions and limit the use of these models. Our main objective is to discuss the methodological challenges in modelling the cost effectiveness of treatments for MS. We conducted a review of published models to describe the approaches taken to date, to identify the key parameters that influence the cost effectiveness of DMTs, and to point out major areas of weakness and uncertainty. Thirty-six published models and analyses were identified. The greatest source of uncertainty is the absence of head-to-head randomized clinical trials. Modellers have used various techniques to compensate, including utilizing extension trials. The use of large observational cohorts in recent studies aids in identifying population-based, ‘real-world’ treatment effects. Major drivers of results include the time horizon modelled and DMT acquisition costs. Model endpoints must target either policy makers (using cost-utility analysis) or clinicians (conducting cost-effectiveness analyses). Lastly, the cost effectiveness of DMTs outside North America and Europe is currently unknown, with the lack of country-specific data as the major limiting factor. We suggest that limited data should not preclude analyses, as models may be built and updated in the future as data become available. Disclosure of modelling methods and assumptions could improve the transferability and applicability of models designed to reflect different healthcare systems. PMID:23640103

Discounting in cost-utility analysis of healthcare interventions: reassessing current practice.

PubMed

Cohen, Brian J

2003-01-01

Cost-utility analysis (CUA) is a technique that can potentially be used as a guide to allocating healthcare resources so as to obtain the maximum health benefits possible under a given budget constraint. However, it is not clear that current practice captures societal preferences regarding health benefits. In analyses of healthcare interventions providing survival benefits, the market rate of interest is the sole empirical variable that reflects societal preferences. This approach is based on the assumptions that: (i) healthcare interventions should be ranked using cost-effectiveness (CE) ratios; (ii) the discount rate for costs in CUA should be equal to that used in cost-benefit analysis (CBA); (iii) the discount rate in CBA should be the market rate of interest on long-term government bonds; and (iv) the Keeler-Cretin paradox is applicable to CUA of healthcare interventions, so that the discount rate for benefits in CUA should be set equal to the discount rate for costs. This approach ignores a fundamental difference between CBA and CUA, namely that CUA assumes that a budget constraint has been specified prior to the analysis. It starts with the assumption that a given amount of funds have been withdrawn from the economy to fund healthcare, so there is no opportunity cost to consider. For that reason, the principles on which the choice of discount rate rests differ in the two techniques. Furthermore, use of CE ratios to rank interventions assumes that the budget constraint can be expressed as a single constraint. But healthcare budgets are multiyear budgets that are roughly constant from year to year. A more realistic model would involve multiple constraints and would require linear programming for solution. This can be reduced to a series of single constraints, thereby allowing use of the simpler CE ratio approach, if we assume that the budget being allocated is intended for one cohort at a time, i.e. all people for whom a new funding decision must be made in a given year. In general, we assume that future cohorts will be allotted comparable funding. However, the Keeler-Cretin paradox depends on the assumption that cohorts are competing with each other for resources, and is therefore not applicable to CUA of healthcare. Other approaches are therefore needed to assign utilities to healthcare interventions providing survival benefits. Methods should be developed that allow analyses to reflect a range of philosophical approaches through sensitivity analysis.

Integrating top-down and bottom-up approaches to design a cost-effective and equitable programme of measures for adaptation of a river basin to global change

NASA Astrophysics Data System (ADS)

Girard, Corentin; Rinaudo, Jean-Daniel; Pulido-Velazquez, Manuel

2016-04-01

Adaptation to the multiple facets of global change challenges the conventional means of sustainably planning and managing water resources at the river basin scale. Numerous demand or supply management options are available, from which adaptation measures need to be selected in a context of high uncertainty of future conditions. Given the interdependency of water users, agreements need to be found at the local level to implement the most effective adaptation measures. Therefore, this work develops an approach combining economics and water resources engineering to select a cost-effective programme of adaptation measures in the context of climate change uncertainty, and to define an equitable allocation of the cost of the adaptation plan between the stakeholders involved. A framework is developed to integrate inputs from the two main approaches commonly used to plan for adaptation. The first, referred to as "top-down", consists of a modelling chain going from global greenhouse gases emission scenarios to local hydrological models used to assess the impact of climate change on water resources. Conversely, the second approach, called "bottom-up", starts from assessing vulnerability at the local level to then identify adaptation measures used to face an uncertain future. The methodological framework presented in this contribution relies on a combination of these two approaches to support the selection of adaptation measures at the local level. Outcomes from these two approaches are integrated to select a cost-effective combination of adaptation measures through a least-cost optimization model developed at the river basin scale. The performances of a programme of measures are assessed under different climate projections to identify cost-effective and least-regret adaptation measures. The issue of allocating the cost of the adaptation plan is considered through two complementary perspectives. The outcome of a negotiation process between the stakeholders is modelled through the implementation of cooperative game theory to define cost allocation scenarios. These results are compared with cost allocation rules based on social justice principles to provide contrasted insights into a negotiation process. The interdisciplinary framework developed in this research combines economics and water resources engineering methods, establishing a promising means of bridging the gap between bottom-up and top-down approaches and supporting the creation of cost-effective and equitable adaptation plans at the local level. The approach has been applied to the Orb river basin in Southern France. Acknowledgements The study has been partially supported by the IMPADAPT project /CGL2013-48424-C2-1-R) from the Spanish ministry MINECO (Ministerio de Economía y Competitividad) and European FEDER funds. Corentin Girard is supported by a grant from the University Lecturer Training Program (FPU12/03803) of the Ministry of Education, Culture and Sports of Spain.

Persistence and healthcare utilization associated with the use of buprenorphine/naloxone film and tablet formulation therapy in adults with opioid dependence.

PubMed

Clay, Emilie; Khemiri, Amine; Zah, Vladimir; Aballéa, Samuel; Ruby, Jane; Asche, Carl V

2014-09-01

Buprenorphine/naloxone film was developed to improve retention in treatment and reduce public health risks over the tablet formulation for opioid dependence. To compare patient persistence and resource utilization between formulations for the treatment of opioid dependence. A longitudinal, retrospective cohort analysis was conducted to compare persistence and healthcare costs in a private US insurance claims database. Previously untreated patients, who initiated treatment with buprenorphine/naloxone following the introduction of the film, were classified in two groups according to the initial prescription. Persistence was defined as the proportion of patients continuing treatment for at least 6 months. Resource utilization and related costs were calculated over the 6- and 12-month periods after treatment initiation. Film and tablet groups included 2796 and 1510 patients enrolled over 9.76 and 13.76 months on average, respectively, from initiation of treatment. Patient characteristics were similar between groups. Mean prescribed doses were 14.62 and 14.26 mg/day in film and tablet groups. Among patients enrolled for at least 6 months from the initial treatment, persistence rates were 63.78% with film vs 58.13% with tablet. Time to treatment discontinuation was longer in the film group, with a hazard ratio of 0.818 (p = 0.0005, 95% CI = [0.730;0.916]) adjusted for baseline characteristics. Patients treated with film had significantly more outpatient visits (+4%, p = 0.0185) and lower probability to be hospitalized (-17%, p = 0.0158), resulting in lower total healthcare costs over the 12-month period after initiation (-27%, p < 0.0001). Patients treated with the film formulation of buprenorphine/naloxone appeared to stay longer on treatment, have a lower probability of hospital admission, and lower health care costs compared to patients treated with the tablet. This study, based on insurance claims data, has the advantage of reflecting real-world practice, but one cannot rule out the existence of bias due to differences in patient or prescriber profiles, despite adjustments made for observed characteristics at treatment initiation.

Active Redesign of a Medicaid Care Management Strategy for Greater Return on Investment: Predicting Impactability.

PubMed

DuBard, C Annette; Jackson, Carlos T

2018-04-01

Care management of high-cost/high-needs patients is an increasingly common strategy to reduce health care costs. A variety of targeting methodologies have emerged to identify patients with high historical or predicted health care utilization, but the more pertinent question for program planners is how to identify those who are most likely to benefit from care management intervention. This paper describes the evolution of complex care management targeting strategies in Community Care of North Carolina's (CCNC) work with the statewide non-dual Medicaid population, culminating in the development of an "Impactability Score" that uses administrative data to predict achievable savings. It describes CCNC's pragmatic approach for estimating intervention effects in a historical cohort of 23,455 individuals, using a control population of 14,839 to determine expected spending at an individual level, against which actual spending could be compared. The actual-to-expected spending difference was then used as the dependent variable in a multivariate model to determine the predictive contribution of a multitude of demographic, clinical, and utilization characteristics. The coefficients from this model yielded the information required to build predictive models for prospective use. Model variables related to medication adherence and historical utilization unexplained by disease burden proved to be more important predictors of impactability than any given diagnosis or event, disease profile, or overall costs of care. Comparison of this approach to alternative targeting strategies (emergency department super-utilizers, inpatient super-utilizers, or patients with highest Hierarchical Condition Category risk scores) suggests a 2- to 3-fold higher return on investment using impactability-based targeting.

Electrical utilities model for determining electrical distribution capacity

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

Fritz, R. L.

1997-09-03

In its simplest form, this model was to obtain meaningful data on the current state of the Site`s electrical transmission and distribution assets, and turn this vast collection of data into useful information. The resulting product is an Electrical Utilities Model for Determining Electrical Distribution Capacity which provides: current state of the electrical transmission and distribution systems; critical Hanford Site needs based on outyear planning documents; decision factor model. This model will enable Electrical Utilities management to improve forecasting requirements for service levels, budget, schedule, scope, and staffing, and recommend the best path forward to satisfy customer demands at themore » minimum risk and least cost to the government. A dynamic document, the model will be updated annually to reflect changes in Hanford Site activities.« less

Aircraft Airframe Cost Estimation Using a Random Coefficients Model

DTIC Science & Technology

1979-12-01

approach will also be used here. 2 Model Formulation Several different types of equations could be used for the basic form of the CER, such as linear ...5) Marcotte developed several CER’s for fighter aircraft airframes using the log- linear model . A plot of the residuals from the CER for recurring...of the natural logarithm. Ordinary Least Squares The ordinary least squares procedure starts with the equation for the general linear model . The

Cost effectiveness of a pragmatic exercise intervention (EXIMS) for people with multiple sclerosis: economic evaluation of a randomised controlled trial.

PubMed

Tosh, J; Dixon, S; Carter, A; Daley, A; Petty, J; Roalfe, A; Sharrack, B; Saxton, J M

2014-07-01

Exercise is a safe, non-pharmacological adjunctive treatment for people with multiple sclerosis but cost-effective approaches to implementing exercise within health care settings are needed. The objective of this paper is to assess the cost effectiveness of a pragmatic exercise intervention in conjunction with usual care compared to usual care only in people with mild to moderate multiple sclerosis. A cost-utility analysis of a pragmatic randomised controlled trial over nine months of follow-up was conducted. A total of 120 people with multiple sclerosis were randomised (1:1) to the intervention or usual care. Exercising participants received 18 supervised and 18 home exercise sessions over 12 weeks. The primary outcome for the cost utility analysis was the incremental cost per quality-adjusted life year (QALY) gained, calculated using utilities measured by the EQ-5D questionnaire. The incremental cost per QALY of the intervention was £10,137 per QALY gained compared to usual care. The probability of being cost effective at a £20,000 per QALY threshold was 0.75, rising to 0.78 at a £30,000 per QALY threshold. The pragmatic exercise intervention is highly likely to be cost effective at current established thresholds, and there is scope for it to be tailored to particular sub-groups of patients or services to reduce its cost impact. © The Author(s) 2013.

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

Dwyer, Morgan Maeve

This report summarizes the results of doctoral research that explored the cost impact of acquiring complex government systems jointly. The report begins by reviewing recent evidence that suggests that joint programs experience greater cost growth than non-joint programs. It continues by proposing an alternative approach for studying cost growth on government acquisition programs and demonstrates the utility of this approach by applying it to study the cost of jointness on three past programs that developed environmental monitoring systems for low-Earth orbit. Ultimately, the report concludes that joint programs' costs grow when the collaborating government agencies take action to retain ormore » regain their autonomy. The report provides detailed qualitative and quantitative data in support of this conclusion and generalizes its findings to other joint programs that were not explicitly studied here. Finally, it concludes by presenting a quantitative model that assesses the cost impacts of jointness and by demonstrating how government agencies can more effectively architect joint programs in the future.« less

Umbilical hernias: the cost of waiting.

PubMed

Strosberg, David S; Pittman, Matthew; Mikami, Dean

2017-02-01

Umbilical hernias are well described in the literature, but its impact on health care is less understood. The purpose of this study was to investigate the effect of non-operative management of umbilical hernias on cost, work absenteeism, and resource utilization. The Truven Health Database, consisting of 279 employers and over 3000 hospitals, was reviewed for all umbilical hernia patients, aged 18-64 who were enrolled in health plans for 12 months prior to surgery and 12 months after surgery. Patients were excluded if they had a recurrence or had been offered a "no surgery" approach within 1 year of the index date. The remaining patients were separated into surgery (open or laparoscopic repair) or no surgery (NS). Post-cost analysis at 90 and 365 days and estimated days off from work were reviewed for each group. The non-surgery cohort had a higher proportion of females and comorbidity index. Adjusted analysis showed significantly higher 90 and 365 costs for the surgery group (p < 0.0001), though the cost difference did decrease over time. NS group had significantly higher estimated days of health-care utilization at both the 90 (1.99 vs. 3.58 p < 0.0001) and 365 (8.69 vs. 11.04 p < 0.0001) day post-index mark. A subgroup analysis demonstrated laparoscopic repair had higher costs compared to open primarily due to higher index procedure costs (p < 0.05). Though the financial costs were found to be higher in the surgery group, the majority of these were due to the surgery itself. Significantly higher days of health-care utilization and estimated days off work were experienced in the NS group. It is our belief that early operative intervention will lead to decreased costs and resource utilization.

Exploring the relationship between planning and procurement in Western U.S. electric utilities

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

Carvallo Bodelon, Juan Pablo; Sanstad, Alan H.; Larsen, Peter H.

Integrated resource planning (IRP) is an important regulatory process used in many U.S. states to formulate and evaluate least-cost and risk-assessed portfolios to meet future load requirements for electric utilities. In principle, effective implementation of IRP seeks to assure regulators and the public that utility investment decisions, given uncertainty, are as cost-effective as possible. However, to date, there is no empirical assessment on the effectiveness of IRP implementation. In this analysis, we compare planning, procurement processes and actual decisions for a sample of twelve load serving entities (LSEs) across the Western U. S. from 2003-2014. The 2008/2009 recession provides amore » unique “stress test” to the planning process and offers an excellent opportunity to trace how procurement decisions responded to this largely unforeseen event. In aggregate, there is a general alignment between planned and procured supply-side capacity. However, there are significant differences in the choice of supply-side resources and type of ownership for individual LSEs. We develop case studies for three LSEs and find that subsequent plans differ significantly due to changes in the planning environment and that procurement decisions in some cases are impacted by factors that are not accounted for in the planning process. Our results reveal that a limited amount of information produced during the long-term planning process (e.g., forecasts, methods, and least cost/risk portfolios) are ultimately used during the procurement process, and that the latter process relies extensively on the most recent information available for decision making. These findings suggest that states' IRP rules and regulations mandating long-term planning horizons with the same analytical complexity throughout the planning period may not create useful information for the procurement process. The social value of a long-term planning process that departs from procurement and the balance between transparency and complexity of the planning and procurement processes is an open question.« less

Spacelab Level 4 programmatic Implementation Assessment Study. Volume 3: Optimization and programmatics

NASA Technical Reports Server (NTRS)

1978-01-01

Alternate level 4 integration approaches were synthesized and evaluated to establish the most cost effective experiment integration approach. Program baseline system trade studies are described, as well as Spacelab equipment utilization. Programmatic analysis of the baseline program was evaluated; the 2/3 and 1/3 traffic models were also considered.

PET-CMR in heart failure - synergistic or redundant imaging?

PubMed

Quail, Michael A; Sinusas, Albert J

2017-07-01

Imaging in heart failure (HF) provides data for diagnosis, prognosis and disease monitoring. Both MRI and nuclear imaging techniques have been successfully used for this purpose in HF. Positron Emission Tomography-Cardiac Magnetic Resonance (PET-CMR) is an example of a new multimodality diagnostic imaging technique with potential applications in HF. The threshold for adopting a new diagnostic tool to clinical practice must necessarily be high, lest they exacerbate costs without improving care. New modalities must demonstrate clinical superiority, or at least equivalence, combined with another important advantage, such as lower cost or improved patient safety. The purpose of this review is to outline the current status of multimodality PET-CMR with regard to HF applications, and determine whether the clinical utility of this new technology justifies the cost.

Toward a Responsibility-Catering Prioritarian Ethical Theory of Risk.

PubMed

Wikman-Svahn, Per; Lindblom, Lars

2018-03-05

Standard tools used in societal risk management such as probabilistic risk analysis or cost-benefit analysis typically define risks in terms of only probabilities and consequences and assume a utilitarian approach to ethics that aims to maximize expected utility. The philosopher Carl F. Cranor has argued against this view by devising a list of plausible aspects of the acceptability of risks that points towards a non-consequentialist ethical theory of societal risk management. This paper revisits Cranor's list to argue that the alternative ethical theory responsibility-catering prioritarianism can accommodate the aspects identified by Cranor and that the elements in the list can be used to inform the details of how to view risks within this theory. An approach towards operationalizing the theory is proposed based on a prioritarian social welfare function that operates on responsibility-adjusted utilities. A responsibility-catering prioritarian ethical approach towards managing risks is a promising alternative to standard tools such as cost-benefit analysis.

Medicare-approved drug discount cards and renal transplant patients: how much can these cards reduce prescription costs?

PubMed

Chisholm, Marie A; Marshall, Josh; Smith, Kimberly E; Garrett, Charlene J; Turner, Jeanie C

2005-06-01

Post-transplant prescription medications are expensive, often costing over 12,000 dollars annually. Many solid-organ transplant patients have Medicare coverage and patients enrolled in Medicare-approved drug discount card (MADDC) programs may be able to receive prescription medications at a reduced price. However, many transplant healthcare practitioners are unaware of the utility of MADDCs. The purpose of this study was to determine whether enrolling renal transplant patients (RTPs) into a MADDC produces significant savings in prescription costs. Two Medicare RTPs, with prescription medication profiles representative of an RTP within 3 months post-transplant and an RTP greater than 5 yr post-transplant, were randomly selected from the Medication Access Program's database. Cost benefit analyses were from the patients' perspective and were performed using the: (i) prescription cost from the Medicare website of MADDCs that listed the greatest and least prescription costs compared with the retail cash price of the same prescription without using the MADDCs; and (ii) MADDCs' annual enrollment fee. The potential cost difference of using MADDCs and not using MADDCs to purchase the prescription medications were calculated. RTPs' monthly out-of-pocket cost for prescription medications ranged from 162 dollars to 340 dollars, and MADDCs offered discounts of 20-37% from retail prices; thus outweighing the MADDC enrollment cost. MADDCs, when selected and used appropriately, can reduce prescription medication cost for RTPs. Card selection is of great importance as discount rates vary greatly among cards, and only under restricted circumstances is a patient allowed to switch to another card. It is imperative that practitioners are aware of these programs and utilize cost-effective prescribing practices.

Application of Boosting Regression Trees to Preliminary Cost Estimation in Building Construction Projects

PubMed Central

2015-01-01

Among the recent data mining techniques available, the boosting approach has attracted a great deal of attention because of its effective learning algorithm and strong boundaries in terms of its generalization performance. However, the boosting approach has yet to be used in regression problems within the construction domain, including cost estimations, but has been actively utilized in other domains. Therefore, a boosting regression tree (BRT) is applied to cost estimations at the early stage of a construction project to examine the applicability of the boosting approach to a regression problem within the construction domain. To evaluate the performance of the BRT model, its performance was compared with that of a neural network (NN) model, which has been proven to have a high performance in cost estimation domains. The BRT model has shown results similar to those of NN model using 234 actual cost datasets of a building construction project. In addition, the BRT model can provide additional information such as the importance plot and structure model, which can support estimators in comprehending the decision making process. Consequently, the boosting approach has potential applicability in preliminary cost estimations in a building construction project. PMID:26339227

Application of Boosting Regression Trees to Preliminary Cost Estimation in Building Construction Projects.

PubMed

Shin, Yoonseok

2015-01-01

Among the recent data mining techniques available, the boosting approach has attracted a great deal of attention because of its effective learning algorithm and strong boundaries in terms of its generalization performance. However, the boosting approach has yet to be used in regression problems within the construction domain, including cost estimations, but has been actively utilized in other domains. Therefore, a boosting regression tree (BRT) is applied to cost estimations at the early stage of a construction project to examine the applicability of the boosting approach to a regression problem within the construction domain. To evaluate the performance of the BRT model, its performance was compared with that of a neural network (NN) model, which has been proven to have a high performance in cost estimation domains. The BRT model has shown results similar to those of NN model using 234 actual cost datasets of a building construction project. In addition, the BRT model can provide additional information such as the importance plot and structure model, which can support estimators in comprehending the decision making process. Consequently, the boosting approach has potential applicability in preliminary cost estimations in a building construction project.

EPDM Based Double Slope Triangular Enclosure Solar Collector: A Novel Approach

PubMed Central

Qureshi, Shafiq R.; Khan, Waqar A.

2014-01-01

Solar heating is one of the important utilities of solar energy both in domestic and industrial sectors. Evacuated tube heaters are a commonly used technology for domestic water heating. However, increasing cost of copper and nickel has resulted in huge initial cost for these types of heaters. Utilizing solar energy more economically for domestic use requires new concept which has low initial and operating costs together with ease of maintainability. As domestic heating requires only nominal heating temperature to the range of 60–90°C, therefore replacing nickel coated copper pipes with any cheap alternate can drastically reduce the cost of solar heater. We have proposed a new concept which utilizes double slope triangular chamber with EPDM based synthetic rubber pipes. This has reduced the initial and operating costs substantially. A detailed analytical study was carried out to design a novel solar heater. On the basis of analytical design, a prototype was manufactured. Results obtained from the experiments were found to be in good agreement with the analytical study. A maximum error of 10% was recorded at noon. However, results show that error is less than 5% in early and late hours. PMID:24688407

EPDM based double slope triangular enclosure solar collector: a novel approach.

PubMed

Qureshi, Shafiq R; Khan, Waqar A; Sarwar, Waqas

2014-01-01

Solar heating is one of the important utilities of solar energy both in domestic and industrial sectors. Evacuated tube heaters are a commonly used technology for domestic water heating. However, increasing cost of copper and nickel has resulted in huge initial cost for these types of heaters. Utilizing solar energy more economically for domestic use requires new concept which has low initial and operating costs together with ease of maintainability. As domestic heating requires only nominal heating temperature to the range of 60-90 °C, therefore replacing nickel coated copper pipes with any cheap alternate can drastically reduce the cost of solar heater. We have proposed a new concept which utilizes double slope triangular chamber with EPDM based synthetic rubber pipes. This has reduced the initial and operating costs substantially. A detailed analytical study was carried out to design a novel solar heater. On the basis of analytical design, a prototype was manufactured. Results obtained from the experiments were found to be in good agreement with the analytical study. A maximum error of 10% was recorded at noon. However, results show that error is less than 5% in early and late hours.

Diabetes benefit management: evolving strategies for payers.

PubMed

Tzeel, Albert L

2011-11-01

Over the next quarter century, the burden of type 2 diabetes mellitus (T2DM) is expected to at least double. Currently, 1 in every 10 healthcare dollars is spent on diabetes management; by 2050, it has been projected that the annual costs of managing T2DM will rise to $336 billion. Without substantial, systemic changes, T2DM management costs will lead to a potentially untenable strain on the healthcare system. However, the appropriate management of diabetes can reduce associated mortality and delay comorbidities. In addition, adequate glycemic control can improve patient outcomes and significantly reduce diabetes-related complications. This article provides an overview of key concepts associated with a value-based insurance design (VBID) approach to T2DM coverage. By promoting the use of services or treatments that provide high benefits relative to cost, and by alternatively discouraging patients from utilizing services whose benefits do not justify their cost, VBID improves the quality of healthcare while simultaneously reining in spending. VBID initiatives tend to focus on chronic disease management and generally target prescription drug use. However, some programs have expanded their scope by incorporating services traditionally offered by wellness and disease management programs. The concept of VBID is growing, and it is increasingly being implemented by a diverse and growing number of public and private entities, including pharmacy benefit managers, health plans, and employers. This article provides key background on VBID strategies, with a focus on T2DM management. It also provides a road map for health plans seeking to implement VBID as part of their programs.

A Two-Layer Least Squares Support Vector Machine Approach to Credit Risk Assessment

NASA Astrophysics Data System (ADS)

Liu, Jingli; Li, Jianping; Xu, Weixuan; Shi, Yong

Least squares support vector machine (LS-SVM) is a revised version of support vector machine (SVM) and has been proved to be a useful tool for pattern recognition. LS-SVM had excellent generalization performance and low computational cost. In this paper, we propose a new method called two-layer least squares support vector machine which combines kernel principle component analysis (KPCA) and linear programming form of least square support vector machine. With this method sparseness and robustness is obtained while solving large dimensional and large scale database. A U.S. commercial credit card database is used to test the efficiency of our method and the result proved to be a satisfactory one.

Health State Utilities Associated with Glucose Monitoring Devices.

PubMed

Matza, Louis S; Stewart, Katie D; Davies, Evan W; Hellmund, Richard; Polonsky, William H; Kerr, David

2017-03-01

Glucose monitoring is important for patients with diabetes treated with insulin. Conventional glucose monitoring requires a blood sample, typically obtained by pricking the finger. A new sensor-based system called "flash glucose monitoring" monitors glucose levels with a sensor worn on the arm, without requiring blood samples. To estimate the utility difference between these two glucose monitoring approaches for use in cost-utility models. In time trade-off interviews, general population participants in the United Kingdom (London and Edinburgh) valued health states that were drafted and refined on the basis of literature, clinician input, and a pilot study. The health states had identical descriptions of diabetes and insulin treatment, differing only in glucose monitoring approach. A total of 209 participants completed the interviews (51.7% women; mean age = 42.1 years). Mean utilities were 0.851 ± 0.140 for conventional monitoring and 0.882 ± 0.121 for flash monitoring (significant difference between the mean utilities; t = 8.3; P < 0.0001). Of the 209 participants, 78 (37.3%) had a higher utility for flash monitoring, 2 (1.0%) had a higher utility for conventional monitoring, and 129 (61.7%) had the same utility for both health states. The flash glucose monitoring system was associated with a significantly greater utility than the conventional monitoring system. This difference may be useful in cost-utility models comparing the value of glucose monitoring devices for patients with diabetes. This study adds to the literature on treatment process utilities, suggesting that time trade-off methods may be used to quantify preferences among medical devices. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A Survey of Cost Estimating Methodologies for Distributed Spacecraft Missions

NASA Technical Reports Server (NTRS)

Foreman, Veronica L.; Le Moigne, Jacqueline; de Weck, Oliver L.

2016-01-01

Satellite constellations and Distributed Spacecraft Mission (DSM) architectures offer unique benefits to Earth observation scientists and unique challenges to cost estimators. The Cost and Risk (CR) module of the Tradespace Analysis Tool for Constellations (TAT-C) being developed by NASA Goddard seeks to address some of these challenges by providing a new approach to cost modeling, which aggregates existing Cost Estimating Relationships (CER) from respected sources, cost estimating best practices, and data from existing and proposed satellite designs. Cost estimation through this tool is approached from two perspectives: parametric cost estimating relationships and analogous cost estimation techniques. The dual approach utilized within the TAT-C CR module is intended to address prevailing concerns regarding early design stage cost estimates, and offer increased transparency and fidelity by offering two preliminary perspectives on mission cost. This work outlines the existing cost model, details assumptions built into the model, and explains what measures have been taken to address the particular challenges of constellation cost estimating. The risk estimation portion of the TAT-C CR module is still in development and will be presented in future work. The cost estimate produced by the CR module is not intended to be an exact mission valuation, but rather a comparative tool to assist in the exploration of the constellation design tradespace. Previous work has noted that estimating the cost of satellite constellations is difficult given that no comprehensive model for constellation cost estimation has yet been developed, and as such, quantitative assessment of multiple spacecraft missions has many remaining areas of uncertainty. By incorporating well-established CERs with preliminary approaches to approaching these uncertainties, the CR module offers more complete approach to constellation costing than has previously been available to mission architects or Earth scientists seeking to leverage the capabilities of multiple spacecraft working in support of a common goal.

Least Squares Solution of Small Sample Multiple-Master PSInSAR System

NASA Astrophysics Data System (ADS)

Zhang, Lei; Ding, Xiao Li; Lu, Zhong

2010-03-01

In this paper we propose a least squares based approach for multi-temporal SAR interferometry that allows to estimate the deformation rate with no need of phase unwrapping. The approach utilizes a series of multi-master wrapped differential interferograms with short baselines and only focuses on the arcs constructed by two nearby points at which there are no phase ambiguities. During the estimation an outlier detector is used to identify and remove the arcs with phase ambiguities, and pseudoinverse of priori variance component matrix is taken as the weight of correlated observations in the model. The parameters at points can be obtained by an indirect adjustment model with constraints when several reference points are available. The proposed approach is verified by a set of simulated data.

Evolutionary space platform concept study. Volume 2, part A: SASP special emphasis trade studies

NASA Technical Reports Server (NTRS)

1982-01-01

Efforts are in progress to define an approach to provide a simple and cost effective solution to the problem of long duration space flight. This approach involves a Space Platform in low Earth orbit, which can be tended by the Space Shuttle and which will provide, for extended periods of time, stability, utilities and access for a variety of replaceable payloads. The feasibility of an evolutionary space system which would cost effectively support unmanned payloads in groups, using a Space Platform which provides centralized basic subsystems is addressed.

A pilot study to explore the feasibility of using theClinical Care Classification System for developing a reliable costing method for nursing services.

PubMed

Dykes, Patricia C; Wantland, Dean; Whittenburg, Luann; Lipsitz, Stuart; Saba, Virginia K

2013-01-01

While nursing activities represent a significant proportion of inpatient care, there are no reliable methods for determining nursing costs based on the actual services provided by the nursing staff. Capture of data to support accurate measurement and reporting on the cost of nursing services is fundamental to effective resource utilization. Adopting standard terminologies that support tracking both the quality and the cost of care could reduce the data entry burden on direct care providers. This pilot study evaluated the feasibility of using a standardized nursing terminology, the Clinical Care Classification System (CCC), for developing a reliable costing method for nursing services. Two different approaches are explored; the Relative Value Unit RVU and the simple cost-to-time methods. We found that the simple cost-to-time method was more accurate and more transparent in its derivation than the RVU method and may support a more consistent and reliable approach for costing nursing services.

From partnerships to networks: new approaches for measuring U.S. National Heritage Area effectiveness.

PubMed

Laven, Daniel N; Krymkowski, Daniel H; Ventriss, Curtis L; Manning, Robert E; Mitchell, Nora J

2010-08-01

National Heritage Areas (NHAs) are an alternative and increasingly popular form of protected area management in the United States. NHAs seek to integrate environmental objectives with community and economic objectives at regional or landscape scales. NHA designations have increased rapidly in the last 20 years, generating a substantial need for evaluative information about (a) how NHAs work; (b) outcomes associated with the NHA process; and (c) the costs and benefits of investing public moneys into the NHA approach. Qualitative evaluation studies recently conducted at three NHAs have identified the importance of understanding network structure and function in the context of evaluating NHA management effectiveness. This article extends these case studies by examining quantitative network data from each of the sites. The authors analyze these data using both a descriptive approach and a statistically more robust approach known as exponential random graph modeling. Study findings indicate the presence of transitive structures and the absence of three-cycle structures in each of these networks. This suggests that these networks are relatively ''open,'' which may be desirable, given the uncertainty of the environments in which they operate. These findings also suggest, at least at the sites reported here, that the NHA approach may be an effective way to activate and develop networks of intersectoral organizational partners. Finally, this study demonstrates the utility of using quantitative network analysis to better understand the effectiveness of protected area management models that rely on partnership networks to achieve their intended outcomes.

Extreme Cost Reductions with Multi-Megawatt Centralized Inverter Systems

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

Schwabe, Ulrich; Fishman, Oleg

2015-03-20

The objective of this project was to fully develop, demonstrate, and commercialize a new type of utility scale PV system. Based on patented technology, this includes the development of a truly centralized inverter system with capacities up to 100MW, and a high voltage, distributed harvesting approach. This system promises to greatly impact both the energy yield from large scale PV systems by reducing losses and increasing yield from mismatched arrays, as well as reduce overall system costs through very cost effective conversion and BOS cost reductions enabled by higher voltage operation.

Inexpensive health care reform: the mathematics of medicine.

PubMed

Forsyth, Roger A

2010-02-01

There is data to support the hypothesis that US healthcare reform will require systemic changes in their delivery system rather than a segment-by-segment approach to improving individual components such as administrative or pharmaceutical costs or illness-by-illness programs such as comparative effectiveness or disease management. Mathematically, personnel costs provide the largest potential for savings. These costs are reflected in utilization rates. However, when governments or insurers try to control utilization, shortages or dissatisfaction ensue. Therefore, reform should be structured to encourage individually initiated reductions in utilization. This can be facilitated by changing from employer-paid comprehensive group policies of variable coverage to a three-part, standardized, individually purchased, group policy with a targeted deductible and co-pays that provide disincentives to over-utilization and incentives (refunds on unused contributions) to reduce utilization. There will be a public health policy (maternal, infant, and immunizations) that will be very inexpensive and not subject to any disincentives, a catastrophic policy with a deductible and enhanced but diminishing co-pays, and a Health Savings Account that pre-positions funds to cover the deductible and co-pays. These changes will lead to a reduction in administrative costs. The excess capacity created will provide care for the currently uninsured. Savings will be refunded to individuals thereby generating taxes that can pay for needed subsidies. Reform can be inexpensive if it puts the mathematics before the politics.

Designing cost effective water demand management programs in Australia.

PubMed

White, S B; Fane, S A

2002-01-01

This paper describes recent experience with integrated resource planning (IRP) and the application of least cost planning (LCP) for the evaluation of demand management strategies in urban water. Two Australian case studies, Sydney and Northern New South Wales (NSW) are used in illustration. LCP can determine the most cost effective means of providing water services or alternatively the cheapest forms of water conservation. LCP contrasts to a traditional approach of evaluation which looks only at means of increasing supply. Detailed investigation of water usage, known as end-use analysis, is required for LCP. End-use analysis allows both rigorous demand forecasting, and the development and evaluation of conservation strategies. Strategies include education campaigns, increasing water use efficiency and promoting wastewater reuse or rainwater tanks. The optimal mix of conservation strategies and conventional capacity expansion is identified based on levelised unit cost. IRP uses LCP in the iterative process, evaluating and assessing options, investing in selected options, measuring the results, and then re-evaluating options. Key to this process is the design of cost effective demand management programs. IRP however includes a range of parameters beyond least economic cost in the planning process and program designs, including uncertainty, benefit partitioning and implementation considerations.

Save water to save carbon and money: developing abatement costs for expanded greenhouse gas reduction portfolios.

PubMed

Stokes, Jennifer R; Hendrickson, Thomas P; Horvath, Arpad

2014-12-02

The water-energy nexus is of growing interest for researchers and policy makers because the two critical resources are interdependent. Their provision and consumption contribute to climate change through the release of greenhouse gases (GHGs). This research considers the potential for conserving both energy and water resources by measuring the life-cycle economic efficiency of greenhouse gas reductions through the water loss control technologies of pressure management and leak management. These costs are compared to other GHG abatement technologies: lighting, building insulation, electricity generation, and passenger transportation. Each cost is calculated using a bottom-up approach where regional and temporal variations for three different California water utilities are applied to all alternatives. The costs and abatement potential for each technology are displayed on an environmental abatement cost curve. The results reveal that water loss control can reduce GHGs at lower cost than other technologies and well below California's expected carbon trading price floor. One utility with an energy-intensive water supply could abate 135,000 Mg of GHGs between 2014 and 2035 and save--rather than spend--more than $130/Mg using the water loss control strategies evaluated. Water loss control technologies therefore should be considered in GHG abatement portfolios for utilities and policy makers.

A cost-utility analysis of a comprehensive orthogeriatric care for hip fracture patients, compared with standard of care treatment.

PubMed

Ginsberg, Gary; Adunsky, Abraham; Rasooly, Iris

2013-01-01

The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients. To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM). A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards. Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio. The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%). A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.

Anonymizing 1:M microdata with high utility

PubMed Central

Gong, Qiyuan; Luo, Junzhou; Yang, Ming; Ni, Weiwei; Li, Xiao-Bai

2016-01-01

Preserving privacy and utility during data publishing and data mining is essential for individuals, data providers and researchers. However, studies in this area typically assume that one individual has only one record in a dataset, which is unrealistic in many applications. Having multiple records for an individual leads to new privacy leakages. We call such a dataset a 1:M dataset. In this paper, we propose a novel privacy model called (k, l)-diversity that addresses disclosure risks in 1:M data publishing. Based on this model, we develop an efficient algorithm named 1:M-Generalization to preserve privacy and data utility, and compare it with alternative approaches. Extensive experiments on real-world data show that our approach outperforms the state-of-the-art technique, in terms of data utility and computational cost. PMID:28603388

The economic burden of human papillomavirus-related precancers and cancers in Sweden

PubMed Central

Silfverschiöld, Maria; Greiff, Lennart; Asciutto, Christine; Wennerberg, Johan; Lydryp, Marie-Louise; Håkansson, Ulf; Sparén, Pär; Borgfeldt, Christer

2017-01-01

Background High-risk (HR) human papillomavirus (HPV) infection is an established cause of malignant disease. We used a societal perspective to estimate the cost of HR HPV-related cervical, vulvar, vaginal, anal, and penile precancer and cancer, and oropharyngeal cancer in Sweden in 2006, 1 year before HPV vaccination became available in the country. Materials and methods This prevalence-based cost-of-illness study used diagnosis-specific data from national registries to determine the number of HR HPV-related precancers and cancers. The HR HPV-attributable fractions of these diseases were derived from a literature review and applied to the total burden to estimate HR HPV-attributable costs. Direct costs were based on health care utilization and indirect costs on loss of productivity due to morbidity (i.e., sick leave and early retirement) and premature mortality. Results The total annual cost of all HR HPV-attributable precancers and cancers was €94 million (€10.3/inhabitant). Direct costs accounted for €31.3 million (€3.4/inhabitant) of the total annual cost, and inpatient care amounted to €20.7 million of direct costs. Indirect costs made up €62.6 million (€6.9/inhabitant) of the total annual cost, and premature mortality amounted to €36 million of indirect costs. Cervical precancer and cancer was most costly (total annual cost €58.4 million). Among cancers affecting both genders, anal precancer and cancer, and oropharyngeal cancer were the most costly (€11.2 million and €11.9 million, respectively). For oropharyngeal cancer, males had the highest health care utilization and represented 71% of the total annual cost. Penile precancer and cancer was least costly (€2.6 million). Conclusion The economic burden of HR HPV-related precancers and cancers is substantial. The disease-related management and treatment costs we report are relevant as a point of reference for future economic evaluations investigating the overall benefits of HPV vaccination in females and males in Sweden. PMID:28651012

Launch Vehicle Production and Operations Cost Metrics

NASA Technical Reports Server (NTRS)

Watson, Michael D.; Neeley, James R.; Blackburn, Ruby F.

2014-01-01

Traditionally, launch vehicle cost has been evaluated based on $/Kg to orbit. This metric is calculated based on assumptions not typically met by a specific mission. These assumptions include the specified orbit whether Low Earth Orbit (LEO), Geostationary Earth Orbit (GEO), or both. The metric also assumes the payload utilizes the full lift mass of the launch vehicle, which is rarely true even with secondary payloads.1,2,3 Other approaches for cost metrics have been evaluated including unit cost of the launch vehicle and an approach to consider the full program production and operations costs.4 Unit cost considers the variable cost of the vehicle and the definition of variable costs are discussed. The full program production and operation costs include both the variable costs and the manufacturing base. This metric also distinguishes operations costs from production costs, including pre-flight operational testing. Operations costs also consider the costs of flight operations, including control center operation and maintenance. Each of these 3 cost metrics show different sensitivities to various aspects of launch vehicle cost drivers. The comparison of these metrics provides the strengths and weaknesses of each yielding an assessment useful for cost metric selection for launch vehicle programs.

Flexible reserve markets for wind integration

NASA Astrophysics Data System (ADS)

Fernandez, Alisha R.

The increased interconnection of variable generation has motivated the use of improved forecasting to more accurately predict future production with the purpose to lower total system costs for balancing when the expected output exceeds or falls short of the actual output. Forecasts are imperfect, and the forecast errors associated with utility-scale generation from variable generators need new balancing capabilities that cannot be handled by existing ancillary services. Our work focuses on strategies for integrating large amounts of wind generation under the flex reserve market, a market that would called upon for short-term energy services during an under or oversupply of wind generation to maintain electric grid reliability. The flex reserve market would be utilized for time intervals that fall in-between the current ancillary services markets that would be longer than second-to-second energy services for maintaining system frequency and shorter than reserve capacity services that are called upon for several minutes up to an hour during an unexpected contingency on the grid. In our work, the wind operator would access the flex reserve market as an energy service to correct for unanticipated forecast errors, akin to paying the generators participating in the market to increase generation during a shortfall or paying the other generators to decrease generation during an excess of wind generation. Such a market does not currently exist in the Mid-Atlantic United States. The Pennsylvania-New Jersey-Maryland Interconnection (PJM) is the Mid-Atlantic electric grid case study that was used to examine if a flex reserve market can be utilized for integrating large capacities of wind generation in a lowcost manner for those providing, purchasing and dispatching these short-term balancing services. The following work consists of three studies. The first examines the ability of a hydroelectric facility to provide short-term forecast error balancing services via a flex reserve market, identifying the operational constraints that inhibit a multi-purpose dam facility to meet the desired flexible energy demand. The second study transitions from the hydroelectric facility as the decision maker providing flex reserve services to the wind plant as the decision maker purchasing these services. In this second study, methods for allocating the costs of flex reserve services under different wind policy scenarios are explored that aggregate farms into different groupings to identify the least-cost strategy for balancing the costs of hourly day-ahead forecast errors. The least-cost strategy may be different for an individual wind plant and for the system operator, noting that the least-cost strategy is highly sensitive to cost allocation and aggregation schemes. The latter may also cause cross-subsidies in the cost for balancing wind forecast errors among the different wind farms. The third study builds from the second, with the objective to quantify the amount of flex reserves needed for balancing future forecast errors using a probabilistic approach (quantile regression) to estimating future forecast errors. The results further examine the usefulness of separate flexible markets PJM could use for balancing oversupply and undersupply events, similar to the regulation up and down markets used in Europe. These three studies provide the following results and insights to large-scale wind integration using actual PJM wind farm data that describe the markets and generators within PJM. • Chapter 2 provides an in-depth analysis of the valuable, yet highly-constrained, energy services multi-purpose hydroelectric facilities can provide, though the opportunity cost for providing these services can result in large deviations from the reservoir policies with minimal revenue gain in comparison to dedicating the whole of dam capacity to providing day-ahead, baseload generation. • Chapter 3 quantifies the system-wide efficiency gains and the distributive effects of PJM's decision to act as a single balancing authority, which means that it procures ancillary services across its entire footprint simultaneously. This can be contrasted to Midwest Independent System Operator (MISO), which has several balancing authorities operating under its footprint. • Chapter 4 uses probabilistic methods to estimate the uncertainty in the forecast errors and the quantity of energy needed to balance these forecast errors at a certain percentile. Current practice is to use a point forecast that describes the conditional expectation of the dependent variable at each time step. The approach here uses quantile regression to describe the relationship between independent variable and the conditional quantiles (equivalently the percentiles) of the dependent variable. An estimate of the conditional density is performed, which contains information about the covariate relationship of the sign of the forecast errors (negative for too much wind generation and positive for too little wind generation) and the wind power forecast. This additional knowledge may be implemented in the decision process to more accurately schedule day-ahead wind generation bids and provide an example for using separate markets for balancing an oversupply and undersupply of generation. Such methods are currently used for coordinating large footprints of wind generation in Europe.

Cost-Effectiveness of Apixaban Compared with Warfarin for Stroke Prevention in Atrial Fibrillation

PubMed Central

Lee, Soyon; Mullin, Rachel; Blazawski, Jon; Coleman, Craig I.

2012-01-01

Background Apixaban was shown to be superior to adjusted-dose warfarin in preventing stroke or systemic embolism in patients with atrial fibrillation (AF) and at least one additional risk factor for stroke, and associated with reduced rates of hemorrhage. We sought to determine the cost-effectiveness of using apixaban for stroke prevention. Methods Based on the results from the Apixaban Versus Warfarin in Patients with Atrial Fibrillation (ARISTOTLE) trial and other published studies, we constructed a Markov model to evaluate the cost-effectiveness of apixaban versus warfarin from the Medicare perspective. The base-case analysis assumed a cohort of 65-year-old patients with a CHADS2 score of 2.1 and no contraindication to oral anticoagulation. We utilized a 2-week cycle length and a lifetime time horizon. Outcome measures included costs in 2012 US$, quality-adjusted life-years (QALYs), life years saved and incremental cost-effectiveness ratios. Results Under base case conditions, quality adjusted life expectancy was 10.69 and 11.16 years for warfarin and apixaban, respectively. Total costs were $94,941 for warfarin and $86,007 for apixaban, demonstrating apixaban to be a dominant economic strategy. Upon one-way sensitivity analysis, these results were sensitive to variability in the drug cost of apixaban and various intracranial hemorrhage related variables. In Monte Carlo simulation, apixaban was a dominant strategy in 57% of 10,000 simulations and cost-effective in 98% at a willingness-to-pay threshold of $50,000 per QALY. Conclusions In patients with AF and at least one additional risk factor for stroke and a baseline risk of ICH risk of about 0.8%, treatment with apixaban may be a cost-effective alternative to warfarin. PMID:23056642

Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands.

PubMed

Tsiachristas, Apostolos; Burgers, Laura; Rutten-van Mölken, Maureen P M H

2015-12-01

Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in The Netherlands to improve care and patient's health behavior. The aim of this study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice. We compared the physical activity, smoking status, quality-adjusted life-years, and yearly costs per patient between the most and the least comprehensive DMPs in four disease categories: primary CVR prevention, secondary CVR prevention, both types of CVR prevention, and COPD (N = 1034). Propensity score matching increased comparability between DMPs. A 2-year cost-utility analysis was performed from the health care and societal perspectives. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on cost-effectiveness. Patients in the most comprehensive DMPs increased their physical activity more (except for primary CVR prevention) and had higher smoking cessation rates. The incremental QALYs ranged from -0.032 to 0.038 across all diseases. From a societal perspective, the most comprehensive DMPs decreased costs in primary CVR prevention (certainty 57%), secondary CVR prevention (certainty 88%), and both types of CVR prevention (certainty 98%). Moreover, the implementation of comprehensive DMPs led to QALY gains in secondary CVR prevention (certainty 92%) and COPD (certainty 69%). The most comprehensive DMPs for CVR and COPD have the potential to be cost saving, effective, or cost-effective compared with the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions that is most suited for each target group. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Chlamydia screening is not cost-effective at low participation rates: evidence from a repeated register-based implementation study in The Netherlands.

PubMed

de Wit, G Ardine; Over, Eelco A B; Schmid, Boris V; van Bergen, Jan E A M; van den Broek, Ingrid V F; van der Sande, Marianne A B; Welte, Robert; Op de Coul, Eline L M; Kretzschmar, Mirjam E

2015-09-01

In three pilot regions of The Netherlands, all 16-29 year olds were invited to participate in three annual rounds of Chlamydia screening. The aim of the present study is to evaluate the cost-effectiveness of repeated Chlamydia screening, based on empirical data. A mathematical model was employed to estimate the influence of repeated screening on prevalence and incidence of Chlamydial infection. A model simulating the natural history of Chlamydia was combined with cost and utility data to estimate the number of major outcomes and quality-adjusted life-years (QALYs) associated with Chlamydia. Six screening scenarios (16-29 years annually; 16-24 years annually; women only; biennial screening; biennial screening women only; screening every five years) were compared with no screening in two sexual networks, representing both lower ('national network') and higher ('urban network') baseline prevalence. Incremental cost-effectiveness ratios (ICERs) for the different screening scenarios were estimated. Uncertainty and sensitivity analyses were performed. In all scenarios and networks, cost per major outcome averted are above €5000. Cost per QALY are at least €50,000. The default scenario as piloted in the Netherlands was least cost-effective, with ICERs of €232,000 in the national and €145,000 in the urban sexual network. Results were robust in sensitivity analyses. It is unlikely that repeated rounds of Chlamydia screening will be cost-effective. Only at high levels of willingness to pay for a QALY (>€50,000) screening may be more cost-effective than no screening. 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.

Streamlining the Design Tradespace for Earth Imaging Constellations

NASA Technical Reports Server (NTRS)

Nag, Sreeja; Hughes, Steven P.; Le Moigne, Jacqueline J.

2016-01-01

Satellite constellations and Distributed Spacecraft Mission (DSM) architectures offer unique benefits to Earth observation scientists and unique challenges to cost estimators. The Cost and Risk (CR) module of the Tradespace Analysis Tool for Constellations (TAT-C) being developed by NASA Goddard seeks to address some of these challenges by providing a new approach to cost modeling, which aggregates existing Cost Estimating Relationships (CER) from respected sources, cost estimating best practices, and data from existing and proposed satellite designs. Cost estimation through this tool is approached from two perspectives: parametric cost estimating relationships and analogous cost estimation techniques. The dual approach utilized within the TAT-C CR module is intended to address prevailing concerns regarding early design stage cost estimates, and offer increased transparency and fidelity by offering two preliminary perspectives on mission cost. This work outlines the existing cost model, details assumptions built into the model, and explains what measures have been taken to address the particular challenges of constellation cost estimating. The risk estimation portion of the TAT-C CR module is still in development and will be presented in future work. The cost estimate produced by the CR module is not intended to be an exact mission valuation, but rather a comparative tool to assist in the exploration of the constellation design tradespace. Previous work has noted that estimating the cost of satellite constellations is difficult given that no comprehensive model for constellation cost estimation has yet been developed, and as such, quantitative assessment of multiple spacecraft missions has many remaining areas of uncertainty. By incorporating well-established CERs with preliminary approaches to approaching these uncertainties, the CR module offers more complete approach to constellation costing than has previously been available to mission architects or Earth scientists seeking to leverage the capabilities of multiple spacecraft working in support of a common goal.

Aviation Fueling: A Cleaner, Greener Approach

NASA Technical Reports Server (NTRS)

Hendricks, Robert C.; Bushnell, Dennis M.; Shouse, Dale T.

2010-01-01

Projected growth of aviation depends on fueling where specific needs must be met. Safety is paramount, and along with political, social, environmental and legacy transport systems requirements, alternate aviation fueling becomes an opportunity of enormous proportions. Biofuels sourced from halophytes, algae, cyanobacteria, and weeds using wastelands, waste water, and seawater have the capacity to be drop-in fuel replacements for petroleum fuels. Biojet fuels from such sources solves the aviation CO2 emissions issue and do not compete with food or freshwater needs. They are not detrimental to the social or environmental fabric and use the existing fuels infrastructure. Cost and sustainable supply remains the major impediments to alternate fuels. Halophytes are the near-term solution to biomass/biofuels capacity at reasonable costs; they simply involve more farming, at usual farming costs. Biofuels represent a win-win approach, proffering as they do at least the ones we are studying massive capacity, climate neutral-to-some sequestration, and ultimately, reasonable costs.

Cost Analysis of Selected Patient Categories within a Dermatology Department Using an ABC Approach

PubMed Central

Papadaki, Šárka; Popesko, Boris

2016-01-01

Background: Present trends in hospital management are facilitating the utilization of more accurate costing methods, which potentially results in superior cost-related information and improved managerial decision-making. However, the Activity-Based Costing method (ABC), which was designed for cost allocation purposes in the 1980s, is not widely used by healthcare organizations. This study analyzes costs related to selected categories of patients, those suffering from psoriasis, varicose ulcers, eczema and other conditions, within a dermatology department at a Czech regional hospital. Methods: The study was conducted in a hospital department where both inpatient and outpatient care are offered. Firstly, the diseases treated at the department were identified. Further costs were determined for each activity using ABC. The study utilized data from managerial and financial accounting, as well as data obtained through interviews with departmental staff. Using a defined cost-allocation procedure makes it possible to determine the cost of an individual patient with a given disease more accurately than via traditional costing procedures. Results: The cost analysis focused on the differences between the costs related to individual patients within the selected diagnoses, variations between inpatient and outpatient treatments and the costs of activities performed by the dermatology department. Furthermore, comparing the costs identified through this approach and the revenue stemming from the health insurance system is an option. Conclusions: Activity-Based Costing is more accurate and relevant than the traditional costing method. The outputs of ABC provide an abundance of additional information for managers. The benefits of this research lie in its practically-tested outputs, resulting from calculating the costs of hospitalization, which could prove invaluable to persons involved in hospital management and decision-making. The study also defines the managerial implications of the performed cost analysis for the hospital management. Based on the analysis results, it is possible to standardize activities and performance appraisal (Benchmarking), and provide all necessary information for hospital budgeting practices, especially Activity-Based Budgeting (ABB). PMID:26755477

Cost Analysis of Selected Patient Categories Within A Dermatology Department Using an ABC Approach.

PubMed

Papadaki, Šárka; Popesko, Boris

2015-11-17

Present trends in hospital management are facilitating the utilization of more accurate costing methods, which potentially results in superior cost-related information and improved managerial decision-making. However, the Activity-Based Costing method (ABC), which was designed for cost allocation purposes in the 1980s, is not widely used by healthcare organizations. This study analyzes costs related to selected categories of patients, those suffering from psoriasis, varicose ulcers, eczema and other conditions, within a dermatology department at a Czech regional hospital. The study was conducted in a hospital department where both inpatient and outpatient care are offered. Firstly, the diseases treated at the department were identified. Further costs were determined for each activity using ABC. The study utilized data from managerial and financial accounting, as well as data obtained through interviews with departmental staff. Using a defined cost-allocation procedure makes it possible to determine the cost of an individual patient with a given disease more accurately than via traditional costing procedures. The cost analysis focused on the differences between the costs related to individual patients within the selected diagnoses, variations between inpatient and outpatient treatments and the costs of activities performed by the dermatology department. Furthermore, comparing the costs identified through this approach and the revenue stemming from the health insurance system is an option. Activity-Based Costing is more accurate and relevant than the traditional costing method. The outputs of ABC provide an abundance of additional information for managers. The benefits of this research lie in its practically-tested outputs, resulting from calculating the costs of hospitalization, which could prove invaluable to persons involved in hospital management and decision-making. The study also defines the managerial implications of the performed cost analysis for the hospital management. Based on the analysis results, it is possible to standardize activities and performance appraisal (Benchmarking), and provide all necessary information for hospital budgeting practices, especially Activity-Based Budgeting (ABB).

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

PubMed Central

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

2015-01-01

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

Converting Parkinson-Specific Scores into Health State Utilities to Assess Cost-Utility Analysis.

PubMed

Chen, Gang; Garcia-Gordillo, Miguel A; Collado-Mateo, Daniel; Del Pozo-Cruz, Borja; Adsuar, José C; Cordero-Ferrera, José Manuel; Abellán-Perpiñán, José María; Sánchez-Martínez, Fernando Ignacio

2018-06-07

The aim of this study was to compare the Parkinson's Disease Questionnaire-8 (PDQ-8) with three multi-attribute utility (MAU) instruments (EQ-5D-3L, EQ-5D-5L, and 15D) and to develop mapping algorithms that could be used to transform PDQ-8 scores into MAU scores. A cross-sectional study was conducted. A final sample of 228 evaluable patients was included in the analyses. Sociodemographic and clinical data were also collected. Two EQ-5D questionnaires were scored using Spanish tariffs. Two models and three statistical techniques were used to estimate each model in the direct mapping framework for all three MAU instruments, including the most widely used ordinary least squares (OLS), the robust MM-estimator, and the generalized linear model (GLM). For both EQ-5D-3L and EQ-5D-5L, indirect response mapping based on an ordered logit model was also conducted. Three goodness-of-fit tests were employed to compare the models: the mean absolute error (MAE), the root-mean-square error (RMSE), and the intra-class correlation coefficient (ICC) between the predicted and observed utilities. Health state utility scores ranged from 0.61 (EQ-5D-3L) to 0.74 (15D). The mean PDQ-8 score was 27.51. The correlation between overall PDQ-8 score and each MAU instrument ranged from - 0.729 (EQ-5D-5L) to - 0.752 (EQ-5D-3L). A mapping algorithm based on PDQ-8 items had better performance than using the overall score. For the two EQ-5D questionnaires, in general, the indirect mapping approach had comparable or even better performance than direct mapping based on MAE. Mapping algorithms developed in this study enable the estimation of utility values from the PDQ-8. The indirect mapping equations reported for two EQ-5D questionnaires will further facilitate the calculation of EQ-5D utility scores using other country-specific tariffs.

Cost-utility analysis of case management for frail older people: effects of a randomised controlled trial.

PubMed

Sandberg, Magnus; Jakobsson, Ulf; Midlöv, Patrik; Kristensson, Jimmie

2015-12-01

To evaluate the effects of a case management intervention for frail older people (aged 65+ years) by cost and utility. One hundred and fifty-three frail older people living at home were randomly assigned to either an intervention (n = 80) or a control group (n = 73). The 1-year intervention was carried out by nurses and physiotherapists working as case managers, who undertook home visits at least once a month. Differences in costs and quality-adjusted life years (QALYs) based on the health-related quality-of-life instruments EQ-5D and EQ-VAS, and also the incremental cost-effectiveness ratio were investigated. All analyses used the intention-to-treat principle. There were no significant differences between the intervention group and control group for total cost, EQ-5D-based QALY or EQ-VAS-based QALY for the 1-year study. Incremental cost-effectiveness ratio was not conducted because no significant differences were found for either EQ-5D- or EQ-VAS-based QALY, or costs. However, the intervention group had significantly lower levels of informal care and help with instrumental activities of daily living both as costs (3,927 vs. 6,550, p = 0.037) and provided hours (200 vs. 333 hours per year, p = 0.037). The intervention was cost neutral and does not seem to have affected health-related quality of life for the 1-year study, which may be because the follow-up period was too short. The intervention seems to have reduced hours and cost of informal care and help required with instrumental activities of daily living. This suggests that the intervention provides relief to informal caregivers.

Medical resource utilization and associated costs in patients with ulcerative colitis in the UK: a chart review analysis.

PubMed

Bodger, Keith; Yen, Linnette; Szende, Agota; Sharma, Gunjan; Chen, Yaozhu J; McDermott, John; Hodgkins, Paul

2014-02-01

Limited evidence is available on the economic burden of ulcerative colitis (UC) in the UK, particularly relating to the impact of relapse frequency on direct medical costs. This study identifies and assesses medical resource utilization (MRU) and associated direct costs in mild and moderate UC patients in the UK. A retrospective chart review of patients with mild-to-moderate UC diagnosed at least 1 year before the study was performed. From 33 general practitioner (GP) and 34 gastroenterologist sites, charts of the last three UC patients fulfilling the inclusion criteria were reviewed. Descriptive statistics were calculated for MRU and 2011 costs (GB£) by number of relapses. The study population included 201 patients with a mean age of 39.9 years; 44% were women and the mean disease duration was 7.4 years. UC-related costs of each MRU category increased with the number of relapses. Comparing patients without relapse with those with more than two relapses, the mean annual UC-related costs were £14 versus £2556 for hospitalizations; £218 versus £988 for visits (including nurse, GP, specialist, and other visits); £21 versus £1303 for procedures; £17 versus £188 for diagnostics; and £1168 versus £6660 for all-cause total costs. Age, sex, and site of data reporting (GP vs. gastroenterologist) were not associated with MRU or costs. Patients with mild-to-moderate UC incurred considerable costs that increased markedly with the number of relapses. These findings support the importance of maintenance therapies in UC that reduce or prevent relapses. Quantifying the relationship between relapse rate and costs will inform future health economic studies.

Costs and Effectiveness of Mindfulness-Based Art Therapy versus Standard Breast Cancer Support Group for Women with Cancer.

PubMed

Prioli, Katherine M; Pizzi, Laura T; Kash, Kathryn M; Newberg, Andrew B; Morlino, Anna Marie; Matthews, Michael J; Monti, Daniel A

2017-09-01

The results of several studies have demonstrated that women and men with a cancer diagnosis benefit from interventions to reduce distress and improve quality of life (QOL). However, little is known about the costs and effectiveness of such interventions. Identifying a stress-reduction program that is low cost and effective is important for payers, employers, and healthcare professionals, as well as for patients with cancer. To evaluate the direct costs and effectiveness of the mindfulness-based art therapy (MBAT) program compared with the cost and effectiveness of a breast cancer support group (BCSG). This economic pilot study evaluated the direct costs and effectiveness of a mindfulness-based intervention for stress reduction in patients with breast cancer who are receiving care versus the cost of a usual care support group used as the comparator. The cost variables for each cohort included the cost of program delivery (ie, staff and supplies), mileage reimbursements, medication costs, and healthcare utilization costs. Effectiveness was measured by a change in quality-adjusted life-year derived from the 36-Item Short-Form Health Survey (SF-36) QOL battery. Overall, the cost for 191 participants in the MBAT intervention group was $992.49 per participant compared with $562.71 per participant for the BCSG intervention. Both interventions achieved a similar change in healthcare utilization based on the SF-36 QOL battery. Although the MBAT intervention was more costly than a BCSG intervention, sensitivity analysis showed that the cost-effectiveness of the MBAT intervention could achieve parity with that of a BCSG if some intervention-related costs, such as staff time and supplies, were reduced. As psychosocial cancer care becomes more refined with time, it will be important to determine the best and most cost-effective interventions for patients with cancer, particularly in light of healthcare reform. Information from this study could help inform payers, employers, and other stakeholders regarding which interventions would be least costly and most effective for patients with cancer.

Expect the unexpected: a role for behavioral economics in understanding the impact of cost-sharing on emergency department utilization.

PubMed

Tzeel, Albert; Brown, Jack

2010-07-01

AS EMPLOYERS AND PAYERS ADDRESS INCREASING HEALTHCARE COSTS, THEY RESORT TO THE TENETS OF CLASSICAL ECONOMICS: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (-58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in each of the 3 study periods. In contrast, in the 2 groups with no increases in emergency department copayments, utilization of these services decreased or remained flat. When assessing the need for emergency department services, many factors besides cost play a role in choosing to obtain emergency department care, including individual assessments of the probability of a given illness and the financial or temporal implications for the care sought in terms of "gains" or "losses" relative to a reference point. Behavioral economics can therefore play a role in understanding why healthcare consumers behave as they do. The implications of behavioral economics need to be factored in when considering a healthcare benefit design.

The Impact of Worksite Clinics on Teacher Healthcare Utilization and Cost, Self-reported Health Status, and Student Academic Achievement growth in a Public School District.

PubMed

Engberg, John B; Harris-Shapiro, Jon; Hines, David; McCarver, Patti; Liu, Harry H

2018-05-29

To examine the impact of worksite clinics on healthcare utilization and cost, self-reported health status, and student achievement growth in a public school district. We used insurance claims, health risk assessment, and student achievement growth data for active teachers during 2007-2015. A difference-in-differences approach was applied to measure the impact of worksite clinics. Compared to using a community-based clinic as the usual source of primary care, using a worksite clinic was associated with significantly lower inpatient admissions (53 vs. 31 per 1,000 teacher years), annual healthcare cost ($5,043 vs. $4,298 in 2016 US dollars, a difference of $62 per teacher per month), and annual absent work hours (63 vs. 61). No significant differences were detected in self-reported health status or student achievement growth. Worksite clinics reduce teacher healthcare cost and absenteeism.

Eliciting older people's preferences for exercise programs: a best-worst scaling choice experiment.

PubMed

Franco, Marcia R; Howard, Kirsten; Sherrington, Catherine; Ferreira, Paulo H; Rose, John; Gomes, Juliana L; Ferreira, Manuela L

2015-01-01

What relative value do older people with a previous fall or mobility-related disability attach to different attributes of exercise? Prospective, best-worst scaling study. Two hundred and twenty community-dwelling people, aged 60 years or older, who presented with a previous fall or mobility-related disability. Online or face-to-face questionnaire. Utility values for different exercise attributes and levels. The utility levels were calculated by asking participants to select the attribute that they considered to be the best (ie, they were most likely to want to participate in programs with this attribute) and worst (ie, least likely to want to participate). The attributes included were: exercise type; time spent on exercise per day; frequency; transport type; travel time; out-of-pocket costs; reduction in the chance of falling; and improvement in the ability to undertake tasks inside and outside of home. The attributes of exercise programs with the highest utility values were: home-based exercise and no need to use transport, followed by an improvement of 60% in the ability to do daily tasks at home, no costs, and decreasing the chances of falling to 0%. The attributes with the lowest utility were travel time of 30 minutes or more and out-of-pocket costs of AUD50 per session. The type of exercise, travel time and costs are more highly valued by older people than the health benefits. These findings suggest that physical activity engagement strategies need to go beyond education about health benefits and focus on improving accessibility to exercise programs. Exercise that can be undertaken at or close to home without any cost is most likely to be taken up by older people with past falls and/or mobility-related disability. Copyright © 2014 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Making an Old Measurement Experiment Modern and Exciting!

ERIC Educational Resources Information Center

Schulze, Paul D.

1996-01-01

Presents a new approach for the determination of the temperature coefficient of resistance of a resistor and a thermistor. Advantages include teaching students how to linearize data in order to utilize least-squares techniques, continuously taking data over desired temperature range, using up-to-date data-acquisition techniques, teaching the use…

Together Achieving More: Primary Care Team Communication and Alcohol-Related Health Care Utilization and Costs

PubMed Central

Mundt, Marlon P.; Zakletskaia, Larissa I.; Shoham, David A.; Tuan, Wen-Jan; Carayon, Pascale

2015-01-01

Background Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Methods Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team’s primary care patient panel. Results Teams (n=31) whose RNs displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (RR=0.90; 95% CI: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1030 (95% CI: −$1819, −$241) lower alcohol-related patient health care costs per 1000 team patients in the past 12 months. Conversely, teams whose primary care practitioner had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR=1.12; 95: CI: 1.03, 1.23) and $1428 (95% CI: $378, $2478) higher alcohol-related healthcare costs per 1000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and co-morbidity diagnoses. Conclusions Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic communication networks include more team members and whose communication to the PCP has been streamlined to fewer team members. PMID:26350957

Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.

PubMed

Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale

2015-10-01

Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic communication networks include more team members and whose communication to the PCP has been streamlined to fewer team members. Copyright © 2015 by the Research Society on Alcoholism.

Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.

PubMed

Crawshaw, Benjamin P; Chien, Hung-Lun; Augestad, Knut M; Delaney, Conor P

2015-05-01

Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated. To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs. Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study. Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization. Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy. Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.

Development of a low cost integrated 15 kW A.C. solar tracking sub-array for grid connected PV power system applications

NASA Astrophysics Data System (ADS)

Stern, M.; West, R.; Fourer, G.; Whalen, W.; Van Loo, M.; Duran, G.

1997-02-01

Utility Power Group has achieved a significant reduction in the installed cost of grid-connected PV systems. The two part technical approach focused on 1) The utilization of a large area factory assembled PV panel, and 2) The integration and packaging of all sub-array power conversion and control functions within a single factory produced enclosure. Eight engineering prototype 15kW ac single axis solar tracking sub-arrays were designed, fabricated, and installed at the Sacramento Municipal Utility District's Hedge Substation site in 1996 and are being evaluated for performance and reliability. A number of design enhancements will be implemented in 1997 and demonstrated by the field deployment and operation of over twenty advanced sub-array PV power systems.

Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study).

PubMed

Koek, Mayke B G; Sigurdsson, Vigfús; van Weelden, Huib; Steegmans, Paul H A; Bruijnzeel-Koomen, Carla A F M; Buskens, Erik

2010-04-20

To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks). Secondary care, provided by a dermatologist in the Netherlands. 196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy. Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01). Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (>/=50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)). Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were euro800 for home treatment and euro752 for outpatient treatment, showing an incremental cost per patient of euro48 (95% CI euro-77 to euro174). The average total costs by one year after the end of phototherapy were euro1272 and euro1148 respectively (difference euro124, 95% CI euro-155 to euro403). Cost utility analyses revealed that patients experienced equal health benefits-that is, a gain of 0.296 versus 0.291 QALY (home v outpatient) by the end of phototherapy (difference 0.0052, -0.0244 to 0.0348) and 1.153 versus 1.126 QALY by one year after the end of phototherapy (difference 0.0267, -0.024 to 0.078). Incremental costs per QALY gained were euro9276 and euro4646 respectively, both amounts well below the normally accepted standard of euro20 000 per QALY. Cost effectiveness analyses indicated that the mean number of days with a relevant treatment effect was 42.4 versus 55.3 by the end of phototherapy (difference -12.9, -23.4 to -2.4). By one year after the end of phototherapy the number of days with a relevant treatment effect were 216.5 and 210.4 respectively (6.1, -41.1 to 53.2), yielding an incremental cost of euro20 per additional day with a relevant treatment effect. Home ultraviolet B phototherapy for psoriasis is not more expensive than phototherapy in an outpatient setting and proved to be cost effective. As both treatments are at least equally effective and patients express a preference for home treatment, the authors conclude that home phototherapy should be the primary treatment option for patients who are eligible for phototherapy with ultraviolet B light. Current Controlled Trials ISRCTN83025173 and Clinicaltrials.gov NCT00150930.

Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study)

PubMed Central

Sigurdsson, Vigfús; van Weelden, Huib; Steegmans, Paul H A; Bruijnzeel-Koomen, Carla A F M; Buskens, Erik

2010-01-01

Objective To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. Design Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks). Setting Secondary care, provided by a dermatologist in the Netherlands. Participants 196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy. Interventions Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01). Main outcome measures Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (≥50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)). Results Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were €800 for home treatment and €752 for outpatient treatment, showing an incremental cost per patient of €48 (95% CI €−77 to €174). The average total costs by one year after the end of phototherapy were €1272 and €1148 respectively (difference €124, 95% CI €−155 to €403). Cost utility analyses revealed that patients experienced equal health benefits—that is, a gain of 0.296 versus 0.291 QALY (home v outpatient) by the end of phototherapy (difference 0.0052, −0.0244 to 0.0348) and 1.153 versus 1.126 QALY by one year after the end of phototherapy (difference 0.0267, −0.024 to 0.078). Incremental costs per QALY gained were €9276 and €4646 respectively, both amounts well below the normally accepted standard of €20 000 per QALY. Cost effectiveness analyses indicated that the mean number of days with a relevant treatment effect was 42.4 versus 55.3 by the end of phototherapy (difference −12.9, −23.4 to −2.4). By one year after the end of phototherapy the number of days with a relevant treatment effect were 216.5 and 210.4 respectively (6.1, −41.1 to 53.2), yielding an incremental cost of €20 per additional day with a relevant treatment effect. Conclusions Home ultraviolet B phototherapy for psoriasis is not more expensive than phototherapy in an outpatient setting and proved to be cost effective. As both treatments are at least equally effective and patients express a preference for home treatment, the authors conclude that home phototherapy should be the primary treatment option for patients who are eligible for phototherapy with ultraviolet B light. Trial registration Current Controlled Trials ISRCTN83025173 and Clinicaltrials.gov NCT00150930 PMID:20406865

Resource Utilization for Patients with Intracerebral Hemorrhage Transferred to a Comprehensive Stroke Center.

PubMed

Nguyen, Claude; Mir, Osman; Vahidy, Farhaan; Wu, Tzu-Ching; Albright, Karen; Boehme, Amelia; Delgado, Rigoberto; Savitz, Sean

2015-12-01

As a comprehensive stroke center (CSC), we accept transfer patients with intracerebral hemorrhage (ICH) in our region. CSC guidelines mandate receipt of patients with ICH for higher level of care. We determined resource utilization of patients accepted from outside hospitals compared with patients directly arriving to our center. From our stroke registry, we compared patients with primary ICH transferred to those directly arriving to our CSC from March 2011-March 2012. We compared the proportion of patients who utilized at least one of these resources: neurointensive care unit (NICU), neurosurgical intervention, or clinical trial enrollment. Among the 362 patients, 210 (58%) were transfers. Transferred patients were older, had higher median Glasgow Coma Scale scores, and lower National Institutes of Health Stroke Scale scores than directly admitted patients. Transfers had smaller median ICH volumes (20.5 cc versus 15.2 cc; P = .04) and lower ICH scores (2.1 ± 1.4 versus 1.6 ± 1.3; P < .01). A smaller proportion of transfers utilized CSC-specific resources compared with direct admits (P = .02). Fewer transferred patients required neurosurgical intervention or were enrolled in trials. No significant difference was found in the proportion of patients who used NICU resources, although transferred patients had a significantly lower length of stay in the NICU. Average hospital stay costs were less for transferred patients than for direct admits. Patients with ICH transferred to our CSC underwent fewer neurosurgical procedures and had a shorter stay in the NICU. These results were reflected in the lower per-patient costs in the transferred group. Our results raise the need to analyze cost-benefits and resource utilization of transferring patients with milder ICH. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Allowance trading activity and state regulatory rulings: Evidence from the US Acid Rain Program

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

Bailey, E.M.

1997-12-31

The US Acid Rain Program is one of the first, and by far the most extensive, applications of a market based approach to pollution control. From the beginning, there has been concern whether utilities would participate in allowance trading, and whether regulatory activity at the state level would further complicate utilities` decision to trade allowances. This paper finds that public utility commission regulation has encouraged allowance trading activity in states with regulatory rulings, but that allowance trading activity has not been limited to states issuing regulations. Until there is evidence suggesting that significant additional cost savings could have been obtainedmore » if additional allowance trading activity had occurred in states without regulations or that utilities in states with regulations are still not taking advantage of all cost saving trading opportunities, this analysis suggests that there is little reason to believe that allowance trading activity is impeded by public utility commission regulations.« less

Cost and efficiency of disaster waste disposal: A case study of the Great East Japan Earthquake.

PubMed

Sasao, Toshiaki

2016-12-01

This paper analyzes the cost and efficiency of waste disposal associated with the Great East Japan Earthquake. The following two analyses were performed: (1) a popular parametric approach, which is an ordinary least squares (OLS) method to estimate the factors that affect the disposal costs; (2) a non-parametric approach, which is a two-stage data envelopment analysis (DEA) to analyze the efficiency of each municipality and clarify the best performance of the disaster waste management. Our results indicate that a higher recycling rate of disaster waste and a larger amount of tsunami sediments decrease the average disposal costs. Our results also indicate that area-wide management increases the average cost. In addition, the efficiency scores were observed to vary widely by municipality, and more temporary incinerators and secondary waste stocks improve the efficiency scores. However, it is likely that the radioactive contamination from the Fukushima Daiichi nuclear power station influenced the results. Copyright © 2016 Elsevier Ltd. All rights reserved.

Self-optimisation and model-based design of experiments for developing a C-H activation flow process.

PubMed

Echtermeyer, Alexander; Amar, Yehia; Zakrzewski, Jacek; Lapkin, Alexei

2017-01-01

A recently described C(sp 3 )-H activation reaction to synthesise aziridines was used as a model reaction to demonstrate the methodology of developing a process model using model-based design of experiments (MBDoE) and self-optimisation approaches in flow. The two approaches are compared in terms of experimental efficiency. The self-optimisation approach required the least number of experiments to reach the specified objectives of cost and product yield, whereas the MBDoE approach enabled a rapid generation of a process model.

Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: a cohort study.

PubMed

Campbell, David J T; Manns, Braden J; Weaver, Robert G; Hemmelgarn, Brenda R; King-Shier, Kathryn M; Sanmartin, Claudia

2017-02-15

Some patients with cardiovascular-related chronic diseases such as diabetes and heart disease report financial barriers to achieving optimal health. Previous surveys report that the perception of having a financial barrier is associated with self-reported adverse clinical outcomes. We sought to confirm these findings using linked survey and administrative data to determine, among patients with cardiovascular-related chronic diseases, if there is an association between perceived financial barriers and the outcomes of: (1) disease-related hospitalizations, (2) all-cause mortality and (3) inpatient healthcare costs. We used ten cycles of the nationally representative Canadian Community Health Survey (administered between 2000 and 2011) to identify a cohort of adults aged 45 and older with hypertension, diabetes, heart disease or stroke. Perceived financial barriers to various aspects of chronic disease care and self-management were identified (including medications, healthful food and home care) from the survey questions, using similar questions to those used in previous studies. The cohort was linked to administrative data sources for outcome ascertainment (Discharge Abstract Database, Canadian Mortality Database, Patient Cost Estimator). We utilized Poisson regression techniques, adjusting for potential confounding variables (age, sex, education, multimorbidity, smoking status), to assess for associations between perceived financial barriers and disease-related hospitalization and all-cause mortality. We used gross costing methodology and a variety of modelling approaches to assess the impact of financial barriers on hospital costs. We identified a cohort of 120,752 individuals over the age of 45 years with one or more of the following: hypertension, diabetes, heart disease or stroke. One in ten experienced financial barriers to at least one aspect of their care, with the two most common being financial barriers to accessing medications and healthful food. Even after adjustment, those with at least one financial barrier had an increased rate of disease-related hospitalization and mortality compared to those without financial barriers with adjusted incidence rate ratios of 1.36 (95% CI: 1.29-1.44) and 1.24 (1.16-1.32), respectively. Furthermore, having a financial barrier to care was associated with 30% higher inpatient costs compared to those without financial barriers. This study, using novel linked national survey and administrative data, demonstrates that chronic disease patients with perceived financial barriers have worse outcomes and higher resource utilization, corroborating the findings from prior self-report studies. The overall exposure remained associated with the primary outcome even in spite of adjustment for income. This suggests that a patient's perception of a financial barrier might be used in clinical and research settings as an additional measure along with standard measures of socioeconomic status (ie. income, education, social status). After adjusting for relevant covariates, perceiving a financial barrier was associated with increased rates of hospitalization and mortality and higher hospital costs compared to those without financial barriers. The demonstrable association with adverse outcomes and increased costs seen in this study may provide an impetus for policymakers to seek to invest in interventions which minimize the impact of financial barriers.

U.S. Army Corps of Engineers Manpower Information System: An Integrated Approach to Manpower Management

DTIC Science & Technology

1994-04-01

engineering and con- struction management services for both military and civil works programs. In FY93, the cost of those programs exceeded $10 billion and...A related issue was to explore the USACE costs , benefits, and barriers to implementing a single Class VI system software package for both the military...provide information in useful ways, track utilization information, I A Class HI system is defined in AR 25-3. It is a system whose total program costs are

Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs

PubMed Central

Epstein, Nancy E.

2012-01-01

Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs. PMID:22905321

Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy: a matched-pair, bicenter analysis with cost comparison using time-driven activity-based costing.

PubMed

Laviana, Aaron A; Tan, Hung-Jui; Hu, Jim C; Weizer, Alon Z; Chang, Sam S; Barocas, Daniel A

2018-03-01

To perform a bicenter, retrospective study of perioperative outcomes of retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN) and assess costs using time-driven activity-based costing (TDABC). We identified 355 consecutive patients who underwent RALPN at University of California Los Angeles and the University of Michigan during 2009-2016. We matched according to RENAL nephrometry score, date, and institution for 78 retroperitoneal versus 78 transperitoneal RALPN. Unadjusted analyses were performed using McNemar's Chi-squared or paired t test, and adjusted analyses were performed using multivariable repeated measures regression analysis. From multivariable models, predicted probabilities were derived according to approach. Cost analysis was performed using TDABC. Patients treated with retroperitoneal versus transperitoneal RALPN were similar in age (P = 0.490), sex (P = 0.715), BMI (P = 0.273), and comorbidity (P = 0.393). Most tumors were posterior or lateral in both the retroperitoneal (92.3%) and transperitoneal (85.9%) groups. Retroperitoneal RALPN was associated with shorter operative times (167.0 versus 191.1 min, P = 0.001) and length of stay (LOS) (1.8 versus 2.7 days, P < 0.001). There were no differences in renal function preservation or cancer control. In adjusted analyses, retroperitoneal RALPN was 17.6-min shorter (P < 0.001) and had a 76% lower probability of LOS at least 2 days (P < 0.001). Utilizing TDABC, transperitoneal RALPN added $2337 in cost when factoring in disposable equipment, operative time, LOS, and personnel. In two high-volume, tertiary centers, retroperitoneal RALPN is associated with reduced operative times and shortened LOS in posterior and lateral tumors, whereas sharing similar clinicopathologic outcomes, which may translate into lower healthcare costs. Further investigation into anterior tumors is needed.

Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial.

PubMed

Goranitis, Ilias; Bellanca, Leana; Daley, Amanda J; Thomas, Adele; Stokes-Lampard, Helen; Roalfe, Andrea K; Jowett, Sue

2017-01-01

To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms. Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective. Primary care. Peri- and postmenopausal women who have not used hormone therapy in the past 3 months and experience ≥ 5 episodes of vasomotor symptoms daily. An individual and a social support-based exercise intervention were evaluated. The former (Exercise-DVD), aimed to prompt exercise with purpose-designed DVD and written materials, whereas the latter (Exercise-Social support) with community exercise social support groups. Costs and outcomes associated with these interventions were compared to those of a control group, who could only have an exercise consultation. An incremental cost-utility analysis was undertaken using bootstrapping to account for the uncertainty around cost-effectiveness point-estimates. Cost per quality-adjusted life-year (QALY). Data for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was £52 (CIs: £18 to £86) and £18 (CIs: -£68 to £105) more expensive per woman than the control group at 6 and 12 months post-randomisation and led to 0.006 (CIs: -0.002 to 0.014) and 0.013 (CIs: -0.01 to 0.036) more QALYs, resulting in an incremental cost-effectiveness ratio of £8,940 and £1,413 per QALY gained respectively. Exercise-Social support had 80%-90% probability of being cost-effective in the UK context. A societal perspective of analysis and a complete-case analysis led to similar findings. Exercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms.

Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial

PubMed Central

Goranitis, Ilias; Bellanca, Leana; Daley, Amanda J.; Thomas, Adele; Stokes-Lampard, Helen; Roalfe, Andrea K.

2017-01-01

Objective To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms. Design Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective. Setting Primary care. Population Peri- and postmenopausal women who have not used hormone therapy in the past 3 months and experience ≥ 5 episodes of vasomotor symptoms daily. Methods An individual and a social support-based exercise intervention were evaluated. The former (Exercise-DVD), aimed to prompt exercise with purpose-designed DVD and written materials, whereas the latter (Exercise-Social support) with community exercise social support groups. Costs and outcomes associated with these interventions were compared to those of a control group, who could only have an exercise consultation. An incremental cost-utility analysis was undertaken using bootstrapping to account for the uncertainty around cost-effectiveness point-estimates. Main outcome measure Cost per quality-adjusted life-year (QALY). Results Data for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was £52 (CIs: £18 to £86) and £18 (CIs: -£68 to £105) more expensive per woman than the control group at 6 and 12 months post-randomisation and led to 0.006 (CIs: -0.002 to 0.014) and 0.013 (CIs: -0.01 to 0.036) more QALYs, resulting in an incremental cost-effectiveness ratio of £8,940 and £1,413 per QALY gained respectively. Exercise-Social support had 80%-90% probability of being cost-effective in the UK context. A societal perspective of analysis and a complete-case analysis led to similar findings. Conclusions Exercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms. PMID:28949974

Econutrition and utilization of food-based approaches for nutritional health.

PubMed

Blasbalg, Tanya L; Wispelwey, Bram; Deckelbaum, Richard J

2011-03-01

Macronutrient and micronutrient deficiencies continue to have a detrimental impact in lower-income countries, with significant costs in morbidity, mortality, and productivity. Food is the primary source of the nutrients needed to sustain life, and it is the essential component that links nutrition, agriculture, and ecology in the econutrition framework. To present evidence and analysis of food-based approaches for improving nutritional and health outcomes in lower-income countries. Review of existing literature. The benefits of food-based approaches may include nutritional improvement, food security, cost-effectiveness, sustainability, and human productivity. Food-based approaches require additional inputs, including nutrition education, gender considerations, and agricultural planning. Although some forms of malnutrition can be addressed via supplements, food-based approaches are optimal to achieve sustainable solutions to multiple nutrient deficiencies.

Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

PubMed

Baltzer, H; Binhammer, P A

2013-08-01

In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

Pollution control: utility ships adapt for spill cleanups

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

Not Available

1986-02-01

A practical and cost effective approach to oil spill cleanup is being undertaken by Dutch companies. The approach involves constructing and equipping multi-use ships for pollution control. Usually, these ships are maintained in another type of service and come into use for spill cleanup only when needed. The use of these ships in pollution control is discussed.

Future of lignite resources: a life cycle analysis.

PubMed

Wang, Qingsong; Liu, Wei; Yuan, Xueliang; Zheng, Xiaoning; Zuo, Jian

2016-12-01

Lignite is a low-quality energy source which accounts for 13 % of China's coal reserves. It is imperative to improve the quality of lignite for large-scale utilization. To further explore and analyze the influence of various key processes on the environment and economic costs, a lignite drying and compression technology is evaluated using an integrated approach of life cycle assessment and life cycle costs. Results showed that lignite mining, direct air emissions, and electricity consumption have most significant impacts on the environment. An integrated evaluation of life cycle assessment and life cycle costs showed that the most significant contributor to the environmental impacts and economic costs was the lignite mining process. The impact of transportation and wastewater treatment process on the environment and economic costs was small enough to be ignored. Critical factors were identified for reducing the environmental and economic impacts of lignite drying and compression technology. These findings provide useful inputs for both industrial practice and policy making for exploitation, processing, and utilization of lignite resources.

Climate change adaptation in regulated water utilities

NASA Astrophysics Data System (ADS)

Vicuna, S.; Melo, O.; Harou, J. J.; Characklis, G. W.; Ricalde, I.

2017-12-01

Concern about climate change impacts on water supply systems has grown in recent years. However, there are still few examples of pro-active interventions (e.g. infrastructure investment or policy changes) meant to address plausible future changes. Deep uncertainty associated with climate impacts, future demands, and regulatory constraints might explain why utility planning in a range of contexts doesn't explicitly consider climate change scenarios and potential adaptive responses. Given the importance of water supplies for economic development and the cost and longevity of many water infrastructure investments, large urban water supply systems could suffer from lack of pro-active climate change adaptation. Water utilities need to balance the potential for high regret stranded assets on the one side, with insufficient supplies leading to potentially severe socio-economic, political and environmental failures on the other, and need to deal with a range of interests and constraints. This work presents initial findings from a project looking at how cities in Chile, the US and the UK are developing regulatory frameworks that incorporate utility planning under uncertainty. Considering for example the city of Santiago, Chile, recent studies have shown that although high scarcity cost scenarios are plausible, pre-emptive investment to guard from possible water supply failures is still remote and not accommodated by current planning practice. A first goal of the project is to compare and contrast regulatory approaches to utility risks considering climate change adaptation measures. Subsequently we plan to develop and propose a custom approach for the city of Santiago based on lessons learned from other contexts. The methodological approach combines institutional assessment of water supply regulatory frameworks with simulation-based decision-making under uncertainty approaches. Here we present initial work comparing the regulatory frameworks in Chile, UK and USA evaluating their ability to incorporate uncertain climate and other changes into long-term infrastructure investment planning. The potential for regulatory and financial adaptive measures is explored in addition to a discussion on evaluating their appropriateness via various modelling-based intervention decision-making approaches.

The utility of prescreening for hepatitis A in military recruits prior to vaccination.

PubMed

Hirota, William K; Duncan, Marten B; Hirota, William K; Tsuchida, Amy

2002-11-01

The U.S. Army administers the hepatitis A virus (HAV) vaccination for prophylaxis against HAV infection. There is little comparative data as to whether prescreening for previous HAV infection before immunization is less costly than universal vaccination. We designed a study to determine the prevalence of previous HAV infection in U.S. Army recruits and then perform a cost analysis. The cost analysis compared selective vaccination versus universal vaccination. Basic demographic information, including age, gender, geographic origin, and ethnicity, were collected after which patients were tested for HAV antibodies. A total of 1,332 individuals was prospectively enrolled with 183 individuals (13.74%) having evidence of previous HAV infection. Minority recruits were found to have a higher prevalence than Caucasian recruits (p = 0.0451. The cost analysis demonstrates that vaccination without prescreening was the least costly of two vaccination strategies for this cohort. To achieve current vaccination goals, all U.S. military recruits should be vaccinated without evaluation for previous HAV immunity.

Help My House Program Profile

EPA Pesticide Factsheets

Learn about Help My House, a program that helps participants reduce their utility bills by nearly 35 percent through low-cost loans for EE improvements. Learn more about the key features, approaches, funding sources, and achievements of this program.

Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs

PubMed Central

Lemos, Laurinda; Alegria, Carlos; Oliveira, Joana; Machado, Ana; Oliveira, Pedro; Almeida, Armando

2011-01-01

In idiopathic trigeminal neuralgia (TN) the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1) a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol]), (2) the association of gabapentin (GBP) and analgesic block of trigger-points with ropivacaine (ROP) (GBP+ROP protocol), and (3) a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol). Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols) from cases of idiopathic TN, or selected for MVD surgery (n = 22) due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS) and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug therapies, while after MDV surgery several patients showed important side effects. Data reinforce that, (1) TN patients should be carefully evaluated before choosing therapy for pain control, (2) different pharmacological approaches are available to initiate pain control at low costs, and (3) criteria for surgical interventions should be clearly defined due to important side effects, with the initial higher costs being strongly reduced with time. PMID:21941455

Cost reduction in space operations - Structuring a planetary program to minimize the annual funding requirement as opposed to minimizing the program runout cost

NASA Technical Reports Server (NTRS)

Herman, D. H.; Niehoff, J. C.; Spadoni, D. J.

1980-01-01

An approach is proposed for the structuring of a planetary mission set wherein the peak annual funding is minimized to meet the annual budget restraint. One aspect of the approach is to have a transportation capability that can launch a mission in any planetary opportunity; such capability can be provided by solar electric propulsion. Another cost reduction technique is to structure a mission test in a time sequenced fashion that could utilize essentially the same spacecraft for the implementation of several missions. A third technique would be to fulfill a scientific objective in several sequential missions rather than attempt to accomplish all of the objectives with one mission. The application of the approach is illustrated by an example involving the Solar Orbiter Dual Probe mission.

Low-cost computing and network communication for a point-of-care device to perform a 3-part leukocyte differential

NASA Astrophysics Data System (ADS)

Powless, Amy J.; Feekin, Lauren E.; Hutcheson, Joshua A.; Alapat, Daisy V.; Muldoon, Timothy J.

2016-03-01

Point-of-care approaches for 3-part leukocyte differentials (granulocyte, monocyte, and lymphocyte), traditionally performed using a hematology analyzer within a panel of tests called a complete blood count (CBC), are essential not only to reduce cost but to provide faster results in low resource areas. Recent developments in lab-on-a-chip devices have shown promise in reducing the size and reagents used, relating to a decrease in overall cost. Furthermore, smartphone diagnostic approaches have shown much promise in the area of point-of-care diagnostics, but the relatively high per-unit cost may limit their utility in some settings. We present here a method to reduce computing cost of a simple epi-fluorescence imaging system using a Raspberry Pi (single-board computer, <$40) to perform a 3-part leukocyte differential comparable to results from a hematology analyzer. This system uses a USB color camera in conjunction with a leukocyte-selective vital dye (acridine orange) in order to determine a leukocyte count and differential from a low volume (<20 microliters) of whole blood obtained via fingerstick. Additionally, the system utilizes a "cloud-based" approach to send image data from the Raspberry Pi to a main server and return results back to the user, exporting the bulk of the computational requirements. Six images were acquired per minute with up to 200 cells per field of view. Preliminary results showed that the differential count varied significantly in monocytes with a 1 minute time difference indicating the importance of time-gating to produce an accurate/consist differential.

The impact of pharmaceutical innovation on premature cancer mortality in Canada, 2000-2011.

PubMed

Lichtenberg, Frank R

2015-09-01

The premature cancer mortality rate has been declining in Canada, but there has been considerable variation in the rate of decline across cancer sites. I analyze the effect that pharmaceutical innovation had on premature cancer mortality in Canada during the period 2000-2011, by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger declines in the premature mortality rate, controlling for changes in the incidence rate. Premature mortality before age 75 is significantly inversely related to the cumulative number of drugs registered at least 10 years earlier. Since mean utilization of drugs that have been marketed for less than 10 years is only one-sixth as great as mean utilization of drugs that have been marketed for at least a decade, it is not surprising that premature mortality is strongly inversely related only to the cumulative number of drugs that had been registered at least ten years earlier. Premature mortality before age 65 and 55 is also strongly inversely related to the cumulative number of drugs that had been registered at least ten years earlier. None of the estimates of the effect of incidence on mortality are statistically significant. Controlling for the cumulative number of drugs, the cumulative number of chemical subgroups does not have a statistically significant effect on premature mortality. This suggests that drugs (chemical substances) within the same class (chemical subgroup) are not therapeutically equivalent. During the period 2000-2011, the premature (before age 75) cancer mortality rate declined by about 9 %. The estimates imply that, in the absence of pharmaceutical innovation during the period 1985-1996, the premature cancer mortality rate would have increased about 12 % during the period 2000-2011. A substantial decline in the "competing risk" of death from cardiovascular disease could account for this. The estimates imply that pharmaceutical innovation during the period 1985-1996 reduced the number of years of potential life lost to cancer before age 75 in 2011 by 105,366. The cost per life-year before age 75 gained from previous pharmaceutical innovation is estimated to have been 2730 USD. Most of the previously-registered drugs were off-patent by 2011, but evidence suggests that, even if these drugs had been sold at branded rather than generic prices, the cost per life-year gained would have been below 11,000 USD, a figure well below even the lowest estimates of the value of a life-year gained. The largest reductions in premature mortality occur at least a decade after drugs are registered, when their utilization increases significantly. This suggests that, if Canada is to obtain substantial additional reductions in premature cancer mortality in the future (a decade or more from now) at a modest cost, pharmaceutical innovation (registration of new drugs) is needed today.

Novel Three-Day, Community-Based, Nonpharmacological Group Intervention for Chronic Musculoskeletal Pain (COPERS): A Randomised Clinical Trial.

PubMed

Taylor, Stephanie J C; Carnes, Dawn; Homer, Kate; Kahan, Brennan C; Hounsome, Natalia; Eldridge, Sandra; Spencer, Anne; Pincus, Tamar; Rahman, Anisur; Underwood, Martin

2016-06-01

Chronic musculoskeletal pain is the leading cause of disability worldwide. The effectiveness of pharmacological treatments for chronic pain is often limited, and there is growing concern about the adverse effects of these treatments, including opioid dependence. Nonpharmacological approaches to chronic pain may be an attractive alternative or adjunctive treatment. We describe the effectiveness of a novel, theoretically based group pain management support intervention for chronic musculoskeletal pain. We conducted a multi-centre, pragmatic, randomised, controlled effectiveness and cost-effectiveness (cost-utility) trial across 27 general practices and community musculoskeletal services in the UK. We recruited 703 adults with musculoskeletal pain of at least 3 mo duration between August 1, 2011, and July 31, 2012, and randomised participants 1.33:1 to intervention (403) or control (300). Intervention participants were offered a participative group intervention (COPERS) delivered over three alternate days with a follow-up session at 2 wk. The intervention introduced cognitive behavioural approaches and was designed to promote self-efficacy to manage chronic pain. Controls received usual care and a relaxation CD. The primary outcome was pain-related disability at 12 mo (Chronic Pain Grade [CPG] disability subscale); secondary outcomes included the CPG disability subscale at 6 mo and the following measured at 6 and 12 mo: anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), pain acceptance (Chronic Pain Acceptance Questionnaire), social integration (Health Education Impact Questionnaire social integration and support subscale), pain-related self-efficacy (Pain Self-Efficacy Questionnaire), pain intensity (CPG pain intensity subscale), the census global health question (2011 census for England and Wales), health utility (EQ-5D-3L), and health care resource use. Analyses followed the intention-to-treat principle, accounted for clustering by course in the intervention arm, and used multiple imputation for missing or incomplete primary outcome data. The mean age of participants was 59.9 y, with 81% white, 67% female, 23% employed, 85% with pain for at least 3 y, and 23% on strong opioids. Symptoms of depression and anxiety were common (baseline mean HADS scores 7.4 [standard deviation 4.1] and 9.2 [4.6], respectively). Overall, 282 (70%) intervention participants met the predefined intervention adherence criterion. Primary outcome data were obtained from 88% of participants. There was no significant difference between groups in pain-related disability at 6 or 12 mo (12 mo: difference -1.0, intervention versus control, 95% CI -4.9 to 3.0), pain intensity, or the census global health question. Anxiety, depression, pain-related self-efficacy, pain acceptance, and social integration were better in the intervention group at 6 mo; at 12 mo, these differences remained statistically significant only for depression (-0.7, 95% CI -1.2 to -0.2) and social integration (0.8, 95% CI 0.4 to 1.2). Intervention participants received more analgesics than the controls across the 12 mo. The total cost of the course per person was £145 (US$214). The cost-utility analysis showed there to be a small benefit in terms of quality-adjusted life years (QALYs) (0.0325, 95% CI -0.0074 to 0.0724), and on the cost side the intervention was a little more expensive than usual care (i.e., £188 [US$277], 95% CI -£125 [-US$184] to £501 [US$738]), resulting in an incremental cost-effectiveness ratio of £5,786 (US$8,521) per QALY. Limitations include the fact that the intervention was relatively brief and did not include any physical activity components. While the COPERS intervention was brief, safe, and inexpensive, with a low attrition rate, it was not effective for reducing pain-related disability over 12 mo (primary outcome). For secondary outcomes, we found sustained benefits on depression and social integration at 6 and 12 mo, but there was no effect on anxiety, pain-related self-efficacy, pain acceptance, pain intensity, or the census global health question at 12 mo. There was some evidence that the intervention may be cost-effective based on a modest difference in QALYs between groups. ISRCTN Registry 24426731.

DSM and electric utility competitiveness: An Illinois perspective

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

Jackson, P.W.

1994-12-31

A predominant theme in the current electric utility industry literature is that competitive forces have emerged and may become more prominent. The wholesale bulk power market is alreadly competitive, as non-utility energy service providers already have had a significant impact on that market; this trend was accelerated by the Energy Policy Act of 1992. Although competition at the retail level is much less pervasive, electric utility customers increasingly have greater choice in selecting energy services. These choices may include, depending on the customer, the ability to self-generate, switch fuels, move to a new location, or rely more heavily on demand-sidemore » management as a means of controlling electric energy use. This paper explores the subject of how demand-side management (DSM) programs, which are often developed by a utility to satisfy resource requirements as a part of its least-cost planning process, can affect the utility`s ability to compete in the energy services marketplace. In this context, the term `DSM` is used in this paper to refer to those demand-side services and programs which provide resources to the utility`s system. Depending on one`s perspective, DSM programs (so defined) can be viewed either as an enhancement to the competitive position of a utility by enabling it to provide its customers with a broader menu of energy services, simultaneously satisfying the objectives of the utility as well as those of the customers, or as a detractor to a utility`s ability to compete. In the latter case, the concern is with respect to the potential for adverse rate impacts on customers who are not participants in DSM programs. The paper consists of an identification of the pros and cons of DSM as a competitive strategy, the tradeoff which can occur between the cost impacts and rate impacts of DSM, and an examination of alternative strategies for maximizing the utilization of DSM both as a resource and as a competitive strategy.« less

Costs and benefits of different methods of esophagectomy for esophageal cancer.

PubMed

Yanasoot, Alongkorn; Yolsuriyanwong, Kamtorn; Ruangsin, Sakchai; Laohawiriyakamol, Supparerk; Sunpaweravong, Somkiat

2017-01-01

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown's esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

Effect of remission definition on healthcare cost savings estimates for patients with rheumatoid arthritis treated with biologic therapies.

PubMed

Barnabe, Cheryl; Thanh, Nguyen Xuan; Ohinmaa, Arto; Homik, Joanne; Barr, Susan G; Martin, Liam; Maksymowych, Walter P

2014-08-01

Sustained remission in rheumatoid arthritis (RA) results in healthcare utilization cost savings. We evaluated the variation in estimates of savings when different definitions of remission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index (CDAI) ≤ 2.8, and Disease Activity Score-28 (DAS28) ≤ 2.6] are applied. The annual mean healthcare service utilization costs were estimated from provincial physician billing claims, outpatient visits, and hospitalizations, with linkage to clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm). Cost savings in patients who had a 1-year continuous period of remission were compared to those who did not, using 4 definitions of remission. In 1086 patients, sustained remission rates were 16.1% for DAS28, 8.8% for Boolean, 5.5% for CDAI, and 4.2% for SDAI. The estimated mean annual healthcare cost savings per patient achieving remission (relative to not) were SDAI $1928 (95% CI 592, 3264), DAS28 $1676 (95% CI 987, 2365), and Boolean $1259 (95% CI 417, 2100). The annual savings by CDAI remission per patient were not significant at $423 (95% CI -1757, 2602). For patients in DAS28, Boolean, and SDAI remission, savings were seen both in costs directly related to RA and its comorbidities, and in costs for non-RA-related conditions. The magnitude of the healthcare cost savings varies according to the remission definition used in classifying patient disease status. The highest point estimate for cost savings was observed in patients attaining SDAI remission and the least with the CDAI; confidence intervals for these estimates do overlap. Future pharmacoeconomic analyses should employ all response definitions in assessing the influence of treatment.

Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009.

PubMed

Hwang, Inuk; Shin, Dong Wook; Kang, Kyoung Hee; Yang, Hyung Kook; Kim, So Young; Park, Jong-Hyock

2016-01-01

The purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea. We studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558. In 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs. Average cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care.

Community exercise program use and changes in healthcare costs for older adults.

PubMed

Ackermann, Ronald T; Cheadle, Allen; Sandhu, Nirmala; Madsen, Linda; Wagner, Edward H; LoGerfo, James P

2003-10-01

Regular exercise is associated with many health benefits. Community-based exercise programs may increase exercise participation, but little is known about cost implications. A retrospective, matched cohort study was conducted to determine if changes in healthcare costs for Medicare-eligible adults who choose to participate in a community-based exercise program were different from similar individuals who did not participate. Exercise program participants included 1114 adults aged > or = 65 years, who were continuously enrolled in Group Health Cooperative of Puget Sound (GHC) between October 1, 1997 and December 31, 2000 and who participated in the Lifetime Fitness (exercise) Program Copyright (LFP) at least once; three GHC enrollees who never attended LFP were randomly selected as controls for each participant by matching on age and gender. Cost and utilization estimates from GHC administrative data for the time from LFP enrollment to December 31, 2000 were compared using multivariable regression models. The average increase in annual total healthcare costs was less in participants compared to controls (+642 dollars vs +1175 dollars; p=0.05). After adjusting for differences in age, gender, enrollment date, comorbidity index, and pre-exposure cost and utilization levels, total healthcare costs for participants were 94.1% (95% confidence interval [CI], 85.6%-103.5%) of control costs. However, for participants who attended the exercise program at an average rate of > or = 1 visit weekly, total adjusted follow-up costs were 79.3% (95% CI, 71.3%-88.2%) of controls. Including a community exercise program as a health insurance benefit shows promise as a strategy for helping some Medicare-eligible adults to improve their health through exercise.

An Enhanced MEMS Error Modeling Approach Based on Nu-Support Vector Regression

PubMed Central

Bhatt, Deepak; Aggarwal, Priyanka; Bhattacharya, Prabir; Devabhaktuni, Vijay

2012-01-01

Micro Electro Mechanical System (MEMS)-based inertial sensors have made possible the development of a civilian land vehicle navigation system by offering a low-cost solution. However, the accurate modeling of the MEMS sensor errors is one of the most challenging tasks in the design of low-cost navigation systems. These sensors exhibit significant errors like biases, drift, noises; which are negligible for higher grade units. Different conventional techniques utilizing the Gauss Markov model and neural network method have been previously utilized to model the errors. However, Gauss Markov model works unsatisfactorily in the case of MEMS units due to the presence of high inherent sensor errors. On the other hand, modeling the random drift utilizing Neural Network (NN) is time consuming, thereby affecting its real-time implementation. We overcome these existing drawbacks by developing an enhanced Support Vector Machine (SVM) based error model. Unlike NN, SVMs do not suffer from local minimisation or over-fitting problems and delivers a reliable global solution. Experimental results proved that the proposed SVM approach reduced the noise standard deviation by 10–35% for gyroscopes and 61–76% for accelerometers. Further, positional error drifts under static conditions improved by 41% and 80% in comparison to NN and GM approaches. PMID:23012552

Capitation of public mental health services in Colorado: a five-year follow-up of system-level effects.

PubMed

Bloom, Joan R; Wang, Huihui; Kang, Soo Hyang; Wallace, Neal T; Hyun, Jenny K; Hu, Teh-wei

2011-02-01

Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs. Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995-1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates. Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reductions in cost per user for both outpatient services and total services. In the not-for-profit programs, there were no significant changes in cost per user for total services; a significant reduction in cost per user for outpatient services was found only in the first two years, 1995 and 1996). The evidence suggests that different strategies were used by the not-for-profit and for-profit programs to control expenditures and utilization and that the for-profit programs were more successful in reducing cost per user.

Explicit least squares system parameter identification for exact differential input/output models

NASA Technical Reports Server (NTRS)

Pearson, A. E.

1993-01-01

The equation error for a class of systems modeled by input/output differential operator equations has the potential to be integrated exactly, given the input/output data on a finite time interval, thereby opening up the possibility of using an explicit least squares estimation technique for system parameter identification. The paper delineates the class of models for which this is possible and shows how the explicit least squares cost function can be obtained in a way that obviates dealing with unknown initial and boundary conditions. The approach is illustrated by two examples: a second order chemical kinetics model and a third order system of Lorenz equations.

Optimization Based Data Mining Approah for Forecasting Real-Time Energy Demand

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

Omitaomu, Olufemi A; Li, Xueping; Zhou, Shengchao

The worldwide concern over environmental degradation, increasing pressure on electric utility companies to meet peak energy demand, and the requirement to avoid purchasing power from the real-time energy market are motivating the utility companies to explore new approaches for forecasting energy demand. Until now, most approaches for forecasting energy demand rely on monthly electrical consumption data. The emergence of smart meters data is changing the data space for electric utility companies, and creating opportunities for utility companies to collect and analyze energy consumption data at a much finer temporal resolution of at least 15-minutes interval. While the data granularity providedmore » by smart meters is important, there are still other challenges in forecasting energy demand; these challenges include lack of information about appliances usage and occupants behavior. Consequently, in this paper, we develop an optimization based data mining approach for forecasting real-time energy demand using smart meters data. The objective of our approach is to develop a robust estimation of energy demand without access to these other building and behavior data. Specifically, the forecasting problem is formulated as a quadratic programming problem and solved using the so-called support vector machine (SVM) technique in an online setting. The parameters of the SVM technique are optimized using simulated annealing approach. The proposed approach is applied to hourly smart meters data for several residential customers over several days.« less

Using science and psychology to improve the dissemination and evaluation of scientific work.

PubMed

Buttliere, Brett T

2014-01-01

Here I outline some of what science can tell us about the problems in psychological publishing and how to best address those problems. First, the motivation behind questionable research practices is examined (the desire to get ahead or, at least, not fall behind). Next, behavior modification strategies are discussed, pointing out that reward works better than punishment. Humans are utility seekers and the implementation of current change initiatives is hindered by high initial buy-in costs and insufficient expected utility. Open science tools interested in improving science should team up, to increase utility while lowering the cost and risk associated with engagement. The best way to realign individual and group motives will probably be to create one, centralized, easy to use, platform, with a profile, a feed of targeted science stories based upon previous system interaction, a sophisticated (public) discussion section, and impact metrics which use the associated data. These measures encourage high quality review and other prosocial activities while inhibiting self-serving behavior. Some advantages of centrally digitizing communications are outlined, including ways the data could be used to improve the peer review process. Most generally, it seems that decisions about change design and implementation should be theory and data driven.

Research opportunities to advance solar energy utilization.

PubMed

Lewis, Nathan S

2016-01-22

Major developments, as well as remaining challenges and the associated research opportunities, are evaluated for three technologically distinct approaches to solar energy utilization: solar electricity, solar thermal, and solar fuels technologies. Much progress has been made, but research opportunities are still present for all approaches. Both evolutionary and revolutionary technology development, involving foundational research, applied research, learning by doing, demonstration projects, and deployment at scale will be needed to continue this technology-innovation ecosystem. Most of the approaches still offer the potential to provide much higher efficiencies, much lower costs, improved scalability, and new functionality, relative to the embodiments of solar energy-conversion systems that have been developed to date. Copyright © 2016, American Association for the Advancement of Science.

Decision support for operations and maintenance (DSOM) system

DOEpatents

Jarrell, Donald B [Kennewick, WA; Meador, Richard J [Richland, WA; Sisk, Daniel R [Richland, WA; Hatley, Darrel D [Kennewick, WA; Brown, Daryl R [Richland, WA; Keibel, Gary R [Richland, WA; Gowri, Krishnan [Richland, WA; Reyes-Spindola, Jorge F [Richland, WA; Adams, Kevin J [San Bruno, CA; Yates, Kenneth R [Lake Oswego, OR; Eschbach, Elizabeth J [Fort Collins, CO; Stratton, Rex C [Richland, WA

2006-03-21

A method for minimizing the life cycle cost of processes such as heating a building. The method utilizes sensors to monitor various pieces of equipment used in the process, for example, boilers, turbines, and the like. The method then performs the steps of identifying a set optimal operating conditions for the process, identifying and measuring parameters necessary to characterize the actual operating condition of the process, validating data generated by measuring those parameters, characterizing the actual condition of the process, identifying an optimal condition corresponding to the actual condition, comparing said optimal condition with the actual condition and identifying variances between the two, and drawing from a set of pre-defined algorithms created using best engineering practices, an explanation of at least one likely source and at least one recommended remedial action for selected variances, and providing said explanation as an output to at least one user.

Design project: Viper

NASA Technical Reports Server (NTRS)

Haithcock, Stephen; Koncak, Kyle; Neufang, Rich; Paufler, David; Snow, Russ; Wlad, Frank

1992-01-01

The design specification of the primary flight trainer are: must conform to F.A.R. 23, including the crashworthiness standards; is limited to two to four occupants; engine must be FAA certified; must comply with FAA standards for VFR and allow for upgrade to IFR flights; must be at least utility category with good spin recovery characteristics; must have a structural lifetime of at least 10,000 flight hours; capable of either of two training missions: climb to 5,000 ft., cruise 500 Nm. plus reserve, land, or climb to 1,000 ft. and descend ten cycles for landing practice, climb to 3,000 ft., maneuver at two g's for 15 minutes, cruise 100 Nm. and land; must have a cruise speed of at least 120 knots; must take-off or land on a runway no longer than 3,000 ft; and has a cost goal of $50,000, not including avionics, for production of 1,000 airplanes over a five year period.

Assessing the Quality of Economic Evaluations of FDA Novel Drug Approvals: A Systematic Review.

PubMed

Woersching, Alex L; Borrego, Matthew E; Raisch, Dennis W

2016-12-01

To systematically review and assess the quality of the novel drugs' economic evaluation literature in print during the drugs' early commercial availability following US regulatory approval. MEDLINE and the United Kingdom National Health Service Economic Evaluation Database were searched from 1946 through December 2011 for economic evaluations of the 50 novel drugs approved by the FDA in 2008 and 2009. The inclusion criteria were English-language, peer-reviewed, original economic evaluations (cost-utility, cost-effectiveness, cost-minimization, and cost-benefit analyses). We extracted and analyzed data from 36 articles considering 19 of the 50 drugs. Two reviewers assessed each publication's quality using the Quality of Health Economic Studies (QHES) instrument and summarized study quality on a 100-point scale. Study quality had a mean of 70.0 ± 16.2 QHES points. The only study characteristics associated with QHES score (with P < 0.05) were having used modeling or advanced statistics, 75.1 versus 61.9 without; using quality-adjusted life years as an outcome, 75.9 versus 64.7 without; and cost-utility versus cost-minimization analysis, 75.9 versus 58.7. Studies most often satisfied quality aspects about stating study design choices and least often satisfied aspects about justifying design choices. The reviewed literature considered a minority of the 2008-2009 novel drugs and had mixed study quality. Cost-effectiveness stakeholders might benefit from efforts to improve the quality and quantity of literature examining novel drugs. Editors and reviewers may support quality improvement by stringently imposing economic evaluation guidelines about justifying study design choices. © The Author(s) 2016.

POEM is a cost-effective procedure: cost-utility analysis of endoscopic and surgical treatment options in the management of achalasia.

PubMed

Miller, Heidi J; Neupane, Ruel; Fayezizadeh, Mojtaba; Majumder, Arnab; Marks, Jeffrey M

2017-04-01

Achalasia is a rare motility disorder of the esophagus. Treatment is palliative with the goal of symptom remission and slowing the progression of the disease. Treatment options include per oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LM) and endoscopic treatments such as pneumatic dilation (PD) and botulinum toxin type A injections (BI). We evaluate the economics and cost-effectiveness of treating achalasia. We performed cost analysis for POEM, LM, PD and BI at our institution from 2011 to 2015. Cost of LM was set to 1, and other procedures are presented as percentage change. Cost-effectiveness was calculated based on cost, number of interventions required for optimal results for dilations and injections and efficacy reported in the current literature. Incremental cost-effectiveness ratio was calculated by a cost-utility analysis using quality-adjusted life year gained, defined as a symptom-free year in a patient with achalasia. Average number of interventions required was 2.3 dilations or two injections for efficacies of 80 and 61 %, respectively. POEM cost 1.058 times the cost of LM, and PD and BI cost 0.559 and 0.448 times the cost of LM. Annual cost per cure over a period of 4 years for POEM, and LM were consistently equivalent, trending the same as PD although this has a lower initial cost. The cost per cure of BI remains stable over 3 years and then doubles. The cost-effectiveness of POEM and LM is equivalent. Myotomy, either surgical or endoscopic, is more cost-effective than BI due to high failure rates of the economical intervention. When treatment is being considered BI should be utilized in patients with less than 2-year life expectancy. Pneumatic dilations are cost-effective and are an acceptable approach to treatment of achalasia, although myotomy has a lower relapse rate and is cost-effective compared to PD after 2 years.

Balancing Army and endangered species concerns: Green vs. Green.

PubMed

McKee, M; Berrens, R P

2001-01-01

A number of endangered, threatened, or at-risk species have been identified on US Army training bases. Before further training is restricted or curtailed under provisions of the US Endangered Species Act (ESA), the Army can explore available proactive options for providing habitat protection and mitigation. This paper investigates the possibility of an Army habitat acquisition program to acquire (by lease or purchase) buffer zones of at-risk species' habitat around its bases and away from training. To identify the most cost-effective manner for acquiring habitat, auction market experiments are utilized for analyzing program design. Laboratory auction experiments provide a powerful and low-cost vehicle for investigating ex ante program design issues. We find the discriminative, as opposed to a uniform price, auction with a minimum quantity requirement to be the least-cost mechanism.

Computational Analysis of Nanoparticles-Molten Salt Thermal Energy Storage for Concentrated Solar Power Systems

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

Kumar, Vinod

2017-05-05

High fidelity computational models of thermocline-based thermal energy storage (TES) were developed. The research goal was to advance the understanding of a single tank nanofludized molten salt based thermocline TES system under various concentration and sizes of the particles suspension. Our objectives were to utilize sensible-heat that operates with least irreversibility by using nanoscale physics. This was achieved by performing computational analysis of several storage designs, analyzing storage efficiency and estimating cost effectiveness for the TES systems under a concentrating solar power (CSP) scheme using molten salt as the storage medium. Since TES is one of the most costly butmore » important components of a CSP plant, an efficient TES system has potential to make the electricity generated from solar technologies cost competitive with conventional sources of electricity.« less

Transmission and Distribution Efficiency Improvement Rearch and Development Survey.

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

Brooks, C.L.; Westinghouse Electric Corporation. Advanced Systems Technology.

Purpose of this study was to identify and quantify those technologies for improving transmission and distribution (T and D) system efficiency that could provide the greatest benefits for utility customers in the Pacific Northwest. Improving the efficiency of transmission and distribution systems offers a potential source of conservation within the utility sector. An extensive review of this field resulted in a list of 49 state-of-the-art technologies and 39 future technologies. Of these, 15 from the former list and 7 from the latter were chosen as the most promising and then submitted to an evaluative test - a modeled sample systemmore » for Benton County PUD, a utility with characteristics typical of a BPA customer system. Reducing end-use voltage on secondary distribution systems to decrease the energy consumption of electrical users when possible, called ''Conservation Voltage Reduction,'' was found to be the most cost effective state-of-the-art technology. Voltampere reactive (var) optimization is a similarly cost effective alternative. The most significant reduction in losses on the transmission and distribution system would be achieved through the replacement of standard transformers with high efficiency transformers, such as amorphous steel transformers. Of the future technologies assessed, the ''Distribution Static VAR Generator'' appears to have the greatest potential for technological breakthroughs and, therefore in time, commercialization. ''Improved Dielectric Materials,'' with a relatively low cost and high potential for efficiency improvement, warrant R and D consideration. ''Extruded Three-Conductor Cable'' and ''Six- and Twelve-Phase Transmission'' programs provide only limited gains in efficiency and applicability and are therefore the least cost effective.« less

Health economic evaluations comparing insulin glargine with NPH insulin in patients with type 1 diabetes: a systematic review

PubMed Central

2011-01-01

Background Compared to conventional human basal insulin (neutral protamine Hagedorn; NPH) the long-acting analogue insulin glargine (GLA) is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience. However, the unit costs of GLA exceed those of NPH. This study aims to systematically review the economic evidence comparing GLA with NPH in basal-bolus treatment (intensified conventional therapy; ICT) of type 1 diabetes in order to facilitate informed decision making in clinical practice and health policy. Methods A systematic literature search was performed for the period of January 1st 2000 to December 1st 2009 via Embase, Medline, the Cochrane Library, the databases GMS (German Medical Science) and DAHTA (Deutsche Agentur für Health Technology Assessment), and the abstract books of relevant international scientific congresses. Retrieved studies were reviewed based on predefined inclusion criteria, methodological and quality aspects. In order to allow comparison between studies, currencies were converted using purchasing power parities (PPP). Results A total of 7 health economic evaluations from 4 different countries fulfilled the predefined criteria: 6 modelling studies, all of them cost-utility analyses, and one claims data analysis with a cost-minimisation design. One cost-utility analysis showed dominance of GLA over NPH. The other 5 cost-utility analyses resulted in additional costs per quality adjusted life year (QALY) gained for GLA, ranging from € 3,859 to € 57,002 (incremental cost effectiveness ratio; ICER). The cost-minimisation analysis revealed lower annual diabetes-specific costs in favour of NPH from the perspective of the German Statutory Health Insurance (SHI). Conclusions The incremental cost-utility-ratios (ICER) show favourable values for GLA with considerable variation. If a willingness-to-pay threshold of £ 30,000 (National Institute of Clinical Excellence, UK) is adopted, GLA is cost-effective in 4 of 6 cost utility analyses (CUA) included. Thus insulin glargine (GLA) seems to offer good value for money. Comparability between studies is limited because of methodological and country specific aspects. The results of this review underline that evaluation of insulin therapy should use evidence on efficacy of therapy from information synthesis. The concept of relating utility decrements to fear of hypoglycaemia is a plausible approach but needs further investigation. Also future evaluations of basal-bolus insulin therapy should include costs of consumables such as needles for insulin injection as well as test strips and lancets for blood glucose self monitoring. PMID:21978524

Fast-Solving Quasi-Optimal LS-S3VM Based on an Extended Candidate Set.

PubMed

Ma, Yuefeng; Liang, Xun; Kwok, James T; Li, Jianping; Zhou, Xiaoping; Zhang, Haiyan

2018-04-01

The semisupervised least squares support vector machine (LS-S 3 VM) is an important enhancement of least squares support vector machines in semisupervised learning. Given that most data collected from the real world are without labels, semisupervised approaches are more applicable than standard supervised approaches. Although a few training methods for LS-S 3 VM exist, the problem of deriving the optimal decision hyperplane efficiently and effectually has not been solved. In this paper, a fully weighted model of LS-S 3 VM is proposed, and a simple integer programming (IP) model is introduced through an equivalent transformation to solve the model. Based on the distances between the unlabeled data and the decision hyperplane, a new indicator is designed to represent the possibility that the label of an unlabeled datum should be reversed in each iteration during training. Using the indicator, we construct an extended candidate set consisting of the indices of unlabeled data with high possibilities, which integrates more information from unlabeled data. Our algorithm is degenerated into a special scenario of the previous algorithm when the extended candidate set is reduced into a set with only one element. Two strategies are utilized to determine the descent directions based on the extended candidate set. Furthermore, we developed a novel method for locating a good starting point based on the properties of the equivalent IP model. Combined with the extended candidate set and the carefully computed starting point, a fast algorithm to solve LS-S 3 VM quasi-optimally is proposed. The choice of quasi-optimal solutions results in low computational cost and avoidance of overfitting. Experiments show that our algorithm equipped with the two designed strategies is more effective than other algorithms in at least one of the following three aspects: 1) computational complexity; 2) generalization ability; and 3) flexibility. However, our algorithm and other algorithms have similar levels of performance in the remaining aspects.

Post-operative bracing after pedicle screw fixation for thoracolumbar burst fractures: A cost-effectiveness study.

PubMed

Piazza, Matthew; Sinha, Saurabh; Agarwal, Prateek; Mallela, Arka; Nayak, Nikhil; Schuster, James; Stein, Sherman

2017-11-01

While frequently prescribed to patients following fixation for spine trauma, the utility of spinal orthoses during the post-operative period is poorly described in the literature. In this study, we calculated rates of reoperation and performed a decision analysis to determine the utility of bracing following pedicle screw fixation for thoracic and lumbar burst fractures. Pubmed was searched for articles published between 2005 and 2015 for terms related to pedicle screw fixation of thoracolumbar fractures. Additionally, a database of neurosurgical patients operated on within the authors institution was also used in the analysis. Incidences of significant adverse events (wound revision for either dehiscence or infection or re-operation for non-union or instability due to hardware failure) were determined. Pooled means and variances of reported parameters were obtained using a random-effects, inverse variance meta-analytic model for observational data. Utilities for surgical outcome and complications were assigned using previously published values. Of the 225 abstracts reviewed, 48 articles were included in the study, yielding a total of 1957 patients. After including patients from the institutional registry, together a total of 2081 patients were included in the final analysis, 1328 of whom were braced. Non-braced patients were older then braced patients, although this only approached significance (p=0.051). Braced patients had significantly lower rates of re-operation for non-union or clinically significant hardware failure (1.3% vs. 1.8%, p<0.001) although the groups had comparable rates of operative wound dehiscence and infection (p=1.000). These two approaches yielded comparable utility scores (p=0.120). Costs between braced and non-braced patients were comparable excluding the cost of the brace (p=0.256); hence, the added cost of the brace suggests that bracing post-operatively is not a cost effective measure. Bracing following operative stabilization of thoracolumbar fracture does not significantly improve stability, nor does it increase wound complications. Moreover, our data suggests that post-operative bracing may not be a cost-effective measure. Copyright © 2017. Published by Elsevier Ltd.

Carbon Capture and Utilization in the Industrial Sector.

PubMed

Psarras, Peter C; Comello, Stephen; Bains, Praveen; Charoensawadpong, Panunya; Reichelstein, Stefan; Wilcox, Jennifer

2017-10-03

The fabrication and manufacturing processes of industrial commodities such as iron, glass, and cement are carbon-intensive, accounting for 23% of global CO 2 emissions. As a climate mitigation strategy, CO 2 capture from flue gases of industrial processes-much like that of the power sector-has not experienced wide adoption given its high associated costs. However, some industrial processes with relatively high CO 2 flue concentration may be viable candidates to cost-competitively supply CO 2 for utilization purposes (e.g., polymer manufacturing, etc.). This work develops a methodology that determines the levelized cost ($/tCO 2 ) of separating, compressing, and transporting carbon dioxide. A top-down model determines the cost of separating and compressing CO 2 across 18 industrial processes. Further, the study calculates the cost of transporting CO 2 via pipeline and tanker truck to appropriately paired sinks using a bottom-up cost model and geo-referencing approach. The results show that truck transportation is generally the low-cost alternative given the relatively small volumes (ca. 100 kt CO 2 /a). We apply our methodology to a regional case study in Pennsylvania, which shows steel and cement manufacturing paired to suitable sinks as having the lowest levelized cost of capture, compression, and transportation.

Heuristic Approach for Configuration of a Grid-Tied Microgrid in Puerto Rico

NASA Astrophysics Data System (ADS)

Rodriguez, Miguel A.

The high rates of cost of electricity that consumers are being charged by the utility grid in Puerto Rico have created an energy crisis around the island. This situation is due to the island's dependence on imported fossil fuels. In order to aid in the transition from fossil-fuel based electricity into electricity from renewable and alternative sources, this research work focuses on reducing the cost of electricity for Puerto Rico through means of finding the optimal microgrid configuration for a set number of consumers from the residential sector. The Hybrid Optimization Modeling for Energy Renewables (HOMER) software, developed by NREL, is utilized as an aid in determining the optimal microgrid setting. The problem is also approached via convex optimization; specifically, an objective function C(t) is formulated in order to be minimized. The cost function depends on the energy supplied by the grid, the energy supplied by renewable sources, the energy not supplied due to outages, as well as any excess energy sold to the utility in a yearly manner. A term for considering the social cost of carbon is also considered in the cost function. Once the microgrid settings from HOMER are obtained, those are evaluated via the optimized function C( t), which will in turn assess the true optimality of the microgrid configuration. A microgrid to supply 10 consumers is considered; each consumer can possess a different microgrid configuration. The cost function C( t) is minimized, and the Net Present Value and Cost of Electricity are computed for each configuration, in order to assess the true feasibility. Results show that the greater the penetration of components into the microgrid, the greater the energy produced by the renewable sources in the microgrid, the greater the energy not supplied due to outages. The proposed method demonstrates that adding large amounts of renewable components in a microgrid does not necessarily translates into economic benefits for the consumer; in fact, there is a trade back between cost and addition of elements that must be considered. Any configurations which consider further increases in microgrid components will result in increased NPV and increased costs of electricity, which deem the configurations as unfeasible.

Controlled ecological life support system: Transportation analysis

NASA Technical Reports Server (NTRS)

Gustan, E.; Vinopal, T.

1982-01-01

This report discusses a study utilizing a systems analysis approach to determine which NASA missions would benefit from controlled ecological life support system (CELSS) technology. The study focuses on manned missions selected from NASA planning forecasts covering the next half century. Comparison of various life support scenarios for the selected missions and characteristics of projected transportation systems provided data for cost evaluations. This approach identified missions that derived benefits from a CELSS, showed the magnitude of the potential cost savings, and indicated which system or combination of systems would apply. This report outlines the analytical approach used in the evaluation, describes the missions and systems considered, and sets forth the benefits derived from CELSS when applicable.

Evaluating a novel tiered scarcity adjusted water budget and pricing structure using a holistic systems modelling approach.

PubMed

Sahin, Oz; Bertone, Edoardo; Beal, Cara; Stewart, Rodney A

2018-06-01

Population growth, coupled with declining water availability and changes in climatic conditions underline the need for sustainable and responsive water management instruments. Supply augmentation and demand management are the two main strategies used by water utilities. Water demand management has long been acknowledged as a least-cost strategy to maintain water security. This can be achieved in a variety of ways, including: i) educating consumers to limit their water use; ii) imposing restrictions/penalties; iii) using smart and/or efficient technologies; and iv) pricing mechanisms. Changing water consumption behaviours through pricing or restrictions is challenging as it introduces more social and political issues into the already complex water resources management process. This paper employs a participatory systems modelling approach for: (1) evaluating various forms of a proposed tiered scarcity adjusted water budget and pricing structure, and (2) comparing scenario outcomes against the traditional restriction policy regime. System dynamics modelling was applied since it can explicitly account for the feedbacks, interdependencies, and non-linear relations that inherently characterise the water tariff (price)-demand-revenue system. A combination of empirical water use data, billing data and customer feedback on future projected water bills facilitated the assessment of the suitability and likelihood of the adoption of scarcity-driven tariff options for a medium-sized city within Queensland, Australia. Results showed that the tiered scarcity adjusted water budget and pricing structure presented was preferable to restrictions since it could maintain water security more equitably with the lowest overall long-run marginal cost. Copyright © 2018 Elsevier Ltd. All rights reserved.

Algorithm-Based Fault Tolerance Integrated with Replication

NASA Technical Reports Server (NTRS)

Some, Raphael; Rennels, David

2008-01-01

In a proposed approach to programming and utilization of commercial off-the-shelf computing equipment, a combination of algorithm-based fault tolerance (ABFT) and replication would be utilized to obtain high degrees of fault tolerance without incurring excessive costs. The basic idea of the proposed approach is to integrate ABFT with replication such that the algorithmic portions of computations would be protected by ABFT, and the logical portions by replication. ABFT is an extremely efficient, inexpensive, high-coverage technique for detecting and mitigating faults in computer systems used for algorithmic computations, but does not protect against errors in logical operations surrounding algorithms.

Spacelab user implementation assessment study (software requirements analysis). Volume 1: Executive study

NASA Technical Reports Server (NTRS)

1976-01-01

The primary objective of this study was to develop an integrated approach for the development, implementation, and utilization of all software that is required to efficiently and cost-effectively support advanced technology laboratory flight and ground operations. It was recognized that certain aspects of the operations would be mandatory computerized services; computerization of other aspects would be optional. Thus, the analyses encompassed not only alternate computer utilization and implementations but trade studies of the programmatic effects of non-computerized versus computerized approaches to the operations. A general overview of the study is presented.

Model prototype utilization in the analysis of fault tolerant control and data processing systems

NASA Astrophysics Data System (ADS)

Kovalev, I. V.; Tsarev, R. Yu; Gruzenkin, D. V.; Prokopenko, A. V.; Knyazkov, A. N.; Laptenok, V. D.

2016-04-01

The procedure assessing the profit of control and data processing system implementation is presented in the paper. The reasonability of model prototype creation and analysis results from the implementing of the approach of fault tolerance provision through the inclusion of structural and software assessment redundancy. The developed procedure allows finding the best ratio between the development cost and the analysis of model prototype and earnings from the results of this utilization and information produced. The suggested approach has been illustrated by the model example of profit assessment and analysis of control and data processing system.

An empty toolbox? Changes in health plans' approaches for managing costs and care.

PubMed

Mays, Glen P; Hurley, Robert E; Grossman, Joy M

2003-02-01

To examine how health plans have changed their approaches for managing costs and utilization in the wake of the recent backlash against managed care. Semistructured interviews with health plan executives, employers, providers, and other health care decision makers in 12 metropolitan areas that were randomly selected to be nationally representative of communities with more than 200,000 residents. Longitudinal data were collected as part of the Community Tracking Study during three rounds of site visits in 1996-1997, 1998-1999, and 2000-2001. Interviews probed about changes in the design and operation of health insurance products--including provider contracting and network development, benefit packages, and utilization management processes--and about the rationale and perceived impact of these changes. Data from more than 850 interviews were coded, extracted, and analyzed using computerized text analysis software. Health plans have begun to scale back or abandon their use of selected managed care tools in most communities, with selective contracting and risk contracting practices fading most rapidly and completely. In turn, plans increasingly have sought cost savings by shifting costs to consumers. Some plans have begun to experiment with new provider networks, payment systems, and referral practices designed to lower costs and improve service delivery. These changes promise to lighten administrative and financial burdens for physicians and hospitals, but they also threaten to increase consumers' financial burdens.

Sparse partial least squares regression for simultaneous dimension reduction and variable selection

PubMed Central

Chun, Hyonho; Keleş, Sündüz

2010-01-01

Partial least squares regression has been an alternative to ordinary least squares for handling multicollinearity in several areas of scientific research since the 1960s. It has recently gained much attention in the analysis of high dimensional genomic data. We show that known asymptotic consistency of the partial least squares estimator for a univariate response does not hold with the very large p and small n paradigm. We derive a similar result for a multivariate response regression with partial least squares. We then propose a sparse partial least squares formulation which aims simultaneously to achieve good predictive performance and variable selection by producing sparse linear combinations of the original predictors. We provide an efficient implementation of sparse partial least squares regression and compare it with well-known variable selection and dimension reduction approaches via simulation experiments. We illustrate the practical utility of sparse partial least squares regression in a joint analysis of gene expression and genomewide binding data. PMID:20107611

A Study to Determine the Cost Advantage of Establishing an Internal Champus Partnership with Civilian Providers for the Delivery of Mental Health Services in the Catchment Area of the Naval Medical Clinic Annapolis, MD

DTIC Science & Technology

1992-06-12

DoD Instruction 6010.12, it is the policy of DoD that the Partnership Program be utilized to intergrate civilian and military health care resources (2...care programs, such as PPO’s, as alternative approaches for delivering mental health services due to their cost containment potential (Trauner, 32...government must fill the role of both payer and broker. The CHAMPUS Partnership Program represents an innovative attempt at approaching a system of managed

Proposed reliability cost model

NASA Technical Reports Server (NTRS)

Delionback, L. M.

1973-01-01

The research investigations which were involved in the study include: cost analysis/allocation, reliability and product assurance, forecasting methodology, systems analysis, and model-building. This is a classic example of an interdisciplinary problem, since the model-building requirements include the need for understanding and communication between technical disciplines on one hand, and the financial/accounting skill categories on the other. The systems approach is utilized within this context to establish a clearer and more objective relationship between reliability assurance and the subcategories (or subelements) that provide, or reenforce, the reliability assurance for a system. Subcategories are further subdivided as illustrated by a tree diagram. The reliability assurance elements can be seen to be potential alternative strategies, or approaches, depending on the specific goals/objectives of the trade studies. The scope was limited to the establishment of a proposed reliability cost-model format. The model format/approach is dependent upon the use of a series of subsystem-oriented CER's and sometimes possible CTR's, in devising a suitable cost-effective policy.

Impact of High-Deductible Health Plans on Health Care Utilization and Costs

PubMed Central

Waters, Teresa M; Chang, Cyril F; Cecil, William T; Kasteridis, Panagiotis; Mirvis, David

2011-01-01

Background High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model. Objective To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans. Data Claims and member data from a major insurer and zip code-level census data. Study Design Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls). Results In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan. Conclusions Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives. PMID:21029087

COPD exacerbation frequency and its association with health care resource utilization and costs.

PubMed

Dhamane, Amol D; Moretz, Chad; Zhou, Yunping; Burslem, Kate; Saverno, Kim; Jain, Gagan; Renda, Andrew; Kaila, Shuchita

2015-01-01

Chronic obstructive pulmonary disease (COPD) exacerbations account for a substantial proportion of COPD-related costs. To describe COPD exacerbation patterns and assess the association between exacerbation frequency and health care resource utilization (HCRU) and costs in patients with COPD in a Medicare population. A retrospective cohort study utilizing data from a large US national health plan was conducted including patients with a COPD diagnosis during January 1, 2007 to December 31, 2012, aged 40-89 years and continuously enrolled in a Medicare Advantage Prescription Drug plan. Exacerbation frequency, HCRU, and costs were assessed during a 24-month period following the first COPD diagnosis (follow-up period). Four cohorts were created based on exacerbation frequency (zero, one, two, and ≥three). HCRU and costs were compared among the four cohorts using chi-square tests and analysis of variance, respectively. A trend analysis was performed to assess the association between exacerbation frequency and costs using generalized linear models. Of the included 52,459 patients, 44.3% had at least one exacerbation; 26.3%, 9.5%, and 8.5% had one, two, and ≥three exacerbations in the 24-month follow-up period, respectively. HCRU was significantly different among cohorts (all P<0.001). In patients with zero, one, two, and ≥three exacerbations, the percentages of patients experiencing all-cause hospitalizations were 49.7%, 66.4%, 69.7%, and 77.8%, respectively, and those experiencing COPD-related hospitalizations were 0%, 40.4%, 48.1%, and 60.5%, respectively. Mean all-cause total costs (medical and pharmacy) were more than twofold greater in patients with ≥three exacerbations compared to patients with zero exacerbations ($27,133 vs $56,033; P<0.001), whereas a greater than sevenfold difference was observed in mean COPD-related total costs ($1,605 vs $12,257; P<0.001). COPD patients frequently experience exacerbations. Increasing exacerbation frequency is associated with a multiplicative increase in all-cause and COPD-related costs. This underscores the importance of identifying COPD patients at risk of having frequent exacerbations for appropriate disease management.

GaAs thin films and methods of making and using the same

DOEpatents

Boettcher, Shannon; Ritenour, Andrew; Boucher, Jason; Greenaway, Ann

2016-06-14

Disclosed herein are embodiments of methods for making GaAs thin films, such as photovoltaic GaAs thin films. The methods disclosed herein utilize sources, precursors, and reagents that do not produce (or require) toxic gas and that are readily available and relatively low in cost. In some embodiments, the methods are readily scalable for industrial applications and can provide GaAs thin films having properties that are at least comparable to or potentially superior to GaAs films obtained from conventional methods.

A Study to Determine the Optimal Feasible Model for the Quality Assurance/Risk Management Program at Naval Hospital, Bethesda

DTIC Science & Technology

1984-05-04

Assurance. Within the last half of this century and especially since the advent of Medicare and Medicaid, a number of forces and trends have been...force in the quality assurance movement. They have been especially concerned about costs, allegations of excessive utilization of services and...ell as teintra- S;L.%.4ce accivities. At least a portion of continuing educacion of irsezvice tra~nn :)u~ e the result of probleI ident ificati on

Schizophrenia: multi-attribute utility theory approach to selection of atypical antipsychotics.

PubMed

Bettinger, Tawny L; Shuler, Garyn; Jones, Donnamaria R; Wilson, James P

2007-02-01

Current guidelines/algorithms recommend atypical antipsychotics as first-line agents for the treatment of schizophrenia. Because there are extensive healthcare costs associated with the treatment of schizophrenia, many institutions and health systems are faced with making restrictive formulary decisions regarding the use of atypical antipsychotics. Often, medication acquisition costs are the driving force behind formulary decisions, while other treatment factors are not considered. To apply a multi-attribute utility theory (MAUT) analysis to aid in the selection of a preferred agent among the atypical antipsychotics for the treatment of schizophrenia. Five atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole) were selected as the alternative agents to be included in the MAUT analysis. The attributes identified for inclusion in the analysis were efficacy, adverse effects, cost, and adherence, with relative weights of 35%, 35%, 20%, and 10%, respectively. For each agent, attribute scores were calculated, weighted, and then summed to generate a total utility score. The agent with the highest total utility score was considered the preferred agent. Aripiprazole, with a total utility score of 75.8, was the alternative agent with the highest total utility score in this model. This was followed by ziprasidone, risperidone, and quetiapine, with total utility scores of 71.8, 69.0, and 65.9, respectively. Olanzapine received the lowest total utility score. A sensitivity analysis was performed and failed to displace aripiprazole as the agent with the highest total utility score. This model suggests that aripiprazole should be considered a preferred agent for the treatment of schizophrenia unless found to be otherwise inappropriate.

Multi-scale connectivity and graph theory highlight critical areas for conservation under climate change

USGS Publications Warehouse

Dilts, Thomas E.; Weisberg, Peter J.; Leitner, Phillip; Matocq, Marjorie D.; Inman, Richard D.; Nussear, Ken E.; Esque, Todd C.

2016-01-01

Conservation planning and biodiversity management require information on landscape connectivity across a range of spatial scales from individual home ranges to large regions. Reduction in landscape connectivity due changes in land-use or development is expected to act synergistically with alterations to habitat mosaic configuration arising from climate change. We illustrate a multi-scale connectivity framework to aid habitat conservation prioritization in the context of changing land use and climate. Our approach, which builds upon the strengths of multiple landscape connectivity methods including graph theory, circuit theory and least-cost path analysis, is here applied to the conservation planning requirements of the Mohave ground squirrel. The distribution of this California threatened species, as for numerous other desert species, overlaps with the proposed placement of several utility-scale renewable energy developments in the American Southwest. Our approach uses information derived at three spatial scales to forecast potential changes in habitat connectivity under various scenarios of energy development and climate change. By disentangling the potential effects of habitat loss and fragmentation across multiple scales, we identify priority conservation areas for both core habitat and critical corridor or stepping stone habitats. This approach is a first step toward applying graph theory to analyze habitat connectivity for species with continuously-distributed habitat, and should be applicable across a broad range of taxa.

Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

PubMed Central

Melloh, Markus; Röder, Christoph; Elfering, Achim; Theis, Jean-Claude; Müller, Urs; Staub, Lukas P; Aghayev, Emin; Zweig, Thomas; Barz, Thomas; Kohlmann, Thomas; Wieser, Simon; Jüni, Peter; Zwahlen, Marcel

2008-01-01

Background There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP) with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. Methods This study aims to examine if 1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP 2. Patient characteristics (work-related, psychological factors, etc.) and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc.) modify the outcome of treatment for CLBP 3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP. This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI) at baseline and after six months. The change in ODI will be the primary endpoint of this study. Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost data. Conclusion This study will provide evidence if differences across health care systems in the outcome of treatment of CLBP exist. It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. Furthermore, cost-utility differences will be identified for different groups of patients with CLBP. Main results of this study should be replicated in future studies on CLBP. PMID:18534034

Resource utilization and costs associated with the diagnostic evaluation of nonrefluxing primary hydronephrosis in infants.

PubMed

Akhavan, Ardavan; Shnorhavorian, Margarett; Garrison, Louis P; Merguerian, Paul A

2014-09-01

Long-term evaluation of postnatal nonrefluxing primary hydronephrosis presents a dilemma for urologists since most cases resolve without surgery. We report longitudinal resource utilization and costs associated with diagnostic evaluation of infants with isolated primary nonrefluxing hydronephrosis to determine the costs associated with diagnosing a surgical case, and we assess the implications using a cost-consequences analysis. A retrospective chart review was used to capture resource utilization for all patients younger than 6 months with hydronephrosis evaluated at our institution during a 5-year period. Infants with confounding urological diagnoses were excluded. Payer and societal perspectives were used. Costs were estimated from resource utilization, including radiographic imaging and clinical encounter types. Data were collected from first clinic visit until surgery or resolution or 3 years, whichever was shortest. Of 165 included patients surgical rates for hydronephrosis were 0% for grade I, 5% for grade II, 21% for grade III and 74% for grade IV. Median respective costs of identifying a single surgical case per increasing hydronephrosis grade 0 to IV were infinite, $37,600, $11,741 and $2,124 (p <0.001), respectively. Diagnostic evaluation of higher grades of hydronephrosis is significantly more productive in terms of identifying patients requiring surgery vs evaluation of patients with lower grade disease. In patients with grades I and II hydronephrosis a more abbreviated diagnostic strategy than the current standard of care may be warranted. For the population in this analysis we project that a less intensive approach could save about 24% of costs. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Patterns of pharmacotherapy and health care utilization and costs prior to total hip or total knee replacement in patients with osteoarthritis.

PubMed

Berger, Ariel; Bozic, Kevin; Stacey, Brett; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

2011-08-01

To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with <2 years of complete data prior to TKR or THR were excluded, as were those with evidence of other conditions for which TKR or THR may be performed (e.g., rheumatoid arthritis). We then examined patterns of health care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches. Copyright © 2011 by the American College of Rheumatology.

Techno-economic and thermodynamic analysis of pre-cooling systems at gaseous hydrogen refueling stations

DOE PAGES

Elgowainy, Amgad; Reddi, Krishna; Lee, Dong-Yeon; ...

2017-10-16

In this study, we conducted a techno-economic and thermodynamic analysis of precooling units (PCUs) at hydrogen refueling stations and developed a cost-minimizing design algorithm for the PCU observing the SAE J2601 refueling protocol for T40 stations. In so doing, we identified major factors that affect PCU cost and energy use. The hydrogen precooling energy intensity depends strongly on the station utilization rate, but approaches 0.3 kWh e/kg-H 2 at full utilization. In early fuel cell electric vehicle markets where utilization of the refueling capacity is low, the overhead cooling load (to keep the heat exchanger cold at -40°C) results inmore » significantly high PCU energy intensity because only a small amount of hydrogen is being dispensed. We developed a parameterized precooling energy intensity prediction formula as a function of the ambient temperature and station utilization rate. We also found that the Joule-Thomson effect of the flow control device introduces a significant increase in temperature upstream of the PCU’s heat exchanger (HX), which impacts the PCU design capacity. An optimal PCU (per dispenser, at 35°C HX inlet temperature) consists of a 13-kW refrigerator and a HX with 1400 kg of thermal mass (aluminum), which currently costs $70,000 (uninstalled). Finally, the total (installed) capital and operation cost of PCU at a fully utilized hydrogen refueling station adds $0.50/kg-H 2.« less

Techno-economic and thermodynamic analysis of pre-cooling systems at gaseous hydrogen refueling stations

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

Elgowainy, Amgad; Reddi, Krishna; Lee, Dong-Yeon

In this study, we conducted a techno-economic and thermodynamic analysis of precooling units (PCUs) at hydrogen refueling stations and developed a cost-minimizing design algorithm for the PCU observing the SAE J2601 refueling protocol for T40 stations. In so doing, we identified major factors that affect PCU cost and energy use. The hydrogen precooling energy intensity depends strongly on the station utilization rate, but approaches 0.3 kWh e/kg-H 2 at full utilization. In early fuel cell electric vehicle markets where utilization of the refueling capacity is low, the overhead cooling load (to keep the heat exchanger cold at -40°C) results inmore » significantly high PCU energy intensity because only a small amount of hydrogen is being dispensed. We developed a parameterized precooling energy intensity prediction formula as a function of the ambient temperature and station utilization rate. We also found that the Joule-Thomson effect of the flow control device introduces a significant increase in temperature upstream of the PCU’s heat exchanger (HX), which impacts the PCU design capacity. An optimal PCU (per dispenser, at 35°C HX inlet temperature) consists of a 13-kW refrigerator and a HX with 1400 kg of thermal mass (aluminum), which currently costs $70,000 (uninstalled). Finally, the total (installed) capital and operation cost of PCU at a fully utilized hydrogen refueling station adds $0.50/kg-H 2.« less

C/SCSC overview: approach, implementation, use. [Cost/Schedule Control Systems Criteria

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

Turf, Larry

1979-01-01

An overview of the Cost/Schedule Control System Criteria, known as C/SCS or C/S Squared is pesented. In the mid-1960s, several DOD service agencies embarked on a new performance measurement concept to track cost and schedule performance on major DOD programs. The performance measurement concept of C/SCS has expanded from DOD use to the Department of Energy (PMS), NASA (533 reports), and private industry such as shipbuilding, utilities, and construction. This paper describes the C/SCSC with the events leading to the C/SCS requirement, how to approach the requirement, and discusses implementing and using the system. Many government publications, directives, and instructionsmore » on the subject are listed in the publication.« less

Retrospective comparison of filgrastim plus plerixafor to other regimens for remobilization after primary mobilization failure: clinical and economic outcomes.

PubMed

Perkins, Janelle B; Shapiro, Jamie F; Bookout, Ryan N; Yee, Gary C; Anasetti, Claudio; Janssen, William E; Fernandez, Hugo F

2012-07-01

We performed a retrospective analysis to evaluate clinical and economic outcomes in patients receiving remobilization therapy after primary mobilization failure. Our primary endpoint was to compare filgrastim plus plerixafor to other regimens in their ability to collect a target cell dose of at least 2 million CD34+ cells/kg (cumulative). Of 96 consecutive patients who failed their primary mobilization therapy and in whom a second mobilization was attempted, remobilization consisted of filgrastim plus plerixafor (n = 38), filgrastim with or without sargramostim (n = 43), or chemotherapy plus filgrastim (n = 15), 84% of filgrastim/plerixafor patients were able to collect at least 2 million CD34+ cells/kg from both mobilizations, compared to 60% of patients mobilized with chemotherapy/filgrastim and 79% of the filgrastim ± sargramostim patients (P = 0.17). However, when combined with cells collected from the first mobilization, 53% of filgrastim/plerixafor patients reached the target of 2 million CD34+ cells in one apheresis, compared to 20% of those receiving chemotherapy/filgrastim and 28% of those receiving filgrastim ± sargramostim (P = 0.02). Resource utilization, mobilization drug costs, clinical care costs, and total costs were significantly different. We conclude that while filgrastim/plerixafor is the most efficient remobilization strategy, those clinical benefits may not translate into lower cost, especially when multiple days of plerixafor administration are required. Copyright © 2012 Wiley Periodicals, Inc.

Cost-sensitive AdaBoost algorithm for ordinal regression based on extreme learning machine.

PubMed

Riccardi, Annalisa; Fernández-Navarro, Francisco; Carloni, Sante

2014-10-01

In this paper, the well known stagewise additive modeling using a multiclass exponential (SAMME) boosting algorithm is extended to address problems where there exists a natural order in the targets using a cost-sensitive approach. The proposed ensemble model uses an extreme learning machine (ELM) model as a base classifier (with the Gaussian kernel and the additional regularization parameter). The closed form of the derived weighted least squares problem is provided, and it is employed to estimate analytically the parameters connecting the hidden layer to the output layer at each iteration of the boosting algorithm. Compared to the state-of-the-art boosting algorithms, in particular those using ELM as base classifier, the suggested technique does not require the generation of a new training dataset at each iteration. The adoption of the weighted least squares formulation of the problem has been presented as an unbiased and alternative approach to the already existing ELM boosting techniques. Moreover, the addition of a cost model for weighting the patterns, according to the order of the targets, enables the classifier to tackle ordinal regression problems further. The proposed method has been validated by an experimental study by comparing it with already existing ensemble methods and ELM techniques for ordinal regression, showing competitive results.

Economic evaluation of Avonex (interferon beta-Ia) in patients following a single demyelinating event.

PubMed

Iskedjian, Michael; Walker, John H; Gray, Trevor; Vicente, Colin; Einarson, Thomas R; Gehshan, Adel

2005-10-01

Interferon beta-Ia (Avonex) 30 microg, intramuscular (i.m.), once weekly is efficacious in delaying clinically definite multiple sclerosis (CDMS) following a single demyelinating event (SDE). This study determined the cost effectiveness of Avonex compared to current treatment in delaying the onset of CDMS. A cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) were performed from Ministry of Health (MoH) and societal perspectives. For CEA, the outcome of interest was time spent in the pre-CDMS state, termed monosymptomatic life years (MLY) gained. For CUA, the outcome was quality-adjusted monosymptomatic life years (QAMLY) gained. A Markov model was developed with transitional probabilities and utilities derived from the literature. Costs were reported in 2002 Canadian dollars. Costs and outcomes were discounted at 5%. The time horizon was 12 years for the CEA, and 15 years for the CUA. All uncertainties were tested via univariate and multivariate sensitivity analyses. In the CEA, the incremental cost of Avonex per ILYgained was $53110 and $44789 from MoH and societal perspectives, respectively. In the CUA, the incremental cost of Avonex per QAMLY gained was $227586 and $189286 from MoH and societal perspectives, respectively. Both models were sensitive to the probability of progressing to CDMS and the analytical time horizon. The CUA was sensitive to the utilities value. Avonex may be considered as a reasonably cost-effective approach to treatment of patients experiencing an SDE In addition, the overall incremental cost-effectiveness profile of Avonex improves if treatment is initiated in pre-CDMS rather than waiting until CDMS.

Curbing the costly trend: exploring the need for a progressive approach to the management of specialty pharmaceuticals under the medical benefit.

PubMed

Jacobs, Michael S; Johnson, Kjel A

2012-07-01

Specialty injectables and protein-based biologic therapies represent the fastest growing segment of the drug trend for many plan sponsors. Coupled with the decline in spending on traditional pharmaceuticals and so-called blockbuster drugs coming off patent, the upward trend of specialty drug spending continues at an unprecedented rate, precipitating a shift in the focus of payers who manage prescription drugs. To characterize the current and future specialty drug spending and describe contemporary trends among payers for managing cost and quality in this segment, as well as to elucidate the shortcomings of the current efforts and to explore a comprehensive approach for addressing the cost and quality concerns directly associated with specialty injectables and protein-based biologics through interrelated management interventions. Although a notable decrease in spending on traditional pharmaceuticals was realized in 2010, disproportionate increases in specialty drug utilization and cost per unit fueled the continuing growth of the injectable and biologic markets. Each course of these therapies can cost in the tens of thousands of dollars, and this upward trend of specialty spending represents an escalation of an already significant spending for payers, employers, and members. Beyond the high cost and growing utilization of specialty pharmaceuticals, current management efforts have been met with variable degrees of success and have often proved challenging and, in some cases, even counterproductive. Common interventions used by payers nationwide for addressing specialty drug spending trend include specialty drug formularies, provider reimbursement strategies, distribution channel management, benefit design modifications, utilization management, and operational and administrative improvements such as postclaim edits. Although often overlooked, appropriate implementation of these tactics, and the extent to which they are integrated with overall drug benefit management, are key to the success of the pharmaceutical management program. Conventional specialty pharmaceutical management initiatives offer promise in various areas, but incentives for the best protocols may be misaligned when they are applied individually. Conversely, a comprehensive approach that integrates effective components of the specialty pharmaceutical management interventions can improve the quality of care and control costs associated with these agents, with significant specialty drug management expertise and access to benchmarking data serving as the foundation for appropriate decision-making.

Benefit-cost estimation for alternative drinking water maximum contaminant levels

NASA Astrophysics Data System (ADS)

Gurian, Patrick L.; Small, Mitchell J.; Lockwood, John R.; Schervish, Mark J.

2001-08-01

A simulation model for estimating compliance behavior and resulting costs at U.S. Community Water Suppliers is developed and applied to the evaluation of a more stringent maximum contaminant level (MCL) for arsenic. Probability distributions of source water arsenic concentrations are simulated using a statistical model conditioned on system location (state) and source water type (surface water or groundwater). This model is fit to two recent national surveys of source waters, then applied with the model explanatory variables for the population of U.S. Community Water Suppliers. Existing treatment types and arsenic removal efficiencies are also simulated. Utilities with finished water arsenic concentrations above the proposed MCL are assumed to select the least cost option compatible with their existing treatment from among 21 available compliance strategies and processes for meeting the standard. Estimated costs and arsenic exposure reductions at individual suppliers are aggregated to estimate the national compliance cost, arsenic exposure reduction, and resulting bladder cancer risk reduction. Uncertainties in the estimates are characterized based on uncertainties in the occurrence model parameters, existing treatment types, treatment removal efficiencies, costs, and the bladder cancer dose-response function for arsenic.

A better way to evaluate remote monitoring programs in chronic disease care: receiver operating characteristic analysis.

PubMed

Brown Connolly, Nancy E

2014-12-01

This foundational study applies the process of receiver operating characteristic (ROC) analysis to evaluate utility and predictive value of a disease management (DM) model that uses RM devices for chronic obstructive pulmonary disease (COPD). The literature identifies a need for a more rigorous method to validate and quantify evidence-based value for remote monitoring (RM) systems being used to monitor persons with a chronic disease. ROC analysis is an engineering approach widely applied in medical testing, but that has not been evaluated for its utility in RM. Classifiers (saturated peripheral oxygen [SPO2], blood pressure [BP], and pulse), optimum threshold, and predictive accuracy are evaluated based on patient outcomes. Parametric and nonparametric methods were used. Event-based patient outcomes included inpatient hospitalization, accident and emergency, and home health visits. Statistical analysis tools included Microsoft (Redmond, WA) Excel(®) and MedCalc(®) (MedCalc Software, Ostend, Belgium) version 12 © 1993-2013 to generate ROC curves and statistics. Persons with COPD were monitored a minimum of 183 days, with at least one inpatient hospitalization within 12 months prior to monitoring. Retrospective, de-identified patient data from a United Kingdom National Health System COPD program were used. Datasets included biometric readings, alerts, and resource utilization. SPO2 was identified as a predictive classifier, with an optimal average threshold setting of 85-86%. BP and pulse were failed classifiers, and areas of design were identified that may improve utility and predictive capacity. Cost avoidance methodology was developed. RESULTS can be applied to health services planning decisions. Methods can be applied to system design and evaluation based on patient outcomes. This study validated the use of ROC in RM program evaluation.

Routeing of power lines through least-cost path analysis and multicriteria evaluation to minimise environmental impacts

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

Bagli, Stefano, E-mail: stefano.bagli@gecosistema.i; Geneletti, Davide, E-mail: davide.geneletti@ing.unitn.i; Center for International Development, Harvard University, 79 JFK Street, Cambridge, MA 02138

2011-04-15

Least-cost path analysis (LCPA) allows designers to find the 'cheapest' way to connect two locations within a cost surface, which can be computed by combining multiple criteria, and therefore by accounting for different issues (environmental impact, economic investment, etc.). This procedure can be easily implemented with modern Geographic Information System (GIS) technologies, and consequently it has been widely employed to support planning and design of different types of linear infrastructures, ranging from roads to pipelines. This paper presents an approach based on the integration of multicriteria evaluation (MCE) and LCPA to identify the most suitable route for a 132 kVmore » power line. Criteria such as cost, visibility, population density, and ecosystem naturalness were used for the analysis. Firstly, spatial MCE and LCPA were combined to generate cost surfaces, and to identify alternative paths. Subsequently, MCE was used to compare the alternatives, and rank them according to their overall suitability. Finally, a sensitivity analysis allowed the stability of the results to be tested and the most critical factors of the evaluation to be detected. The study found that small changes in the location of the power line start and end points can result in significantly different paths, and consequently impact levels. This suggested that planners should always consider alternative potential locations of terminals in order to identify the best path. Furthermore, it was shown that the use of different weight scenarios may help making the model adaptable to varying environmental and social contexts. The approach was tested on a real-world case study in north-eastern Italy.« less

Links between social environment and health care utilization and costs.

PubMed

Brault, Marie A; Brewster, Amanda L; Bradley, Elizabeth H; Keene, Danya; Tan, Annabel X; Curry, Leslie A

2018-01-01

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

Estimating the benefits of public health policies that reduce harmful consumption.

PubMed

Ashley, Elizabeth M; Nardinelli, Clark; Lavaty, Rosemarie A

2015-05-01

For products such as tobacco and junk food, where policy interventions are often designed to decrease consumption, affected consumers gain utility from improvements in lifetime health and longevity but also lose utility associated with the activity of consuming the product. In the case of anti-smoking policies, even though published estimates of gross health and longevity benefits are up to 900 times higher than the net consumer benefits suggested by a more direct willingness-to-pay estimation approach, there is little recognition in the cost-benefit and cost-effectiveness literature that gross estimates will overstate intrapersonal welfare improvements when utility losses are not netted out. This paper presents a general framework for analyzing policies that are designed to reduce inefficiently high consumption and provides a rule of thumb for the relationship between net and gross consumer welfare effects: where there exists a plausible estimate of the tax that would allow consumers to fully internalize health costs, the ratio of the tax to the per-unit long-term cost can provide an upper bound on the ratio of net to gross benefits. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost-effective analysis.

PubMed

Kim, Chong H; Simmons, Sierra C; Williams, Lance A; Staley, Elizabeth M; Zheng, X Long; Pham, Huy P

2017-11-01

The ADAMTS13 test distinguishes thrombotic thrombocytopenic purpura (TTP) from other thrombotic microangiopathies (TMAs). The PLASMIC score helps determine the pretest probability of ADAMTS13 deficiency. Due to inherent limitations of both tests, and potential adverse effects and cost of unnecessary treatments, we performed a cost-effectiveness analysis (CEA) investigating the benefits of incorporating an in-hospital ADAMTS13 test and/or PLASMIC score into our clinical practice. A CEA model was created to compare four scenarios for patients with TMAs, utilizing either an in-house or a send-out ADAMTS13 assay with or without prior risk stratification using PLASMIC scoring. Model variables, including probabilities and costs, were gathered from the medical literature, except for the ADAMTS13 send-out and in-house tests, which were obtained from our institutional data. If only the cost is considered, in-house ADAMTS13 test for patients with intermediate- to high-risk PLASMIC score is the least expensive option ($4,732/patient). If effectiveness is assessed as measured by the number of averted deaths, send-out ADAMTS13 test is the most effective. Considering the cost/effectiveness ratio, the in-house ADAMTS13 test in patients with intermediate- to high-risk PLASMIC score is the best option, followed by the in-house ADAMTS13 test without the PLASMIC score. In patients with clinical presentations of TMAs, having an in-hospital ADAMTS13 test to promptly establish the diagnosis of TTP appears to be cost-effective. Utilizing the PLASMIC score further increases the cost-effectiveness of the in-house ADAMTS13 test. Our findings indicate the benefit of having a rapid and reliable in-house ADAMTS13 test, especially in the tertiary medical center. © 2017 AABB.

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

Siddiqui, Afzal; Marnay, Chris

This paper examines a California-based microgrid s decision to invest in a distributed generation (DG) unit that operates on natural gas. While the long-term natural gas generation cost is stochastic, we initially assume that the microgrid may purchase electricity at a fixed retail rate from its utility. Using the real options approach, we find natural gas generating cost thresholds that trigger DG investment. Furthermore, the consideration of operational flexibility by the microgrid accelerates DG investment, while the option to disconnect entirely from the utility is not attractive. By allowing the electricity price to be stochastic, we next determine an investmentmore » threshold boundary and find that high electricity price volatility relative to that of natural gas generating cost delays investment while simultaneously increasing the value of the investment. We conclude by using this result to find the implicit option value of the DG unit.« less

Modeling a phosphorus credit trading program in an agricultural watershed.

PubMed

Corrales, Juliana; Naja, G Melodie; Bhat, Mahadev G; Miralles-Wilhelm, Fernando

2014-10-01

Water quality and economic models were linked to assess the economic and environmental benefits of implementing a phosphorus credit trading program in an agricultural sub-basin of Lake Okeechobee watershed, Florida, United States. The water quality model determined the effects of rainfall, land use type, and agricultural management practices on the amount of total phosphorus (TP) discharged. TP loadings generated at the farm level, reaching the nearby streams, and attenuated to the sub-basin outlet from all sources within the sub-basin, were estimated at 106.4, 91, and 85 mtons yr(-)(1), respectively. Almost 95% of the TP loadings reaching the nearby streams were attributed to agriculture sources, and only 1.2% originated from urban areas, accounting for a combined TP load of 87.9 mtons yr(-)(1). In order to compare a Least-Cost Abatement approach to a Command-and-Control approach, the most cost effective cap of 30% TP reduction was selected, and the individual allocation was set at a TP load target of 1.6 kg ha(-1) yr(-1) (at the nearby stream level). The Least-Cost Abatement approach generated a potential cost savings of 27% ($1.3 million per year), based on an optimal credit price of $179. Dairies (major buyer), ornamentals, row crops, and sod farms were identified as potential credit buyers, whereas citrus, improved pastures (major seller), and urban areas were identified as potential credit sellers. Almost 81% of the TP credits available for trading were exchanged. The methodology presented here can be adapted to deal with different forms of trading sources, contaminants, or other technologies and management practices. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Appropriate Use of Neuroimaging in the Diagnostic Work-Up of Dementia

PubMed Central

Bermingham, SL

2014-01-01

Background Structural brain imaging is often performed to establish the underlying causes of dementia. However, recommendations differ as to who should receive neuroimaging and whether computed tomography (CT) or magnetic resonance imaging (MRI) should be used. Objectives This study aimed to determine the cost-effectiveness in Ontario of offering structural imaging to all patients with mild to moderate dementia compared with offering it selectively according to guidelines from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCC). We compared the cost-effectiveness of CT and MRI as first-line strategies. Methods We performed a systematic literature search (2000 to 2013) to identify cost-effectiveness studies of clinical prediction rules and structural imaging modalities. Studies were assessed for quality and applicability to Ontario. We also developed a model to evaluate the cost-effectiveness of clinical guidelines (image all versus according to CCC) and modalities (CT versus MRI). Transition probabilities, utilities, and costs were obtained from published literature or expert opinion. Results were expressed in terms of costs and quality adjusted life years (QALYs). Results No relevant cost-effectiveness analyses were identified in the published literature. According to the base-case results of our model, the most effective and cost-effective strategy is to image patients who meet CCC criteria with CT and to follow-up with MRI for suspected cases of space-occupying lesions (SOL). However, the results were sensitive to the specificity of MRI for detecting vascular causes of dementia. At a specificity of 64%, the most cost-effective strategy is CCC followed by MRI. Limitations Studies used to estimate diagnostic accuracy were limited by a lack of a gold standard test for establishing the cause of dementia. The model does not include costs to patients and their families, nor does it account for patient preferences about diagnostic information. Conclusions Given the relative prevalence of vascular dementia and SOLs, and the improvement in QALYs associated with treatment, the strategy with the greatest combined sensitivity (CCC with CT followed by MRI for patients with SOLs) results in the greatest number of QALYs and is the least costly. Due to limitations in the clinical data and challenges in the interpretation of this evidence, the model should be considered a framework for assessing uncertainty in the evidence base rather than providing definitive answers to the research questions. Plain Language Summary There is wide debate about whether or not brain scans should routinely be used to assess patients with mild to moderate dementia. Proponents say that imaging is important to detect or rule out possible underlying causes of dementia, such as silent strokes and tumours. Opponents call for a more selective approach, considering the need for clinical judgement and the cost of the technology. Using data from published research, a model was developed to study the cost-effectiveness of different approaches to brain imaging for a hypothetical group of patients with dementia. The model compared 2 strategies: imaging all patients and imaging selectively based on clinical practice guidelines from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCC). It also compared 2 types of technology: computed tomography (CT) and magnetic resonance imaging (MRI). The results of the model depended on the accuracy of CT and MRI in diagnosing dementia caused by vascular disease. Unfortunately, because there is no “gold standard” approach to diagnosing dementia, interpreting the published research is challenging. Based on current evidence, in which diagnostic strategies are assessed using a mix of methods, the model showed that the most effective and least costly strategy is to image selectively according to the CCC guidelines, using CT first and then MRI as a follow-up for patients suspected of having space-occupying lesions such as tumours. However, if we assumed that MRI plus clinical assessment is the gold standard, then imaging all patients with MRI is the most cost-effective strategy, despite the higher cost of this technology. The model did not take into account the value that physicians, patients, and families place on having diagnostic information, even if effective treatment does not yet exist. The model was not able to answer the specific research questions with confidence, but it provides a framework for identifying areas where more research is needed to support decision-making in the diagnosis of dementia. PMID:24592297

Cost-utility analysis of the EVOLVO study on remote monitoring for heart failure patients with implantable defibrillators: randomized controlled trial.

PubMed

Zanaboni, Paolo; Landolina, Maurizio; Marzegalli, Maurizio; Lunati, Maurizio; Perego, Giovanni B; Guenzati, Giuseppe; Curnis, Antonio; Valsecchi, Sergio; Borghetti, Francesca; Borghi, Gabriella; Masella, Cristina

2013-05-30

Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f).

Cistern Performance for Stormwater Management in Camden, NJ - abstract

EPA Science Inventory

The Camden County Municipal Utilities Authority (CCMUA) installed different types of green infrastructure Stormwater Control Measures (SCMs) at locations around the city of Camden, NJ. The installed SCMs include cisterns. Cisterns provide a cost effective approach to reduce st...

Cistern Performance for Stormwater Management in Camden, NJ - presentation

EPA Science Inventory

The Camden County Municipal Utilities Authority (CCMUA) installed different types of green infrastructure Stormwater Control Measures (SCMs) at locations around the city of Camden, NJ. The installed SCMs include cisterns. Cisterns provide a cost effective approach to reduce st...

The Economic Impact of Acetabular Labral Tears: A Cost-effectiveness Analysis Comparing Hip Arthroscopic Surgery and Structured Rehabilitation Alone in Patients Without Osteoarthritis.

PubMed

Lodhia, Parth; Gui, Chengcheng; Chandrasekaran, Sivashankar; Suarez-Ahedo, Carlos; Dirschl, Douglas R; Domb, Benjamin G

2016-07-01

Hip arthroscopic surgery has emerged as a successful procedure to manage acetabular labral tears and concurrent hip injuries, which if left untreated, may contribute to hip osteoarthritis (OA). Therefore, it is essential to analyze the economic impact of this treatment option. To investigate the cost-effectiveness of hip arthroscopic surgery versus structured rehabilitation alone for acetabular labral tears, to examine the effects of age on cost-effectiveness, and to estimate the rate of symptomatic OA and total hip arthroplasty (THA) in both treatment arms over a lifetime horizon. Economic and decision analysis; Level of evidence, 2. A cost-effectiveness analysis of hip arthroscopic surgery compared with structured rehabilitation for symptomatic labral tears was performed using a Markov decision model constructed over a lifetime horizon. It was assumed that patients did not have OA. Direct costs (in 2014 United States dollars), utilities of health states (in quality-adjusted life years [QALYs] gained), and probabilities of transitioning between health states were estimated from a comprehensive literature review. Costs were estimated using national averages of Medicare reimbursements, adjusted for all payers in the United States from a societal perspective. Utilities were estimated from the Harris Hip Score. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to determine the effect of uncertainty on the model outcomes. For a cohort representative of patients undergoing hip arthroscopic surgery at our facility, arthroscopic surgery was more costly (additional $2653) but generated more utility (additional 3.94 QALYs) compared with rehabilitation over a lifetime. The mean ICER was $754/QALY, well below the conventional willingness to pay of $50,000/QALY. Arthroscopic surgery was cost-effective for 94.5% of patients. Although arthroscopic surgery decreased in cost-effectiveness with increasing age, arthroscopic surgery remained more cost-effective than rehabilitation for patients in the second to seventh decades of life. The lifetime incidence of symptomatic hip OA was over twice as high for patients treated with rehabilitation compared with arthroscopic surgery. The preferred treatment was sensitive to the utility after successful hip arthroscopic surgery, although the utility at which arthroscopic surgery becomes less cost-effective than rehabilitation is far below our best estimate. For older patients, the lifetime cost of arthroscopic surgery was greater, while the lifetime utility of arthroscopic surgery was less, approaching that of the rehabilitation arm. Hip arthroscopic surgery is more cost-effective and results in a considerably lower incidence of symptomatic OA than structured rehabilitation alone in treating symptomatic labral tears of patients in the second to seventh decades of life without pre-existing OA. © 2016 The Author(s).

ACA-mandated elimination of cost sharing for preventive screening has had limited early impact.

PubMed

Mehta, Shivan J; Polsky, Daniel; Zhu, Jingsan; Lewis, James D; Kolstad, Jonathan T; Loewenstein, George; Volpp, Kevin G

2015-07-01

The Affordable Care Act eliminated patient cost sharing for evidence-based preventive care, yet the impact of this policy on colonoscopy and mammography rates is unclear. We examined the elimination of cost sharing among small business beneficiaries of Humana, a large national insurer. This was a retrospective interrupted time series analysis of whether the change in cost-sharing policy was associated with a change in screening utilization, using grandfathered plans as a comparison group. We compared beneficiaries in small business nongrandfathered plans that were required to eliminate cost sharing (intervention) with those in grandfathered plans that did not have to change cost sharing (control). There were 63,246 men and women aged 50 to 64 years eligible for colorectal cancer screening, and 30,802 women aged 50 to 64 years eligible for breast cancer screening. The primary outcome variables were rates of colonoscopy and mammography per person-month, with secondary analysis of colonoscopy rates coded as preventive only. There was no significant change in the level or slope of colonoscopy and mammography utilization for intervention plans relative to the control plans. There was also no significant relevant change among those colonoscopies coded as preventive. The results suggest that the implementation of the policy is not having its intended effects, as cost sharing rates for colonoscopy and mammography did not change substantially, and utilization of colonoscopy and mammography changed little, following this new policy approach.

Diversity, social justice, and intersectionality trends in C/MFT: a content analysis of three family therapy journals, 2004-2011.

PubMed

Seedall, Ryan B; Holtrop, Kendal; Parra-Cardona, José Ruben

2014-04-01

In this study, we analyzed the amount of attention given to diversity, social justice, and an intersectional approach to social inequalities over an 8-year period (769 articles) in three family therapy journals. Overall, 28.1% of articles addressed at least one diversity issue, and a social justice framework was utilized in 48.1% of diversity articles. A systemic, intersectional approach to conceptualizing and analyzing multiple social inequalities was utilized in 17.6% of diversity articles. The most common goals addressed in diversity articles, articles using a social justice framework, and articles using an intersectional approach are also identified. Findings indicate that, despite important work being carried out, more work remains to further identify how addressing diversity issues can improve client outcomes. © 2013 American Association for Marriage and Family Therapy.

Resource utilization, costs and treatment patterns of switching and discontinuing treatment of MS patients with high relapse activity.

PubMed

Raimundo, Karina; Tian, Haijun; Zhou, Huanxue; Zhang, Xin; Kahler, Kristijan H; Agashivala, Neetu; Kim, Edward

2013-04-08

Multiple sclerosis (MS) is a chronic disease that affects mainly adults in the prime of their lives. However, few studies report the impact of high annual relapse rates on outcomes. The purpose of this study was to identify high relapse activity (HRA) in patients with MS, comparing differences in outcomes between patients with and without HRA. A retrospective longitudinal study was conducted using the MarketScan® Commercial Claims and Encounters and Medicare Supplemental Database. Patients had to have at least one ICD-9 for MS (340.XX) in 2009 and one in 2008, be older than 18 years, and have continuous enrolment in the years 2009-2010. HRA was defined as having ≥2 relapses in 2009. Multivariate analyses compared all-cause and MS-specific emergency room (ER) visits, hospitalizations, and all-cause costs, excluding disease modifying therapy (DMT) costs, in 2010 between patients with and without HRA, controlling for baseline characteristics. A subgroup analysis using treatment exposure was also performed. 19,219 patients were included: 5.3% (n=1,017) had ≥2 relapses in 2009. Patients with HRA were more likely to have all-cause and MS-specific resource utilization than patients without HRA. Mean total all-cause non DMT costs were $12,057 higher for the HRA group. In the subgroup analysis, HRA treatment-naïve patients were more likely to start treatment, and HRA treatment-experienced patients were more likely to discontinue or switch index DMT (P<0.01). Patients with ≥2 relapses annually have higher resource utilization and costs. The difference in cost was over twice as large in treatment-naïve patients versus treatment-experienced patients. HRA was also associated with an increased likelihood of starting DMT treatment (treatment-naïve patients), and switching or discontinuing DMT therapy (treatment-experienced patients).

Reliability and cost evaluation of small isolated power systems containing photovoltaic and wind energy

NASA Astrophysics Data System (ADS)

Karki, Rajesh

Renewable energy application in electric power systems is growing rapidly worldwide due to enhanced public concerns for adverse environmental impacts and escalation in energy costs associated with the use of conventional energy sources. Photovoltaics and wind energy sources are being increasingly recognized as cost effective generation sources. A comprehensive evaluation of reliability and cost is required to analyze the actual benefits of utilizing these energy sources. The reliability aspects of utilizing renewable energy sources have largely been ignored in the past due the relatively insignificant contribution of these sources in major power systems, and consequently due to the lack of appropriate techniques. Renewable energy sources have the potential to play a significant role in the electrical energy requirements of small isolated power systems which are primarily supplied by costly diesel fuel. A relatively high renewable energy penetration can significantly reduce the system fuel costs but can also have considerable impact on the system reliability. Small isolated systems routinely plan their generating facilities using deterministic adequacy methods that cannot incorporate the highly erratic behavior of renewable energy sources. The utilization of a single probabilistic risk index has not been generally accepted in small isolated system evaluation despite its utilization in most large power utilities. Deterministic and probabilistic techniques are combined in this thesis using a system well-being approach to provide useful adequacy indices for small isolated systems that include renewable energy. This thesis presents an evaluation model for small isolated systems containing renewable energy sources by integrating simulation models that generate appropriate atmospheric data, evaluate chronological renewable power outputs and combine total available energy and load to provide useful system indices. A software tool SIPSREL+ has been developed which generates risk, well-being and energy based indices to provide realistic cost/reliability measures of utilizing renewable energy. The concepts presented and the examples illustrated in this thesis will help system planners to decide on appropriate installation sites, the types and mix of different energy generating sources, the optimum operating policies, and the optimum generation expansion plans required to meet increasing load demands in small isolated power systems containing photovoltaic and wind energy sources.

A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program.

PubMed

Gomez, Marta; Reddy, Amanda L; Dixon, Sherry L; Wilson, Jonathan; Jacobs, David E

Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for patients with poorly controlled asthma or who may be at risk for poor asthma control, to include services that address triggers in the home environment.

The impact of surgeon choice on the cost of performing laparoscopic appendectomy.

PubMed

Chu, Thomas; Chandhoke, Ryan A; Smith, Paul C; Schwaitzberg, Steven D

2011-04-01

While laparoscopic appendectomy (LA) can be performed using a myriad of techniques, the cost of each method varies. The purpose of this study is to analyze the effects of surgeon choice of technique on the cost of key steps in LA. Surgeon operative notes, hospital invoice lists, and surgeon instrumentation preference sheets were obtained for all LA cases in 2008 at Cambridge Health Alliance (CHA). Only cases (N = 89) performed by fulltime staff general surgeons (N = 8) were analyzed. Disposable costs were calculated for the following components of LA: port access, mesoappendix division, and management of the appendiceal stump. The actual cost of each disposable was determined based on the hospital's materials management database. Actual hospital reimbursements for LA in 2008 were obtained for all payers and compared with the disposable cost per case. Disposable cost per case for the three portions analyzed for 126 theoretical models were calculated and found to range from US $81 to US $873. The surgeon with the most cost-effective preferred method (US $299) utilized one multi-use endoscopic clip applier for mesoappendix division, two commercially available pretied loops for management of the appendiceal stump, and three 5-mm trocars as their preferred technique. The surgeon with the least cost-effective preferred method (US $552) utilized two staple firings for mesoappendix division, one staple firing for management of the appendiceal stump, and 12/5/10-mm trocars for access. The two main payers for LA patients were Medicaid and Health Safety Net, whose total hospital reimbursements ranged from US $264 to US $504 and from US $0 to US $545 per case, respectively, for patients discharged on day 1. Disposable costs frequently exceeded hospital reimbursements. Currently, there is no scientific literature that clearly illustrates a superior surgical method for performing these portions of LA in routine cases. This study suggests that surgeons should review the cost implications of their practice and to find ways to provide the most cost-effective care without jeopardizing clinical outcome.

Processor Would Find Best Paths On Map

NASA Technical Reports Server (NTRS)

Eberhardt, Silvio P.

1990-01-01

Proposed very-large-scale integrated (VLSI) circuit image-data processor finds path of least cost from specified origin to any destination on map. Cost of traversal assigned to each picture element of map. Path of least cost from originating picture element to every other picture element computed as path that preserves as much as possible of signal transmitted by originating picture element. Dedicated microprocessor at each picture element stores cost of traversal and performs its share of computations of paths of least cost. Least-cost-path problem occurs in research, military maneuvers, and in planning routes of vehicles.

Incremental cost of postacute care in nursing homes.

PubMed

Spector, William D; Limcangco, Maria Rhona; Ladd, Heather; Mukamel, Dana

2011-02-01

To determine whether the case mix index (CMI) based on the 53-Resource Utilization Groups (RUGs) captures all the cross-sectional variation in nursing home (NH) costs or whether NHs that have a higher percent of Medicare skilled care days (%SKILLED) have additional costs. DATA AND SAMPLE: Nine hundred and eighty-eight NHs in California in 2005. Data are from Medicaid cost reports, the Minimum Data Set, and the Economic Census. We estimate hybrid cost functions, which include in addition to outputs, case mix, ownership, wages, and %SKILLED. Two-stage least-square (2SLS) analysis was used to deal with the potential endogeneity of %SKILLED and CMI. On average 11 percent of NHs days were due to skilled care. Based on the 2SLS model, %SKILLED is associated with costs even when controlling for CMI. The marginal cost of a one percentage point increase in %SKILLED is estimated at U.S.$70,474 or about 1.2 percent of annual costs for the average cost facility. Subanalyses show that the increase in costs is mainly due to additional expenses for nontherapy ancillaries and rehabilitation. The 53-RUGs case mix does not account completely for all the variation in actual costs of care for postacute patients in NHs. © Health Research and Educational Trust.

Incremental Cost of Postacute Care in Nursing Homes

PubMed Central

Spector, William D; Limcangco, Maria Rhona; Ladd, Heather; Mukamel, Dana A

2011-01-01

Objectives To determine whether the case mix index (CMI) based on the 53-Resource Utilization Groups (RUGs) captures all the cross-sectional variation in nursing home (NH) costs or whether NHs that have a higher percent of Medicare skilled care days (%SKILLED) have additional costs. Data and Sample Nine hundred and eighty-eight NHs in California in 2005. Data are from Medicaid cost reports, the Minimum Data Set, and the Economic Census. Research Design We estimate hybrid cost functions, which include in addition to outputs, case mix, ownership, wages, and %SKILLED. Two-stage least-square (2SLS) analysis was used to deal with the potential endogeneity of %SKILLED and CMI. Results On average 11 percent of NHs days were due to skilled care. Based on the 2SLS model, %SKILLED is associated with costs even when controlling for CMI. The marginal cost of a one percentage point increase in %SKILLED is estimated at U.S.$70,474 or about 1.2 percent of annual costs for the average cost facility. Subanalyses show that the increase in costs is mainly due to additional expenses for nontherapy ancillaries and rehabilitation. Conclusion The 53-RUGs case mix does not account completely for all the variation in actual costs of care for postacute patients in NHs. PMID:21029085

Anti-social welfare functions: a reply to Hansen et al.

PubMed

Edlin, Richard

2004-09-01

We could reasonably expect society to give at least the same weight to the marginal utility of the poor as to the rich, and to the marginal utility of the ill as compared to the healthy. Whilst Hansen et al. [Journal of Health Economics (2004)], may be said to link CEA and CBA within a welfarist framework, the assumptions they require are inconsistent with these types of ethical preferences. Thus, the degree to which they employ a reasonable social welfare function is doubtful. This paper argues that any link between CEA and CBA will occur not within a welfarist framework but instead within a non-welfarist one in which it is unlikely that CBA results could be easily transformed into cost-effectiveness ratios.

Asymmetric Switch Costs in Numeral Naming and Number Word Reading: Implications for Models of Bilingual Language Production.

PubMed

Reynolds, Michael G; Schlöffel, Sophie; Peressotti, Francesca

2015-01-01

One approach used to gain insight into the processes underlying bilingual language comprehension and production examines the costs that arise from switching languages. For unbalanced bilinguals, asymmetric switch costs are reported in speech production, where the switch cost for L1 is larger than the switch cost for L2, whereas, symmetric switch costs are reported in language comprehension tasks, where the cost of switching is the same for L1 and L2. Presently, it is unclear why asymmetric switch costs are observed in speech production, but not in language comprehension. Three experiments are reported that simultaneously examine methodological explanations of task related differences in the switch cost asymmetry and the predictions of three accounts of the switch cost asymmetry in speech production. The results of these experiments suggest that (1) the type of language task (comprehension vs. production) determines whether an asymmetric switch cost is observed and (2) at least some of the switch cost asymmetry arises within the language system.

Asymmetric Switch Costs in Numeral Naming and Number Word Reading: Implications for Models of Bilingual Language Production

PubMed Central

Reynolds, Michael G.; Schlöffel, Sophie; Peressotti, Francesca

2016-01-01

One approach used to gain insight into the processes underlying bilingual language comprehension and production examines the costs that arise from switching languages. For unbalanced bilinguals, asymmetric switch costs are reported in speech production, where the switch cost for L1 is larger than the switch cost for L2, whereas, symmetric switch costs are reported in language comprehension tasks, where the cost of switching is the same for L1 and L2. Presently, it is unclear why asymmetric switch costs are observed in speech production, but not in language comprehension. Three experiments are reported that simultaneously examine methodological explanations of task related differences in the switch cost asymmetry and the predictions of three accounts of the switch cost asymmetry in speech production. The results of these experiments suggest that (1) the type of language task (comprehension vs. production) determines whether an asymmetric switch cost is observed and (2) at least some of the switch cost asymmetry arises within the language system. PMID:26834659

Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures.

PubMed

Yeung, Kai; Basu, Anirban; Hansen, Ryan N; Watkins, John B; Sullivan, Sean D

2017-02-01

Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments. The objective of the study was to determine the impact of the VBF. Interrupted time series of employer-sponsored plans from 2006 to 2013. Intervention group: 5235 beneficiaries exposed to the VBF. 11,171 beneficiaries in plans without any changes in pharmacy benefits. The VBF-assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers. Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and nonmedication expenditures. In the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) [95% confidence interval (CI), $1-$3] or 9%, whereas health plan medication expenditures decreased by $10 PMPM (CI, $18-$2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15-$2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days' supply (CI, 1.29-2.62) or 17%. Total medication utilization, health services utilization, and nonmedication expenditures did not change. Cost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.

Reducing barriers to older persons' use of dental services.

PubMed

Kiyak, H A

1989-06-01

In the United States elderly persons are the least likely of any age group to utilize dental services. With the increase in the elderly population and expansion of interest in their dental care, our understanding of the barriers to that care is particularly important. Studies have indicated that cost of treatment, fear of dentistry, functional independence and poor general health are of little significance in explaining the low utilization patterns of this age group. Perceived need seems to be the strongest predictor in deciding whether dental services are sought by an individual. Two programmes established by The University of Washington aimed to enhance the utilization of dental services by the elderly. One provided free screenings for over 65's on low incomes, coupled with a low cost dental care scheme. Although it was found that the convenient location of a dental clinic was a valuable incentive for the increased uptake of services, the difficulty remained one of patient perception of need. The second programme sought to overcome this latter problem by providing information on the importance of oral health to the independent elderly. This included a weekly class for small groups conducted by a health educator over a 6-week period together with a self-monitoring chart for each participant. It is anticipated that the heightened awareness aroused by this education programme will translate into perceived need and thus greater dental service utilization by the participants.

Healthcare professionals' perceptions of psychological treatment for chronic pain in Singapore: challenges, barriers, and the way forward.

PubMed

Yang, Su-Yin; Bogosian, Angeliki; Moss-Morris, Rona; McCracken, Lance M

2016-08-01

There are very few studies on healthcare providers' experiences of delivering treatment for chronic pain in a Southeast Asian setting. The aims of this study are to understand the experiences of professionals delivering treatment for people with chronic pain in Singapore and identify possible barriers to psychological treatment for this condition within the broader experiences of these professionals. Healthcare professionals with at least 1-year experience treating chronic pain were recruited and purposefully sampled. Fifteen inductive semi-structured interviews were conducted to explore healthcare professionals' experiences of treating people with chronic pain. Interviews were transcribed verbatim and analysed using thematic analysis. Four main themes were identified: 'System Barriers', 'Core Beliefs and management of Chronic Pain', 'Engaging Patients in treatment' and 'Creating Awareness for Chronic Pain Management'. Professionals trained in a multidisciplinary approach to pain management were seen as rare. Professionals who could refer patients for psychological treatment do not refer due to costs, and their perception that patients may lack understanding of such a treatment. Reducing barriers in the access to psychological treatment in settings like Singapore will require a multifaceted approach. Implications for Rehabilitation A multifaceted approach is required to reduce barriers to psychological treatment for chronic pain in settings like Singapore. Educating healthcare professionals on the need for a multidisciplinary approach to chronic pain could help in reducing misconceptions and increase understanding of the benefits of psychological approaches. Utilizing both media and technological platforms as a means to facilitate psychological treatment uptake for chronic pain may be a way forward for a technological savvy generation.

Effectiveness of recruitment to a smartphone-delivered nutrition intervention in New Zealand: analysis of a randomised controlled trial

PubMed Central

Volkova, Ekaterina; Michie, Jo; Corrigan, Callie; Sundborn, Gerhard; Eyles, Helen; Jiang, Yannan; Mhurchu, Cliona Ni

2017-01-01

Objectives Delivery of interventions via smartphone is a relatively new initiative in public health, and limited evidence exists regarding optimal strategies for recruitment. We describe the effectiveness of approaches used to recruit participants to a smartphone-enabled nutrition intervention trial. Methods Internet and social media advertising, mainstream media advertising and research team networks were used to recruit New Zealand adults to a fully automated smartphone-delivered nutrition labelling trial (no face-to-face visits were required). Recruitment of Māori and Pacific participants was a key focus and ethically relevant recruitment materials and approaches were used where possible. The effectiveness of recruitment strategies was evaluated using Google Analytics, monitoring of study website registrations and randomisations, and self-reported participant data. The cost of the various strategies and associations with participant demographics were assessed. Results Over a period of 13 months, there were 2448 registrations on the study website, and 1357 eligible individuals were randomised into the study (55%). Facebook campaigns were the most successful recruitment strategy overall (43% of all randomised participants) and for all ethnic groups (Māori 44%, Pacific 44% and other 43%). Significant associations were observed between recruitment strategy and age (p<0.001), household size (p<0.001), ethnicity (p<0.001), gender (p=0.005) and interest in healthy eating (p=0.022). Facebook campaigns resulted in the highest absolute numbers of study registrations and randomisations (966 and 584, respectively). Network strategies and Facebook campaigns cost least per randomised participant (NZ$4 and NZ$5, respectively), whereas radio advertising costs most (NZ$179 per participant). Conclusion Internet and social media advertising were the most effective and least costly approaches to recruiting participants to a smartphone-delivered trial. These approaches also reached diverse ethnic groups. However, more culturally appropriate recruitment strategies are likely to be necessary in studies where large numbers of participants from specific ethnic groups are sought. Trial registration ACTRN12614000644662; Post-results. PMID:28674144

The impact of differences in EQ-5D and SF-6D utility scores on the acceptability of cost-utility ratios: results across five trial-based cost-utility studies.

PubMed

Joore, Manuela; Brunenberg, Danielle; Nelemans, Patricia; Wouters, Emiel; Kuijpers, Petra; Honig, Adriaan; Willems, Danielle; de Leeuw, Peter; Severens, Johan; Boonen, Annelies

2010-01-01

This article investigates whether differences in utility scores based on the EQ-5D and the SF-6D have impact on the incremental cost-utility ratios in five distinct patient groups. We used five empirical data sets of trial-based cost-utility studies that included patients with different disease conditions and severity (musculoskeletal disease, cardiovascular pulmonary disease, and psychological disorders) to calculate differences in quality-adjusted life-years (QALYs) based on EQ-5D and SF-6D utility scores. We compared incremental QALYs, incremental cost-utility ratios, and the probability that the incremental cost-utility ratio was acceptable within and across the data sets. We observed small differences in incremental QALYs, but large differences in the incremental cost-utility ratios and in the probability that these ratios were acceptable at a given threshold, in the majority of the presented cost-utility analyses. More specifically, in the patient groups with relatively mild health conditions the probability of acceptance of the incremental cost-utility ratio was considerably larger when using the EQ-5D to estimate utility. While in the patient groups with worse health conditions the probability of acceptance of the incremental cost-utility ratio was considerably larger when using the SF-6D to estimate utility. Much of the appeal in using QALYs as measure of effectiveness in economic evaluations is in the comparability across conditions and interventions. The incomparability of the results of cost-utility analyses using different instruments to estimate a single index value for health severely undermines this aspect and reduces the credibility of the use of incremental cost-utility ratios for decision-making.

Strategies to Prevent Opioid Misuse, Abuse, and Diversion That May Also Reduce the Associated Costs

PubMed Central

Hahn, Kathryn L.

2011-01-01

Background The use of prescription opioid drugs has the potential to lead to patient abuse of these medications, addiction, and diversion. Such an abuse is associated with increased costs because of excessive healthcare utilization. Finding ways to minimize the risk for abuse and addiction can enhance patient outcomes and reduce costs to patients and to payers. Objective To review current strategies that may reduce the risk for misuse and abuse of opioid medications, which in turn can enhance patient outcomes and lower costs to health insurers and patients. Discussion Implementing approaches that will encourage the use of safe practices (universal precautions) in pain management by providers can reduce the risk for abuse and misuse associated with chronic pain medications, especially opioids. These approaches include, but are not limited to, extensive physician and patient education regarding these medications and their associated risks for abuse; the development of prescription monitoring programs to detect physician or pharmacy shopping; the detection of inappropriate prescribing and medical errors; the use of physician-patient contracts concerning opioid treatment; the requirement of presenting a photo identification to pick up an opioid prescription at the pharmacy; urine drug toxicology screening; provisions for safe disposal of unused opioids; referrals to pain and addiction specialists; and potentially encouraging the use of opioid formulations aimed at reducing abuse. Conclusion Supporting such approaches by health insurers and educating providers and patients on the risks associated with chronic pain medications can help minimize the risk of prescription opioid abuse, addiction, and diversion; reduce health services utilization associated with opioid abuse; improve patient outcomes; and reduce overall costs. PMID:25126342

Evaluating disease management programme effectiveness: an introduction to instrumental variables.

PubMed

Linden, Ariel; Adams, John L

2006-04-01

This paper introduces the concept of instrumental variables (IVs) as a means of providing an unbiased estimate of treatment effects in evaluating disease management (DM) programme effectiveness. Model development is described using zip codes as the IV. Three diabetes DM outcomes were evaluated: annual diabetes costs, emergency department (ED) visits and hospital days. Both ordinary least squares (OLS) and IV estimates showed a significant treatment effect for diabetes costs (P = 0.011) but neither model produced a significant treatment effect for ED visits. However, the IV estimate showed a significant treatment effect for hospital days (P = 0.006) whereas the OLS model did not. These results illustrate the utility of IV estimation when the OLS model is sensitive to the confounding effect of hidden bias.

Impact of comorbid conditions in COPD patients on health care resource utilization and costs in a predominantly Medicare population

PubMed Central

Schwab, Phil; Dhamane, Amol D; Hopson, Sari D; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

2017-01-01

Background Patients with chronic obstructive pulmonary disease (COPD) often have multiple underlying comorbidities, which may lead to increased health care resource utilization (HCRU) and costs. Objective To describe the comorbidity profiles of COPD patients and examine the associations between the presence of comorbidities and HCRU or health care costs. Methods A retrospective cohort study utilizing data from a large US national health plan with a predominantly Medicare population was conducted. COPD patients aged 40–89 years and continuously enrolled for 12 months prior to and 24 months after the first COPD diagnosis during the period of January 01, 2009, through December 31, 2010, were selected. Eleven comorbidities of interest were identified 12 months prior through 12 months after COPD diagnosis. All-cause and COPD-related hospitalizations and costs were assessed 24 months after diagnosis, and the associations with comorbidities were determined using multivariate statistical models. Results Ninety-two percent of 52,643 COPD patients identified had at least one of the 11 comorbidities. Congestive heart failure (CHF), coronary artery disease, and cerebrovascular disease (CVA) had the strongest associations with all-cause hospitalizations (mean ratio: 1.56, 1.32, and 1.30, respectively; P<0.0001); other comorbidities examined had moderate associations. CHF, anxiety, and sleep apnea had the strongest associations with COPD-related hospitalizations (mean ratio: 2.01, 1.32, and 1.21, respectively; P<0.0001); other comorbidities examined (except chronic kidney disease [CKD], obesity, and osteoarthritis) had moderate associations. All comorbidities assessed (except obesity and CKD) were associated with higher all-cause costs (mean ratio range: 1.07–1.54, P<0.0001). CHF, sleep apnea, anxiety, and osteoporosis were associated with higher COPD-related costs (mean ratio range: 1.08–1.67, P<0.0001), while CVA, CKD, obesity, osteoarthritis, and type 2 diabetes were associated with lower COPD-related costs. Conclusion This study confirms that specific comorbidities among COPD patients add significant burden with higher HCRU and costs compared to patients without these comorbidities. Payers may use this information to develop tailored therapeutic interventions for improved management of patients with specific comorbidities. PMID:28260880

Underestimation of Variance of Predicted Health Utilities Derived from Multiattribute Utility Instruments.

PubMed

Chan, Kelvin K W; Xie, Feng; Willan, Andrew R; Pullenayegum, Eleanor M

2017-04-01

Parameter uncertainty in value sets of multiattribute utility-based instruments (MAUIs) has received little attention previously. This false precision leads to underestimation of the uncertainty of the results of cost-effectiveness analyses. The aim of this study is to examine the use of multiple imputation as a method to account for this uncertainty of MAUI scoring algorithms. We fitted a Bayesian model with random effects for respondents and health states to the data from the original US EQ-5D-3L valuation study, thereby estimating the uncertainty in the EQ-5D-3L scoring algorithm. We applied these results to EQ-5D-3L data from the Commonwealth Fund (CWF) Survey for Sick Adults ( n = 3958), comparing the standard error of the estimated mean utility in the CWF population using the predictive distribution from the Bayesian mixed-effect model (i.e., incorporating parameter uncertainty in the value set) with the standard error of the estimated mean utilities based on multiple imputation and the standard error using the conventional approach of using MAUI (i.e., ignoring uncertainty in the value set). The mean utility in the CWF population based on the predictive distribution of the Bayesian model was 0.827 with a standard error (SE) of 0.011. When utilities were derived using the conventional approach, the estimated mean utility was 0.827 with an SE of 0.003, which is only 25% of the SE based on the full predictive distribution of the mixed-effect model. Using multiple imputation with 20 imputed sets, the mean utility was 0.828 with an SE of 0.011, which is similar to the SE based on the full predictive distribution. Ignoring uncertainty of the predicted health utilities derived from MAUIs could lead to substantial underestimation of the variance of mean utilities. Multiple imputation corrects for this underestimation so that the results of cost-effectiveness analyses using MAUIs can report the correct degree of uncertainty.

Cost savings associated with an alternative payment model for integrating behavioral health in primary care.

PubMed

Ross, Kaile M; Gilchrist, Emma C; Melek, Stephen P; Gordon, Patrick D; Ruland, Sandra L; Miller, Benjamin F

2018-05-23

Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project. Each practice had at least one on-site behavioral health clinician providing integrated behavioral health services. Three practices received non-fee-for-service payments (i.e., SHAPE payment) to support provision of behavioral health services for 18 months. Three practices did not receive the SHAPE payment and served as control practices for comparison purposes. Assignment to condition was nonrandom. Patient claims data were collected for 9 months before the start of the SHAPE demonstration project (pre-period) and for 18 months during the SHAPE project (post-period) to evaluate cost savings. During the 18-month post-period, analysis of the practices' claims data demonstrated that practices receiving the SHAPE payment generated approximately $1.08 million in net cost savings for their public payer population (i.e., Medicare, Medicaid, and Dual Eligible; N = 9,042). The cost savings were primarily achieved through reduction in downstream utilization (e.g., hospitalizations). The SHAPE demonstration project found that non-fee-for-service payments for behavioral health integrated into primary care may be associated with significant cost savings for public payers, which could have implications on future delivery and payment work in public programs (e.g., Medicaid).

[Contrast-enhanced ultrasound for the characterization of incidental liver lesions - an economical evaluation in comparison with multi-phase computed tomography].

PubMed

Giesel, F L; Delorme, S; Sibbel, R; Kauczor, H-U; Krix, M

2009-06-01

The aim of the study was to conduct a cost-minimization analysis of contrast-enhanced ultrasound (CEUS) compared to multi-phase computed tomography (M-CT) as the diagnostic standard for diagnosing incidental liver lesions. Different scenarios of a cost-covering realization of CEUS in the ambulant sector in the general health insurance system of Germany were compared to the current cost situation. The absolute savings potential was estimated using different approaches for the calculation of the incidence of liver lesions which require further characterization. CEUS was the more cost-effective method in all scenarios in which CEUS examinations where performed at specialized centers (122.18-186.53 euro) compared to M-CT (223.19 euro). With about 40 000 relevant liver lesions per year, systematic implementation of CEUS would result in a cost savings of 4 m euro per year. However, the scenario of a cost-covering CEUS examination for all physicians who perform liver ultrasound would be the most cost-intensive approach (e. g., 407.87 euro at an average utilization of the ultrasound machine of 25 %, and a CEUS ratio of 5 %). A cost-covering realization of the CEUS method can result in cost savings in the German healthcare system. A centralized approach as proposed by the DEGUM should be targeted.

Use of the internet to study the utility values of the public.

PubMed Central

Lenert, Leslie A.; Sturley, Ann E.

2002-01-01

One of the most difficult tasks in cost-effectiveness analysis is the measurement of quality weights (utilities) for health states. The task is difficult because subjects often lack familiarity with health states they are asked to rate and because utilities measures such as the standard gamble, ask subjects to perform tasks that are complex and far from everyday experience. A large body of research suggests that computer methods can play an important role in explaining health states and measuring utilities. However, administering computer surveys to a "general public" sample, the most relevant sample for cost-effectiveness analysis, is logistically difficult. In this paper, we describe a software system designed to allow the study of general population preferences in a volunteer Internet survey panel. The approach, which relied on over sampling of ethnic groups and older members of the panel, produced a data set with an ethnically, chronologically and geographically diverse group of respondents, but was not successful in replicating the joint distribution of demographic patterns in the population. PMID:12463862

Cost-effectiveness of per oral endoscopic myotomy relative to laparoscopic Heller myotomy for the treatment of achalasia.

PubMed

Greenleaf, Erin K; Winder, Joshua S; Hollenbeak, Christopher S; Haluck, Randy S; Mathew, Abraham; Pauli, Eric M

2018-01-01

Per oral endoscopic myotomy (POEM) has recently emerged as a viable option relative to the classic approach of laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. In this cost-utility analysis of POEM and LHM, we hypothesized that POEM would be cost-effective relative to LHM. A stochastic cost-utility analysis of treatment for achalasia was performed to determine the cost-effectiveness of POEM relative to LHM. Costs were estimated from the provider perspective and obtained from our institution's cost-accounting database. The measure of effectiveness was quality-adjusted life years (QALYs) which were estimated from direct elicitation of utility using a visual analog scale. The primary outcome was the incremental cost-effectiveness ratio (ICER). Uncertainty was assessed by bootstrapping the sample and computing the cost-effectiveness acceptability curve (CEAC). Patients treated within an 11-year period (2004-2016) were recruited for participation (20 POEM, 21 LHM). During the index admission, the mean costs for POEM ($8630 ± $2653) and the mean costs for LHM ($7604 ± $2091) were not significantly different (P = 0.179). Additionally, mean QALYs for POEM (0.413 ± 0.248) were higher than that associated with LHM (0.357 ± 0.338), but this difference was also not statistically significant (P = 0.55). The ICER suggested that it would cost an additional $18,536 for each QALY gained using POEM. There was substantial uncertainty in the ICER; there was a 48.25% probability that POEM was cost-effective at the mean ICER. At a willingness-to-pay threshold of $100,000, there was a 68.31% probability that POEM was cost-effective relative to LHM. In the treatment of achalasia, POEM appears to be cost-effective relative to LHM depending on one's willingness-to-pay for an additional QALY.

Costing bias in economic evaluations.

PubMed

Frappier, Julie; Tremblay, Gabriel; Charny, Mark; Cloutier, L Martin

2015-01-01

Determining the cost-effectiveness of healthcare interventions is key to the decision-making process in healthcare. Cost comparisons are used to demonstrate the economic value of treatment options, to evaluate the impact on the insurer budget, and are often used as a key criterion in treatment comparison and comparative effectiveness; however, little guidance is available to researchers for establishing the costing of clinical events and resource utilization. Different costing methods exist, and the choice of underlying assumptions appears to have a significant impact on the results of the costing analysis. This editorial describes the importance of the choice of the costing technique and it's potential impact on the relative cost of treatment options. This editorial also calls for a more efficient approach to healthcare intervention costing in order to ensure the use of consistent costing in the decision-making process.

Expect the Unexpected: A Role for Behavioral Economics in Understanding the Impact of Cost-Sharing on Emergency Department Utilization

PubMed Central

Tzeel, Albert; Brown, Jack

2010-01-01

Background As employers and payers address increasing healthcare costs, they resort to the tenets of classical economics: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. Objective To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. Method In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Results Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (−58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in each of the 3 study periods. In contrast, in the 2 groups with no increases in emergency department copayments, utilization of these services decreased or remained flat. Conclusion When assessing the need for emergency department services, many factors besides cost play a role in choosing to obtain emergency department care, including individual assessments of the probability of a given illness and the financial or temporal implications for the care sought in terms of “gains” or “losses” relative to a reference point. Behavioral economics can therefore play a role in understanding why healthcare consumers behave as they do. The implications of behavioral economics need to be factored in when considering a healthcare benefit design. PMID:25126317

Carbon dioxide capture from power or process plant gases

DOEpatents

Bearden, Mark D; Humble, Paul H

2014-06-10

The present invention are methods for removing preselected substances from a mixed flue gas stream characterized by cooling said mixed flue gas by direct contact with a quench liquid to condense at least one preselected substance and form a cooled flue gas without substantial ice formation on a heat exchanger. After cooling additional process methods utilizing a cryogenic approach and physical concentration and separation or pressurization and sorbent capture may be utilized to selectively remove these materials from the mixed flue gas resulting in a clean flue gas.

Systems Approaches to the Management of Public Education.

ERIC Educational Resources Information Center

Mansergh, Gerald G., Ed.

Three major presentations made at an October 1968 conference at Hartland, Michigan, for public school administrators and university professors are "The Systems Movement and Educational Administration," by Glenn L. Immegart; "Cost-Utility Analysis and Educational Decision-Making," by Austin D. Swanson; and "Educational…

Cistern Performance for Stormwater Management in Camden, NJ

EPA Science Inventory

The Camden County Municipal Utilities Authority (CCMUA) installed cisterns at locations around the city of Camden, NJ. Cisterns provide a cost effective approach to reduce stormwater runoff volume and peak discharge. The collected water can be substituted for potable water in s...

A decision theoretical approach for diffusion promotion

NASA Astrophysics Data System (ADS)

Ding, Fei; Liu, Yun

2009-09-01

In order to maximize cost efficiency from scarce marketing resources, marketers are facing the problem of which group of consumers to target for promotions. We propose to use a decision theoretical approach to model this strategic situation. According to one promotion model that we develop, marketers balance between probabilities of successful persuasion and the expected profits on a diffusion scale, before making their decisions. In the other promotion model, the cost for identifying influence information is considered, and marketers are allowed to ignore individual heterogeneity. We apply the proposed approach to two threshold influence models, evaluate the utility of each promotion action, and provide discussions about the best strategy. Our results show that efforts for targeting influentials or easily influenced people might be redundant under some conditions.

ECASTAR: Energy conservation. An assessment of systems, technologies and requirements

NASA Technical Reports Server (NTRS)

1975-01-01

A methodology was presented for a systems approach to energy conservation actions and their potentials and impacts in the United States. Constraints affecting the approach were ranked, and the most important ones are the present economic and technical conditions. The following unresolved issues were identified: consumptive lifestyles vs. conservation ethic, environmental standards vs. energy conservation, capital availability, decentralization and vertical integration vs. centralization, fuel rich regions vs. fuel poor regions, supply vs. end use conservation, life cycle costing vs. initial cost, mandatory savings vs. voluntary savings, labor intensive vs. capital intensive, price control vs. free market. The following recommendations were made: provide action/impact assessment, establish regional energy centers, improve technology articulation with government, design total energy systems, utilize existing systems approach expertise.

Manual physical therapy combined with high-intensity functional rehabilitation for severe lower extremity musculoskeletal injuries: a case series*

PubMed Central

Crowell, Michael S.; Deyle, Gail D.; Owens, Johnny; Gill, Norman W.

2016-01-01

Objectives Severe lower extremity trauma accounts for large healthcare costs and often results in elective amputation and poor long-term outcomes. The purpose of this case series is to describe an orthopedic manual physical therapy (OMPT) approach combined with a return to run (RTR) clinical pathway consisting of high-intensity functional rehabilitation with a custom energy-storing orthosis. Methods Three consecutive male patients, aged 21–23 years, with severe lower extremity musculoskeletal injuries were treated with a combined intervention that included a mean (SD) of 12 (2·1) OMPT sessions and 24 (8·7) functional rehabilitation sessions over a mean of 6 weeks (1·0). Additional training with a custom energy-storing orthosis consisted of a mean of 15 (1·2) additional sessions over 4 weeks. Patient self-report outcome measures and a variety of physical performance tests captured change in function. Results Baseline lower extremity functional scale (LEFS) and foot and ankle ability measure activities of daily living subscale (FAAM-ADL) scores indicated severe disability. All patients exceeded the minimal clinically important difference (MCID) in at least one self-report outcome or physical performance test without a brace. Two of three patients exceeded the MCID for at least two physical performance tests after training with and utilizing a custom energy-storing orthosis. Discussion Clinically meaningful changes in self-reported function or physical performance were observed in all patients. A multi-modal approach, including manual therapy and functional exercise, may address the entire spectrum of impairments in patients with severe lower extremity trauma, resulting in improvements in both braced and un-braced function. PMID:27252581

An Information-Centric Approach to Autonomous Trajectory Planning Utilizing Optimal Control Techniques

DTIC Science & Technology

2009-09-01

to promote one way as the best, but to show there are several ways to define the problem. 107 Figure 71. Final Orientation/Obstacle Scenario...a comparison of the running cost vs. distance from an obstacle for varying values of p. Simulations have shown that for 4p  , the running cost...sliding door example. This scenario shows a major weakness when conducting trajectory planning using snapshots in a dynamic environment

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

McLean, B.J.

The paper outlines and/or gives data on the following: environmental concerns; goal of Title IV; national SO{sub 2} emissions; reductions in wet sulfate deposition; SO{sub 2} allowance program--benefits and costs; utility NO{sub x} emissions; NO{sub x} compliance options; cost effectiveness of NO{sub x} control; electric power regulations timeline; Clean Air power initiative; what a new approach would look like; and an analysis of NO{sub x} and SO{sub 2} cap and trade scenarios.

Cost-effectiveness analysis of the Xpert MTB/RIF assay for rapid diagnosis of suspected tuberculosis in an intermediate burden area.

PubMed

You, Joyce H S; Lui, Grace; Kam, Kai Man; Lee, Nelson L S

2015-04-01

We examined, from a Hong Kong healthcare providers' perspective, the cost-effectiveness of rapid diagnosis with Xpert in patients hospitalized for suspected active pulmonary tuberculosis (PTB). A decision tree was designed to simulate outcomes of three diagnostic assessment strategies in adult patients hospitalized for suspected active PTB: conventional approach, sputum smear plus Xpert for acid-fast bacilli (AFB) smear-negative, and a single sputum Xpert test. Model inputs were derived from the literature. Outcome measures were direct medical cost, one-year mortality rate, quality-adjusted life-years (QALYs) and incremental cost per QALY (ICER). In the base-case analysis, Xpert was more effective with higher QALYs gained and a lower mortality rate when compared with smear plus Xpert by an ICER of USD99. A conventional diagnostic approach was the least preferred option with the highest cost, lowest QALYs gained and highest mortality rate. Sensitivity analysis showed that Xpert would be the most cost-effective option if the sensitivity of sputum AFB smear microscopy was ≤74%. The probabilities of Xpert, smear plus Xpert and a conventional approach to be cost-effective were 94.5%, 5.5% and 0%, respectively, in 10,000 Monte Carlo simulations. The Xpert sputum test appears to be a highly cost-effective diagnostic strategy for patients with suspected active PTB in an intermediate burden area like Hong Kong. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.