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Total Cost (total + cost)
Kinds of Total Cost Selected AbstractsTotal Cost of Ownership in the Services Sector: A Case StudyJOURNAL OF SUPPLY CHAIN MANAGEMENT, Issue 1 2006Krisje Hurkens SUMMARY Few detailed studies exist of the trade-offs to be made when developing a comprehensive, strategically focused total cost of ownership (TCO) model. Moreover, most studies of TCO have been conducted in manufacturing firms, with little or no TCO research directed toward service organizations. This research presents the results of a study conducted at a leading vehicle glass repair and replacement organization. The results show how TCO information can be used for strategic decision making regarding the allocation of volumes. This information can also be used in the identification of improvement areas for preferred suppliers by introducing a limited number of key performance indicators that have a significant impact on the TCO of supplier offerings. The paper highlights some of the trade-offs required in designing such a model. It fills an existing literature gap that allows service organizations to better understand the development and implementation of total cost measurement systems. [source] Total Cost of Ownership Models: An Exploratory StudyJOURNAL OF SUPPLY CHAIN MANAGEMENT, Issue 3 2002Bruce G. Ferrin SUMMARY This research examines organizational purchasing models focusing on the use of total cost of ownership (TCO) to value purchase opportunities. The research presents evidence that leading-edge companies actually use such models. This exploratory study provides, for the first time, data on the nature, and use, of the cost drivers on which organizations base their TCO computations. The study suggests a generic model of total cost of ownership is not appropriate. However, the findings of this research suggest a TCO model based on a core set of cost drivers, along with an auxiliary set of cost drivers, is appropriate. The core cost drivers would be present in all, or most, TCO computations. Purchasing managers could use different, specific cost drivers from the auxiliary set to tailor the TCO computation for a particular purchase situation. The authors also suggest that a value-based, multi-firm, or supply chain, TCO computation model is needed. Such a TCO model should be similar to a single-firm TCO model. [source] Health care costs of persons with newly diagnosed hepatitis C virus: a population-based, observational studyJOURNAL OF VIRAL HEPATITIS, Issue 9 2008Thu-Ha Nguyen Summary., The objective of this paper was to conduct an analysis of the health services costs for persons who have been diagnosed with hepatitis C, from the time of diagnosis. Data were based on 1230 persons diagnosed with hepatitis C in 1998 in the Capital Health region of Alberta. Identifiers and dates of diagnosis were sent to Alberta Health and Wellness where records were linked to those of physician visits and billings, as well as hospital (inpatient and outpatient) visit records. Costs were assigned to all visits, and data were analysed for one pre- and two post-diagnosis years. Total cost per person increased from $2630 (Canadian) to $3514 between the pre- and first post-diagnosis year. They then returned to $2694 in the second post-diagnosis year. Liver-related costs were a low portion of the total in all periods, though they increased following diagnosis. Mental-health related costs were the largest component. Observational data present a more balanced picture of the costs of persons with hepatitis C, though most current estimates are not based on such data. Our results indicate that, when analysed within the picture of the entire person, liver-related costs (which have been the focus of most studies to date) are the tip of the iceberg. [source] The economic impact of severe asthma to low-income familiesALLERGY, Issue 3 2009R. Franco Background:, To estimate the direct and indirect costs of severe asthma and the economic impact of its management to low-income families in Salvador, Brazil. Methods:, One hundred and ninety-seven patients with severe asthma and referred to a state-funded asthma center providing free treatment were evaluated. At registration, they were asked about family cost-events in the previous year and had a baseline assessment of lung function, symptoms and quality of life. During the subsequent year, they were reassessed prospectively. Results:, One hundred-eighty patients concluded a 12-month follow-up. Eighty-four percent were female patients, and the median family income was US$ 2955/year. Forty-seven percent of family members had lost their jobs because of asthma. Total cost of asthma management took 29% of family income. After proper treatment, asthma control scores improved by 50% and quality of life by 74%. The income of the families increased by US$ 711/year, as their members went back to work. The total cost of asthma to the families was reduced by a median US$ 789/family/year. Consequently, an annual surplus of US$ 1500/family became available. Conclusions:, Family costs of severe asthma consumed over one-fourth of the family income of the underprivileged population in a middle-income country. Adequate management brings major economic benefit to individuals and families. [source] Losartan reduces the costs of diabetic end-stage renal disease: An Asian perspectiveNEPHROLOGY, Issue 5 2005WONG KOK SENG SUMMARY: Objective: To evaluate losartan and conventional antihypertensive therapy (CT) compared with CT alone on the cost associated with end-stage renal disease (ESRD) in Hong Kong, Japan, Korea, Malaysia, Singapore and Taiwan. Methods: Reduction of end-points in non-insulin-dependent diabetes mellitus with the angiotensin II antagonist losartan (RENAAL) was a multinational, double-blind, randomized, placebo-controlled trial to evaluate the renal protective effects of losartan on a background of CT in patients with type 2 diabetes and nephropathy. The primary composite end-point was a doubling of serum creatinine, ESRD or death. Data on the duration of ESRD for the Asian subgroup of patients enrolled in RENAAL were used to estimate the economic benefits of slowing the progression of nephropathy. The cost associated with ESRD was estimated by combining the number of days each patient experienced ESRD with the average daily cost of dialysis from the third-party payer perspective in Hong Kong, Japan, Korea, Malaysia, Singapore and Taiwan. Total cost, converted to US dollars, was the sum of ESRD and losartan costs. Results: Losartan plus CT reduced the number of days with ESRD by 37.9 per patient over 3.5 years compared with CT alone. This reduction in ESRD days resulted in a decrease in the cost associated with ESRD, which ranges from $910 to $4346 per patient over 3.5 years across the six countries or regions. After accounting for the cost of losartan, the reduction in ESRD days resulted in net savings in each of the six countries or regions, ranging from $55 to $515 per patient. Conclusion: Treatment with losartan in patients with type 2 diabetic nephropathy not only reduced the incidence of ESRD among Asian patients, but resulted in direct medical cost savings in countries or regions representing Asia. [source] A Novel Approach to Teaching PeriocardiocentesisACADEMIC EMERGENCY MEDICINE, Issue 2009Mara Aloi Pericardiocentesis can be a life-saving intervention but it is associated with significant complications if not performed appropriately. Periocardiocentesis should ideally be done under ultrasound guidance. However, in many community emergency departments (EDs) ultrasound is not routinely available, leaving the ED physician the anatomic approach. Emergency medicine residents need to achieve competence in this procedure using both techniques, but there are limited opportunities for residents to perform this procedure on live patients. Many residency programs teach this procedure using cadaver models. We have devised a model, made with readily available, inexpensive materials, that allows residents to practice pericardiocentesis using both the subxiphoid and parasternal approach in a setting that we feel is more life-like than with that using the dessicated tissue of routine cadaver models. Materials: Two racks of pork or beef ribs, wire, pericardiocentesis tray, Betadine, plastic baggies. The racks of ribs are wired together to make a thorax and are then covered with an opaque covering to simulate skin. One plastic bag is filled with Betadine and then placed within another plastic bag containing water, to simulate pericardial effusion. The bag-within-bag set-up is then secured on the under surface of the thorax. Residents can then practice either the parasternal or subxiphoid approach with the intent of aspirating clear fluid. Aspiration of dark-fluid represents cardiac penetration and is considered an unsuccessful procedure. Bags can be replaced as needed, but based on our experience, approximately 10 attempts were done before any significant leakage occurred. Total cost for the materials was less than $35. [source] Evaluation of cost of treatment of drug-related events in a tertiary care public sector hospital in Northern India: a prospective studyBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2009Smita Pattanaik WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Drug related events include ADRs, events due to patient or physician noncompliance, drug overdosage and drug interactions. , Economic burden of management of drug related events are substantial and include both direct and indirect costs. , Some data regarding cost of treatment of ADR exist from south and western India. WHAT THIS STUDY ADDS , An approximate cost of management of drug related events presenting to the emergency medical department in a tertiary care hospital over a period of 4 months. , Compares the cost incurred in a public sector hospital to the projected cost of management of same events in a private sector hospital. , Gives a rough estimate of economic burden on the health care system due to adverse drug events. AIMS Drug related events (DREs) contribute significantly to hospital admissions. These are largely preventable events and require optimum use of the therapeutic agents. The study was conducted to analyze the cost of treatment of DREs. PATIENTS & METHODS All visits to medical emergency department of a tertiary care public sector hospital in northern India were recorded in a prospective, non-interventional manner over a period of 4 months. DREs were recognized and were followed up till their stay in the hospital. Data about the cost generating components of direct and indirect costs of treatment of DREs were collected. The projected cost of treatment of the same DREs in a private sector hospital was estimated and compared. RESULTS Out of 1833 admissions, 92(5.01%) were due to DREs. Maximum cases were due to non compliance (66%) followed by ADR (28%) and drug overdose(6%). The common DREs leading to ED visits were cerebrovascular accident(19.44%), followed by accelerated hypertension(18.36%) and diabetic ketoacidosis(14.04%). Total cost of management of all the 92 DREs in our hospital was calculated to be INR17,37,339(,30,215). The direct cost was INR1,72,961(,3008) and the approximate indirect cost was INR15,64, 378(,27, 206). The projected cost of management of all the 92 DREs was estimated to be INR63,63,872(,1,01, 676) in a private sector hospital. CONCLUSION The study shows that ADEs leading to emergency department visits and hospitalizations constitute a significant economic burden. Training of the patients and the prescribers may lessen the economic burden on the patient as well as the health care system. [source] Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care ClaimsHEALTH SERVICES RESEARCH, Issue 6 2008Manabu Akazawa Objective. To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD). Data Sources. Claims between 1997 and 2005 from a large managed care database. Study Design. Individual-level, fixed-effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided. Data Extraction Methods. COPD patients aged 40 or older with ,15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed. Principal Findings. ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost-effectiveness ratio of $2,973 per exacerbation avoided; for patients ,50 years old, ICS was cost saving 57 percent of time. Conclusions. ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates. [source] The epidemiologic, health-related quality of life, and economic burden of gastrointestinal stromal tumoursJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2007P. Reddy PharmD Summary Background and objectives:, Gastrointestinal stromal tumours (GIST) are uncommon tumours believed to arise from interstitial cells of Cajal or their precursors in the gastrointestinal (GI) tract, accounting for a small percentage of GI neoplasms and sarcomas. Given the recent recognition of GIST as a distinct cancer, as well as new treatment options available today, a review of the epidemiologic, health-related quality of life (HRQL), and economic burden of GIST is timely from a payer, provider and patient perspective and may provide guidance for treatment decision making and reimbursement. Methods:, A systematic literature review of PubMed and five scientific meeting databases, was conducted to identify published studies and abstracts describing the epidemiologic, HRQL and economic impact of GIST. Publications deemed worthy of further review, based on the information available in the abstract, were retrieved in full text. Results and discussion:, Thirty-four publications met the review criteria: 29 provided data on GIST epidemiology, one provided cost data, three reported HRQL outcomes, and one reported cost and HRQL outcomes. The annual incidence of GIST (cases per million) ranged from 6·8 in the USA to 14·5 in Sweden, with an estimated 5-year survival rate of 45,64%. On the Functional Illness of Chronic Therapy-fatigue instrument, GIST patients scored 40·0 compared with 37·6 in anaemic cancer patients (0 = worst; 52 = least fatigue). Total costs over 10 years for managing GIST patients with molecularly targeted treatment was estimated at £47 521,£56 146 per patient compared with £4047,£4230 per patient with best supportive care. Conclusions:, The incidence of GIST appears to be similar by country; the lower estimate in one country could be explained by differences in method of case ascertainment. Data suggest that the HRQL burden of GIST is similar to that with other cancers although this requires further exploration. The value of new therapies in GIST needs to consider not only cost but also anticipated benefits and the unmet medical need in this condition. [source] Estimation of health-care costs for work-related injuries in the Mexican Institute of social securityAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2009Fernando Carlos-Rivera MScE Abstract Background Data on the economic consequences of occupational injuries is scarce in developing countries which prevents the recognition of their economic and social consequences. This study assess the direct heath care costs of work-related accidents in the Mexican Institute of Social Security, the largest health care institution in Latin America, which covered 12,735,856 workers and their families in 2005. Methods We estimated the cost of treatment for 295,594 officially reported occupational injuries nation wide. A group of medical experts devised treatment algorithms to quantify resource utilization for occupational injuries to which unit costs were applied. Total costs were estimated as the product of the cost per illness and the severity weighted incidence of occupational accidents. Results Occupational injury rate was 2.9 per 100 workers. Average medical care cost per case was $2,059 USD. The total cost of the health care of officially recognized injured workers was $753,420,222 USD. If injury rate is corrected for underreporting, the cost for formal injured workers is 791,216,460. If the same costs are applied for informal workers, approximately half of the working population in Mexico, the cost of healthcare for occupational injuries is about 1% of the gross domestic product. Conclusions Health care costs of occupational accidents are similar to the economic direct expenditures to compensate death and disability in the social security system in Mexico. However, indirect costs might be as important as direct costs. Am. J. Ind. Med. 52:195,201, 2009. © 2008 Wiley-Liss, Inc. [source] Treatment of Acute Renal Failure in the Intensive Care Unit: Lower Costs by Intermittent Dialysis Than Continuous Venovenous HemodiafiltrationARTIFICIAL ORGANS, Issue 8 2009Stefan Farese Abstract Intermittent and continuous renal replacement therapies (RRTs) are available for the treatment of acute renal failure (ARF) in the intensive care unit (ICU). Although at present there are no adequately powered survival studies, available data suggest that both methods are equal with respect to patient outcome. Therefore, cost comparison between techniques is important for selecting the modality. Expenditures were prospectively assessed as a secondary end point during a controlled, randomized trial comparing intermittent hemodialysis (IHD) with continuous venovenous hemodiafiltration (CVVHDF). The outcome of the primary end points of this trial, that is, ICU and in-hospital mortality, has been previously published. One hundred twenty-five patients from a Swiss university hospital ICU were randomized either to CVVHDF or IHD. Out of these, 42 (CVVHDF) and 34 (IHD) were available for cost analysis. Patients' characteristics, delivered dialysis dose, duration of stay in the ICU or hospital, mortality rates, and recovery of renal function were not different between the two groups. Detailed 24-h time and material consumption protocols were available for 369 (CVVHDF) and 195 (IHD) treatment days. The mean daily duration of CVVHDF was 19.5 ± 3.2 h/day, resulting in total expenditures of ,436 ± 21 (21% for human resources and 79% for technical devices). For IHD (mean 3.0 ± 0.4 h/treatment), the costs were lower (,268 ± 26), with a larger proportion for human resources (45%). Nursing time spent for CVVHDF was 113 ± 50 min, and 198 ± 63 min per IHD treatment. Total costs for RRT in ICU patients with ARF were lower when treated with IHD than with CVVHDF, and have to be taken into account for the selection of the method of RRT in ARF on the ICU. [source] A Risk-Cost Optimized Maintenance Strategy for Corrosion-Affected Concrete StructuresCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 5 2007Chun-Qing Li It is also observed that some severely deteriorated concrete structures survive for many years without maintenance. This raises the question of why and how to maintain corrosion-affected concrete structures, in particular in the climate of an increasing scarcity of resources. The present article attempts to formulate a maintenance strategy based on risk-cost optimization of a structure during its whole service life. A time-dependent reliability method is employed to determine the probability of exceeding a limit state at each phase of the service life. To facilitate practical application of the formulated maintenance strategy, an algorithm is developed and programmed in a user-friendly manner with a worked example. A merit of the proposed maintenance strategy is that models used in risk assessment for corrosion-affected concrete structures are related to some of the design criteria used by practitioners. It is found in the article that there exists an optimal number of maintenances for cracking and delamination that returns the minimum total cost for the structure in its whole life. The maintenance strategy presented in the article can help structural engineers, operators, and asset managers develop a cost-effective management scheme for corrosion-affected concrete structures. [source] Towards virtualized desktop environmentCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 4 2010Xiaofei Liao Abstract Virtualization is being widely used now as an emerging trend. Rapid improvements in network bandwidth, ubiquitous security hazards and high total cost of ownership of personal computers have created a growing market for desktop virtualization. Much like server virtualization, virtualizing desktops involves separating the physical location of a client device from its logical interface. But, the performance and usability of some traditional desktop frameworks do not satisfy end-users. Other solutions, including WebOS, which needs to rebuild all daily-used applications into Client/Server mode, cannot be easily accepted by people in a short time. We present LVD, a system that combines the virtualization technology and inexpensive personal computers (PCs) to realize a lightweight virtual desktop system. Comparing to the previous desktop systems, LVD builds an integrated novel desktop environment, which can support the backup, mobility, suspending and resuming of per-user's working environment, and support synchronous using of incompatible applications on different platforms and achieves great saving in power consumption. We have implemented LVD in a cluster with Xen and compared its performance against widely used commercial approaches, including Microsoft RDP, Citrix MetaFrameXP and Sun Ray. Experimental results demonstrate that LVD is effective in performing the functions while imposing little overhead. Copyright © 2009 John Wiley & Sons, Ltd. [source] Anemia and Cost in Medicare Patients With Congestive Heart FailureCONGESTIVE HEART FAILURE, Issue 6 2006Craig A. Solid MS The objective of this study was to examine the total cost to Medicare associated with the presence of anemia in congestive heart failure (CHF) patients. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify anemia, CHF, and comorbid conditions in 2002, and total Medicare costs were calculated for 2003. The mean patient age was 77.8 years. Anemia, present in 32% of CHF patients, was associated with older age, female sex, non-white race, and increasing burden of comorbidity. The total per-member-per-month cost in 2003 was $1781.01 among CHF patients with anemia in the preceding year compared with $1142.38 for CHF patients without anemia, a ratio of 1.56 (95% confidence interval, 1.5589,1.5592). When adjustment was made for baseline demographic factors and comorbid conditions, the corresponding ratio was 1.25 (95% confidence interval, 1.2546,1.2548). Anemia, a common association of CHF in elderly patients, is an antecedent association of increased societal medical expenditure. [source] Baghouse system design based on economic optimizationENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 4 2000Antonio C. Caputo In this paper a method is described for using economic optimization in the design of baghouse systems. That is, for a given emission control problem, the total filtration surface area, the overall pressure drop, fabric material effects, and the cleaning cycle frequency, may all be evaluated simultaneously. In fact, as baghouse design parameters affect capital and operating expenses in interrelated and counteracting manners, a minimum total cost may be searched defining the best arrangement of dust collection devices. With this in mind, detailed cost functions have been developed with the aim of providing an overall economic model. As a result, a discounted total annual cost has been obtained that may be minimized by allowing for optimal baghouse characterization. Finally, in order to highlight the capabilities of the proposed methodology, some optimized solutions are also presented, which consider the economic impact of both bag materials and dust properties. [source] Direct Cost of Medical Management of Epilepsy among Adults in Italy: A Prospective Cost-of-Illness Study (EPICOS)EPILEPSIA, Issue 2 2004Ettore Beghi Summary: Purpose: To investigate the costs of epilepsy from a nationwide survey comparing adult patients included in different prognostic categories. Methods: A 12-month prospective observational study was conducted in 15 epilepsy centers from Northern, Central, and Southern Italy. The study population included a random sample of individuals aged 18 years and older with newly diagnosed (ND) epilepsy, seizure remission (R), occasional seizures (OS), active non,drug-resistant (NDR) seizures, drug-resistant (DR) seizures, or surgical candidates (SC). Estimates of the direct costs of care of epilepsy were based on the use of diagnostic examinations, laboratory tests, specialist consultations, hospital admissions, day-hospital days, and drugs, taking the Italian National Health Service perspective. Results: The sample included 631 patients (ND 62, R 158, OS 155, NDR 114, DR 128, and SC 14). The SC group had the highest total cost per patient (,3,619) followed by DR (,2,190), ND (,976), NDR (,894), OS (,830), and R (,561). For each epilepsy group, the main components of the total cost were drugs and hospital admissions. Drug costs increased from the R group to the DR group. The new antiepileptic drugs (AEDs) were the largest part of the cost of treatment. Conclusions: The costs of epilepsy in referral patients vary significantly according to the time course of the disease and the response to treatment. Hospital admissions and drugs are the major sources of expenditure. [source] Is it possible to identify early predictors of the future cost of chronic arthritis?FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2009The VErA project Abstract This study was conducted to identify early predictors of the total cost of inflammatory arthritis (IA). One hundred and eighty patients affected by undifferentiated arthritis (UA) or rheumatoid arthritis (RA) were included in the French Very Early rheumatoid Arthritis (VErA) cohort between 1998 and 2001. Health economic data for 2003 were collected using a patient self-questionnaire. Results were analysed in terms of direct, indirect and total costs in 2003 euros (2003,) for the population as a whole and in diagnostic subgroups. A payor perspective (the French National Health Insurance, in this case) was adopted. Multiple linear regression models were used to identify predictors of total cost from among the criteria assessed on recruitment. Results of the study showed that for the study population as a whole, the mean total cost was ,4700 per patient. The costs attributable to the RA and UA sub-groups were ,5928 and ,2424 per patient, respectively. In a univariate analysis, certain parameters were significantly correlated with a higher cost of illness. In the multivariate analysis, some of these parameters were further identified as being predictive of higher cost. Two strong significant, early predictors of total cost were identified: higher pain (P = 0.002) and the presence of rheumatoid factor (P = 0.004). In the RA sub-group, lower grip strength of the dominant hand (P = 0.039) was another predictor of the illness's subsequent economic impact. In conclusion, our data show that simple clinical and laboratory parameters can be used early in the course of IA to predict the condition's impact on healthcare budgets. [source] Orthopaedic surgery in severe bleeding disorders: a low-volume, high-cost procedureHAEMOPHILIA, Issue 6 2002V. Mishra Summary. As more and more nations are scrutinizing their health care costs, attention has been focused on high-cost low-density disease. Assessment of actual total cost of care for haemophilia and its positive outcome becomes essential to justify support for these patients. In this study, we assessed hospital cost and diagnosis-related group (DRG) reimbursement for patients undergoing elective orthopaedic surgical procedures from May 1999 to December 1999. Hospital cost was assessed by a prospective microcost-analysis method. To identify real hospital costs, we performed registration of preoperative phase, operative phase and 1-year follow-up costs. Hospital cost included personnel costs and costs for clinical and laboratory procedures, blood products, prosthetic implants, coagulation factor concentrates and drugs. These data were compared with hospital DRG reimbursement. We included nine consecutive patients, with a mean age 38 years (19,54 years) who had had 10 major orthopaedic surgical procedures performed during the study period. Six patients had haemophilia A, two had haemophilia B and one had factor VII deficiency. Data analysis showed a mean cost of US$ 54 201 (range US$ 25 795,105 479; 1US$ = 8.5 NOK). The average actual hospital revenue (50% DRG reimbursement + income related to length of stay) was $4730 (range $ 1 308,13 601). Our study confirms that orthopaedic surgery in patients with severe bleeding disorders puts the hospital to a considerable expense. Activity-based financing, as used in Norway, does not provide a proper reimbursement for this part of the haemophilia care. [source] The cost effectiveness of specialised facilities for service users with persistent challenging behavioursHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2001Angela Hallam MSc Abstract Little systematic research relates specifically to the last people to leave a psychiatric hospital at the end of a closure programme. The long-running evaluation of the reprovision of services from Friern Hospital in North London allowed a special study to be made of such a group (67 people in all), whose range of problem behaviours made placement in community settings most difficult. The patients were relatively young, with a shorter length of stay than the remainder of the former long-stay hospital population. They were assessed three times: before leaving Friern, and one and 5 years after relocation. The social and clinical characteristics of each person were measured, and the full costs of their care calculated. The ,difficult-to-place' patients moved to four highly staffed rehabilitation facilities, where the total cost of their care was, on average, £1230 per week. There was no overall change in their psychiatric state over the 5 years after they left Friern Hospital although, in the longer-term, they gained skills in several areas of daily functioning. Most importantly, there was a fall of almost 50% in the number of challenging behaviours exhibited by the study group. At the five-year follow-up point, the cost of care had fallen, on average, by £170 per week, and 24 people had been able to move to more independent accommodation arrangements. Study participants had gained a new network of community service contacts, and used services provided by a greater variety of agencies. The indicators suggest that high expenditure on alternative care was justified retrospectively by overall long-term outcomes. An important policy lesson from the Friern Hospital reprovision study is that adequate funds should be reserved until the end of the closure programme to allow the investment of resources in provision for patients with the most severe problem behaviours. [source] Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countriesHEALTH ECONOMICS, Issue S1 2008Tom Stargardt Abstract This paper assesses variations in the cost of primary hip replacement between and within nine member states of the European Union (EU). It also compares the cost of service with public-payer reimbursements. To do so, data on cost and reimbursement were surveyed at the micro-level in 42 hospitals in Denmark, England, France, Germany, Hungary, Italy, The Netherlands, Poland, and Spain. The total cost of treatment ranged from ,1290 (Hungary) to ,8739 (The Netherlands), with a mean cost of ,5043 (STD±,2071). The main cost drivers were found to be implants (34% of total cost on average) and ward costs (20.9% of total cost on average). A one-way random effects analysis of variance model indicated that 74.0% of variation was between and only 26% of variation was within countries. In a two-level random-intercept regression model, purchasing-power parities explained 79.4% of the explainable between-country variation, while the percentage of uncemented implants used and the number of beds explained 12.1 and 1.6% of explainable within-country variation, respectively. The large differences in cost and reimbursement between Poland, Hungary, and the other EU member states shows that primary total hip replacement is a highly relevant case for cross-border care. Copyright © 2008 John Wiley & Sons, Ltd. [source] Using multilevel models for assessing the variability of multinational resource use and cost dataHEALTH ECONOMICS, Issue 2 2005Richard Grieve Abstract Multinational economic evaluations often calculate a single measure of cost-effectiveness using cost data pooled across several countries. To assess the validity of pooling international cost data the reasons for cost variation across countries need to be assessed. Previously, ordinary least-squares (OLS) regression models have been used to identify factors associated with variability in resource use and total costs. However, multilevel models (MLMs), which accommodate the hierarchical structure of the data, may be more appropriate. This paper compares these different techniques using a multinational dataset comprising case-mix, resource use and cost data on 1300 stroke admissions from 13 centres in 11 European countries. OLS and MLMs were used to estimate the effect of patient and centre-level covariates on the total length of hospital stay (LOS) and total cost. MLMs with normal and gamma distributions for the data within centres were compared. The results from the OLS model showed that both patient and centre-level covariates were associated with LOS and total cost. The estimates from the MLMs showed that none of the centre-level characteristics were associated with LOS, and the level of spending on health was the centre-level variable most highly associated with total cost. We conclude that using OLS models for assessing international variation can lead to incorrect inferences, and that MLMs are more appropriate for assessing why resource use and costs vary across centres. Copyright © 2004 John Wiley & Sons, Ltd. [source] Heuristic and simulated annealing algorithms for solving extended cell assignment problem in wireless ATM networksINTERNATIONAL JOURNAL OF COMMUNICATION SYSTEMS, Issue 1 2002Der-Rong Din Abstract In this paper, we investigate the extended cell assignment problem which optimally assigns new adding and splitting cells in Personal Communication Service (PCS) to switches in a wireless Asynchronous Transfer Mode (ATM) network. Given cells in a PCS network and switches on an ATM network (whose locations are fixed and known), we would like to do the assignment in an attempt to minimize a cost criterion. The cost has two components: one is the cost of handoffs that involve two switches, and the other is the cost of cabling. This problem is modeled as a complex integer programming problem, and finding an optimal solution to this problem is NP-hard. A heuristic algorithm and a simulated annealing algorithm are proposed to solve this problem. The heuristic algorithm, Extended Assignment Algorithm (EEA), consists of two phases, initial assigning phase and cell exchanging phase. First, in the initial assigning phase, the initial assignments of cells to switches are found. Then, these assignments are improved by performing cell exchanging phase in which two cells are repeatedly exchanged in different switches with great reduction of the total cost. The simulated annealing algorithm, ESA (enhanced simulated annealing), generates constraint-satisfied configurations, and uses three configuration perturbation schemes to change current configuration to a new one. Experimental results indicate that EAA and ESA algorithms have good performances. Copyright © 2002 John Wiley & Sons, Ltd. [source] Application of ozone treatment and pinch technology in cooling water systems design for water and energy conservationINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 6 2010A. Ataei Abstract Re-circulating cooling water systems offer the means to remove heat from a wide variety of industrial processes that generate excess heat. Such systems consist of a cooling tower and a heat-exchanger network that conventionally has a parallel configuration. However, reuse of water between different cooling duties allows cooling water networks to be designed in a series arrangement. This results in performance improvement and increased cooling tower capacity. In addition, by the integration of ozone treatment into the cooling tower, the cycle of concentration can be increased. The ozone treatment also dramatically reduces the blow-down that, in turn, is environmentally constructive. In this study, a new environmental-friendly and cost-effective design methodology for cooling water systems was introduced. Using this design methodology, Integrated Ozone Treatment Cooling System (IOTCS), achievement of minimum environmental impacts and total cost were afforded through a simultaneous integration of the cooling system components using an ozone treatment cooling tower and optimum heat-exchanger network configuration. Moreover, in the proposed method, the cooling tower optimum design was achieved through a mathematical model. The IOTCS design method is based upon a complex design approach using a combined pinch analysis and mathematical programming that provides an optimum heat-exchanger configuration while maximizing water and energy conservation and minimizing total cost. Related coding in MATLAB version 7.3 was used for the illustrative example to obtain optimal values in the IOTCS design method computations. The results of the recently introduced design methodology were compared with the conventional method. Copyright © 2009 John Wiley & Sons, Ltd. [source] Power sector development in India with CO2 emission targets: Effects of regional grid integration and the role of clean technologiesINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 7 2003A. K. Srivastava Abstract The power sector in India at present comprises of five separate regional electricity grids having practically no integrated operation in between them. This study analyses the utility planning, environmental and economical effects of integrated power sector development at the national level in which the regional electric grids are developed and operated as one integrated system. It also examines the effects of selected CO2 emission reduction targets in the power sector and the role of renewable power generation technologies in India. The study shows that the integrated development and operation of the power system at the national level would reduce the total cost including fuel cost by 4912 million $, total capacity addition by 2784 MW, while the emission of CO2, SO2 and NOx would be reduced by 231.6 (1.9%), 0.8 (0.9%), 0.4 (1.2%) million tons, respectively, during the planning horizon. Furthermore, the study shows that the expected unserved energy, one of the indices of generation system reliability, would decrease to 26 GWh under integrated national power system from 5158 GWh. As different levels of CO2 emission reduction targets were imposed, there is a switching of generation from conventional coal plants to gas fired plants, clean coal technologies and nuclear based plants. As a result the capacity expansion cost has increased. It was found that wind power plant is most attractive and economical in the Indian perspective among the renewable options considered (Solar, wind and biomass). Copyright © 2003 John Wiley & Sons, Ltd. [source] Application of local and global particle swarm optimization algorithms to optimal design and operation of irrigation pumping systems,IRRIGATION AND DRAINAGE, Issue 3 2009M. H. Afshar stations de pompage; conception et exploitation; optimisation par essaims particulaires locale et globale Abstract A particle swarm optimization (PSO) algorithm is used in this paper for optimal design and operation of irrigation pumping systems. An irrigation pumping systems design and management model is first introduced and subsequently solved with the newly introduced PSO algorithm. The solution of the model is carried out in two steps. In the first step an exhaustive enumeration is carried out to find all feasible sets of pump combinations able to cope with a given demand curve over the required period. The PSO algorithm is then called in to search for optimal operation of each set. Having solved the operation problem of all feasible sets, the total cost of operation and depreciation of initial investment is calculated for all the sets and the optimal set and the corresponding optimal operating policy is determined. The proposed model is applied to the design and operation of a real-world irrigation pumping system and the results are presented and compared with those of a genetic algorithm. Two global and local versions of the PSO algorithm are used and their efficiencies are compared to each other and that of a genetic algorithm (GA) model. The results indicate that the proposed model in conjunction with the PSO algorithm is a versatile management model for the design and operation of real-world irrigation pumping systems. Copyright © 2008 John Wiley & Sons, Ltd. Un algorithme d'optimisation par essaims particulaires (PSO en anglais) est employé dans cet article pour la conception et l'exploitation optimale des systèmes d'irrigation avec pompages. Un modèle de conception et de gestion du système est d'abord présenté et ensuite résolu avec le nouvel algorithme PSO. La solution du modèle est effectuée dans deux étapes. Dans la première étape une énumération exhaustive est effectuée pour trouver toutes les combinaisons possibles de pompes capables de répondre à une courbe de demande donnée pendant la période souhaitée. L'algorithme d'optimisation par essaims particulaires est alors utilisé pour rechercher la gestion optimale de chaque ensemble. Ayant résolu le problème de gestion de toutes les combinaisons possibles, le coût d'exploitation et d'amortissement de l'investissement initial est calculé pour chacune et la combinaison optimale et sa stratégie de gestion optimale est déterminée. Le modèle proposé est appliqué à la conception et l'exploitation d'un système irrigué réel et les résultats sont présentés et comparés à ceux d'un algorithme génétique. Deux versions globales et locales de l'algorithme PSO sont employées et leurs efficacités sont comparées entre eux et avec celles d'un modèle à algorithme génétique. Les résultats indiquent que le modèle proposé associé à l'algorithme d'optimisation par essaims particulaires est un modèle souple pour la conception et l'exploitation systèmes irrigués réels avec pompage. Copyright © 2008 John Wiley & Sons, Ltd. [source] Optimal feeder bus routes on irregular street networksJOURNAL OF ADVANCED TRANSPORTATION, Issue 2 2000Steven Chien The methodology presented here seeks to optimize bus routes feeding a major intermodal transit transfer station while considering intersection delays and realistic street networks. A model is developed for finding the optimal bus route location and its operating headway in a heterogeneous service area. The criterion for optimality is the minimum total cost, including supplier and user costs. Irregular and discrete demand distributions, which realistically represent geographic variations in demand, are considered in the proposed model. The optimal headway is derived analytically for an irregularly shaped service area without demand elasticity, with non-uniformly distributed demand density, and with a many-to-one travel pattern. Computer programs are designed to analyze numerical examples, which show that the combinatory type routing problem can be globally optimized. The improved computational efficiency of the near-optimal algorithm is demonstrated through numerical comparisons to an optimal solution obtained by the exhaustive search (ES) algorithm. The CPU time spent by each algorithm is also compared to demonstrate that the near-optimal algorithm converges to an acceptable solution significantly faster than the ES algorithm. [source] A Mathematical Programming Approach for Procurement Using Activity Based CostingJOURNAL OF BUSINESS FINANCE & ACCOUNTING, Issue 1-2 2000Zeger Degraeve Activity Based Costing and Management are important topics in today's management accounting literature. While there has been much attention paid in the Activity Based Costing literature to customer profitability analysis, process improvement and product design, there has been far less notice taken of purchasing. In this paper we develop an Activity Based Costing approach for the determination of procurement strategies. Vendor selection using an Activity Based Costing approach is choosing the combination of suppliers for a given product group that minimizes the total costs associated with the purchasing strategy. To this end we develop a mathematical programming model where decisions involve the selection of vendors and the determination of order quantities. The system computes the total cost of ownership, thereby increasing the objectivity in the selection process and giving the opportunity for various kinds of sensitivity analysis. [source] The hidden costs of outsourcingJOURNAL OF CORPORATE ACCOUNTING & FINANCE, Issue 6 2008Paul E. Juras Many outsourcing arrangements fail to deliver the expected cost savings. Why is this so? The author argues that management hasn't calculated the total cost of outsourcing, which includes your risks,and he shows you how to do it. © 2008 Wiley Periodicals, Inc. [source] Evaluation and economic impact analysis of different treatment options for ankle distortions in occupational accidentsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2010Amaryllis Audenaert Grad Eng PhD Abstract Rationale, aims and objectives, Appropriate use of diagnostic and treatment modalities are essential for rational use of resources. The aim of this study is to evaluate the use of diagnostic modalities and different treatment options and their economic impacts following an acute ankle distortion resulting from an occupational accident. We evaluated the type-of-treatment impact on the victims' course of recovery as well as its impact on the associated accident costs. Research was carried out in Belgium. Methods, An ankle distortion victims' database consisting of 200 cases of (Belgian) occupational accidents during the period 2005,2007 was analysed. Results, Patients who were prescribed immobilization or the use of adjuvant support or physical therapy (118 cases) were not employed during a period of 37 days on average, with a mean total cost of 3140.14 Euros caused by the ankle sprain. Patients without any adjuvant therapy (82 cases) were characterized by an unemployment rate of 15 days on average, and a total cost of 1077.86 Euros. Cast immobilization, although its application is not supported by evidence-based literature, was still applied in 36% of the population studied and resulted in the longest average absence of work of 42 days with an obvious significant increase in medical and total costs. Conclusions, Our results show a high rate of inappropriate use of cast immobilizations for ankle distortions. From an economic point of view and for the same clinical endpoint (being full resumption of the occupational activities), simple conventional treatment, consisting of rest, ice, compression and elevation at diagnosis with allowance of early weight bearing in the further clinical course, leads to the quickest full resumption of activities in combination with the lowest medical costs, if compared with any other kind of treatment. [source] A portable system for continuous monitoring of bird nests using digital video recordersJOURNAL OF FIELD ORNITHOLOGY, Issue 3 2007Andrew J. Pierce ABSTRACT A variety of photographic methods have been described for monitoring nest predation. All have limitations for studying active nests in remote situations, such as size, expense, volume of data recorded, and types of trigger mechanisms. We developed a digital video surveillance system using infrared cameras to monitor predation at bird nests. The main advantage of this system over other video recorders is the small size of the recorder that can run continuously at 29 frames/s for more than 3 days. The recorder's built-in monitor makes it more transportable and allows for easy setup. Digital data is compact, can be reviewed quickly, and requires less physical storage space than videotapes. We recorded nest predation by mammals, birds, and snakes as well as egg and nestling losses not caused by predation. System failure rates were low and the total cost was comparable to ($700 US) video cassette recorders that are often used to monitor nests. SINOPSIS Se han descrito una gran variedad de métodos fotográficos para monitorear la depredación de nidos. Todos los métodos tienen limitaciones para estudiar nidos activos a distancia, como su tamaño, costo, volumen de los datos grabados y mecanismos para activar el equipo. Desarrollamos un sistema digital de vigilancia, utilizando cámaras infrarrojas para monitorear la depredación de nidos. La ventaja principal de este equipo sobre otros similares es el tamaño de la grabadora, la cual puede funcionar continuamente a 29 cuadros/s por más de tres días. El monitor integrado a la cámara hace que el equipo que sea más fácil de transportar y permite que se pueda montar con facilidad. Los datos digitales son compactos, se pueden revisar rápidamente, y requieren menos espacio de almacenaje que las cintas de video convencionales. Grabamos depredación de nidos por mamíferos, aves y culebras al igual que la pérdida de huevos y pichones por otras causas. La tasa de malfuncionamiento fue baja y el costo del equipo ($700 US) es comparable a otros equipos de videograbación a cassette que se utilizan frecuentemente para monitorear nidos. [source] | |||||||||||||||||||||||||||||||||||||||||||