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Acquisition Cost (acquisition + cost)
Selected AbstractsFinancial Issues Constraining the Use of Pancreata Recovered for Islet Transplantation: A White PaperAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2008J. F. Markmann Islet transplantation is a very promising therapy for select patients with type 1 diabetes. Continued clinical investigation is required to define the long-term safety and efficacy outcomes before the procedure will be accepted as a standard of care even for those with the most severe manifestations of diabetes. Threatening successful accomplishment of these and other innovative studies designed to advance the field are the complex financial cost accounting issues that pose undue burden on organ procurement organizations and transplant centers trying to manage the costs of the pancreata from deceased donors needed to isolate islets. Compounding the problem is the recent ruling by CMS regarding ,intent to transplant' (CMS-1543-R Dec. 21, 2006: Allocation of Donor Acquisition Costs Incurred by Organ Procurement Organizations) that does not account for the clinical need to complete the manufacturing process for islets before suitability and transplant intent of the pancreata involved can be determined. We provide a consensus document supported by a diverse group of stakeholders in islet transplantation to suggest actions to address this problem. [source] Paliperidone palmitate , review of the efficacy, safety and cost of a new second-generation depot antipsychotic medicationINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2010L. Citrome Summary Objective:, To describe the efficacy, safety and cost of paliperidone palmitate, a depot antipsychotic medication recently approved for the treatment of schizophrenia. Data sources:, A literature search was conducted by querying the websites http://www.pubmed.gov, http://www.fda.gov, http://www.accessdata.fda.gov/scripts/cder/drugsatfda and http://www.clinicaltrials.gov for the search term ,paliperidone palmitate'. Cost information was obtained from the pharmaceutical vendor servicing a local state-operated psychiatric facility. Study selection:, All available reports of studies were identified. Product labelling provided additional information. Data extraction:, Descriptions of the principal results and calculation of the number needed to treat (NNT) and number needed to harm (NNH) for relevant dichotomous outcomes were extracted from the study reports and synopses. Additional safety outcomes subject to NNH analysis were obtained from product labelling. Data synthesis:, Paliperidone palmitate is a newly available depot formulation of paliperidone (the 9-OH metabolite of risperidone). Upon injection into the deltoid or gluteal muscle, the release of the drug starts as early as day 1, reaches maximum plasma concentrations at 13 days and lasts for as long as 126 days. Maximum concentration following deltoid injection is approximately 28% higher compared with injection into the gluteal muscle, and thus paliperidone palmitate requires initiation by two initial deltoid injections spread 1 week apart to achieve therapeutic concentrations rapidly. Subsequent injections are at 4-week intervals. Acute efficacy was evidenced by four short-term double-blind, randomised, placebo-controlled, fixed-dose studies of acutely relapsed adult inpatients who met DSM-IV criteria for schizophrenia. NNT for a 30% or greater decrease in the Positive and Negative Syndrome Scale total score compared with placebo was consistently lower for the higher dose strengths of 156 and 234 mg, suggesting a therapeutic dose,response. Treatment with paliperidone palmitate at doses between 39 and 156 mg significantly delayed the time to recurrence of symptoms of schizophrenia after 24 weeks of maintained symptom stability. The NNT vs. placebo to avoid a recurrence of symptoms was 5 (95% CI 4,7). Overall, paliperidone palmitate was reasonably well tolerated, with low rates of extrapyramidal symptoms or body weight gain; however, these may be more common at higher doses. Injection site reactions occurred at a rate ranging from 4% to 10%, depending on the dose regimen, compared with 2% for the pooled placebo arms. The acquisition cost of a maintenance dose of paliperidone palmitate calculated on a per day basis is similar to that for risperidone microspheres, but about double the cost for oral paliperidone and approximately 19 times the cost of oral generic risperidone. Conclusions:, Paliperidone palmitate is efficacious for the acute and maintenance treatment of schizophrenia and is reasonably well tolerated. It offers several advantages over other available second-generation depot antipsychotics: it comes in prefilled syringes in a number of different dosage strengths; it does not require refrigeration; it does not require supplementation with oral antipsychotics; it can be administered once monthly; it can be administered with a very small bore needle; the injection volume is small; the injection site can be either the deltoid or gluteal muscles; it does not require an additional precautionary observation period after the injection. For patients for whom oral risperidone or paliperidone is otherwise effective, paliperidone palmitate offers a guaranteed delivery system that enhances adherence. However, the high acquisition cost of paliperidone palmitate will likely be an important obstacle to its routine use. [source] Could interchangeable use of dry powder inhalers affect patients?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2005D. Price Summary The aim of asthma treatment is optimal disease control. Poor asthma control results in considerable patient morbidity, as well as contributing to the considerable burden placed by the disease on healthcare budgets. There is a need for costs to be carefully scrutinised, with the switching of patients to inhaler devices with lower acquisition costs likely to be increasingly considered. However, before such practice becomes widespread, it is important to establish whether or not this could adversely impact on patients and the level of disease control. For approval to have been given, all marketed inhalers must have satisfied current regulatory requirements for devices. Full preclinical and clinical development programmes are not required when application is made for authorisation to market a new inhaler containing an existing chemical entity, although clinical equivalence testing must be used. Both beneficial and adverse effects should be tested, and the limits of equivalence must be clearly defined, based on therapeutic relevance. It should be noted that equivalence studies are invalid when the end point is not responding (i.e. at the top of the dose,response curve) and when equivalence limits approach or are equal to the magnitude of the drug effect. Approval on the basis of regulations designed to safeguard quality of dry powder inhalers does not mean that devices are interchangeable. When using an inhaler, there are many stages between the patient and the therapeutic effect, involving device design, pharmaceutical performance and patient behaviour. Regulations governing new devices cover only a few of the many factors affecting disease control. Furthermore, clinical trials to assess equivalence may not take into account factors in patient behaviour or variations in patient inhaler technique that may affect use of devices in real-life situations. When assessing the consequences of interchangeable use of dry powder inhalers on healthcare costs, it is important to ensure that the acquisition cost of the devices is not the only cost considered. Other costs that should be considered include the cost of time spent demonstrating to the patient how to use the new device, the cost of additional physician visits to address patient concerns and the management costs if disease control is adversely affected. [source] Economic Evaluation of Oseltamivir Phosphate for Postexposure Prophylaxis of Influenza in Long-Term Care FacilitiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2005Nancy A. Risebrough MPhil Candidate Objectives: To compare the cost-effectiveness of oseltamivir postexposure prophylaxis during influenza A outbreaks with that of amantadine postexposure prophylaxis or no postexposure prophylaxis in long-term care facilities (LTCFs). Design: Cost-effectiveness analysis based on decision analytic model from a government-payer perspective. Setting: A Canadian LTCF, with high staff vaccination, at the beginning of influenza season. Participants: Elderly, influenza-vaccinated patients living in a Canadian LTCF. Measurements: Incremental costs (or savings) per influenza-like illness case avoided compared with usual care. Results: From a government-payer perspective, this analysis showed that oseltamivir was a dominant strategy because it was associated with the fewest influenza-like illness cases, with cost savings of $1,249 per 100 patients in 2001 Canadian dollars compared with amantadine and $3,357 per 100 patients compared with no prophylaxis. Costs for amantadine dose calculation and hospitalization for adverse events contributed to amantadine being a more-expensive prophylaxis strategy than oseltamivir. Both prophylaxis strategies were more cost-effective than no prophylaxis. Conclusion: Despite high influenza vaccination rates, influenza outbreaks continue to emerge in LTCFs, necessitating cost-effective measures to further limit the spread of influenza and related complications. Although amantadine has a lower acquisition cost than oseltamivir, it is associated with more adverse events, lower efficacy, and individualized dosing requirements, leading to higher overall costs and more influenza-like illness cases than oseltamivir. Therefore the use of oseltamivir postexposure prophylaxis is more cost-effective than the current standard of care with amantadine prophylaxis or no prophylaxis. [source] Stimulating or conventional perineural catheters after hallux valgus repair: a double-blind, pharmaco-economic evaluationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2006A. Casati Background:, We prospectively evaluated direct analgesia-related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair. Methods:, The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient-controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock-out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post-operative nausea and vomiting (PONV) treatment, and patient's satisfaction were recorded during first 24-h infusion. Cost calculations were based on the acquisition cost of drugs and devices. Results:, Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml (P= 0.004) and 21% vs. 60% (P= 0.001)]. The analgesia-related costs for 24 h were similar when 100-ml bags of ropivacaine 2 mg/ml were used (66 , vs. 67 ,; P= 0.26). When 200-ml bags of ropivacaine were used, the analgesia-related costs were higher in the Stimulating group than the Conventional group (75 , vs. 55 ,; P= 0.0005). Conclusions:, Direct costs of continuous sciatic nerve block ranged from 55 to 75 ,. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100-ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200-ml bags of ropivacaine. [source] Is the Cost of Adult Living Donor Liver Transplantation Higher Than Deceased Donor Liver Transplantation?LIVER TRANSPLANTATION, Issue 3 2004Mark W. Russo MD Background An important long-term consideration for living-donor liver transplantation (LDLT) is the expense compared with cadaveric-liver transplantation. LDLT is a more complex procedure than cadaveric transplantation and the cost of donor evaluation, donor surgery, and postoperative donor care must be included in a cost analysis for LDLT. In this study, we compare the comprehensive cost of LDLT with that of cadaveric-liver transplantation. Methods All costs for medical services provided at our institution were recorded for 24 LDLT and 43 cadaveric recipients with greater than 1 year follow-up transplanted between August 1997 and April 2000. The donor costs include donors evaluated and rejected, donors evaluated and accepted, donor right hepatectomy costs, and donor follow-up costs (365 days postdonation). LDLT and cadaveric recipient costs include medical care 90 days pre-LDLT, recipient transplant costs, and recipient follow-up costs (365 days posttransplant) including retransplantation. Cost is expressed as an arbitrary cost unit (CU) that is a value between $500 to $1,500. Results Total LDLT costs (evaluations of rejected donors + evaluations of accepted donors + donor hepatectomy + donor follow-up care for 1 year + pretransplant recipient care [90 days pretransplant] + recipient transplantation + recipient 1-year posttransplant care)= 162.7 CU. Total mean cadaveric transplant costs (pretransplant recipient care [90 days pretransplant] + recipient transplantation [including organ acquisition cost] + recipient 1-year posttransplant care)=134.5 CU, (P = ns) Conclusions The total comprehensive cost of LDLT is 21% higher than cadaveric transplantation, although this difference is not significant. (Transplantation 2003;75:473,476.) [source] Pricing of Private Placements of EquityASIA-PACIFIC JOURNAL OF FINANCIAL STUDIES, Issue 1 2010Jaiho Chung D82; G32 Abstract Building on the models of Benveniste & Spindt (1989) and Maksimovic & Pichler (2006), the present paper examines the optimal pricing and allocation mechanism for private placements of equity. Our model shows that for firms that receive favorable information prior to private placements, both the information acquisition cost and the value of information affect the offer discount. However, for firms that receive unfavorable information, only the information acquisition cost is the driving force behind the discount. We also show that the value of information has a greater impact on the discount level in private offerings compared to public offerings. However, the information acquisition cost has a greater effect on the discount in public offerings than in private placements. [source] Evaluating high-performance computers,CONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 10 2005Jeffrey S. Vetter Abstract Comparisons of high-performance computers based on their peak floating point performance are common but seldom useful when comparing performance on real workloads. Factors that influence sustained performance extend beyond a system's floating-point units, and real applications exercise machines in complex and diverse ways. Even when it is possible to compare systems based on their performance, other considerations affect which machine is best for a given organization. These include the cost, the facilities requirements (power, floorspace, etc.), the programming model, the existing code base, and so on. This paper describes some of the important measures for evaluating high-performance computers. We present data for many of these metrics based on our experience at Lawrence Livermore National Laboratory (LLNL), and we compare them with published information on the Earth Simulator. We argue that evaluating systems involves far more than comparing benchmarks and acquisition costs. We show that evaluating systems often involves complex choices among a variety of factors that influence the value of a supercomputer to an organization, and that the high-end computing community should view cost/performance comparisons of different architectures with skepticism. Published in 2005 by John Wiley & Sons, Ltd. [source] Population Synthesis: Comparing the Major Techniques Using a Small, Complete Population of FirmsGEOGRAPHICAL ANALYSIS, Issue 2 2009Justin Ryan Recently, disaggregate modeling efforts that rely on microdata have received wide attention by scholars and practitioners. Synthetic population techniques have been devised and are used as a viable alternative to the collection of microdata that normally are inaccessible because of confidentiality concerns or incomplete because of high acquisition costs. The two most widely discussed synthetic techniques are the synthetic reconstruction method (IPFSR), which makes use of iterative proportional fitting (IPF) techniques, and the combinatorial optimization (CO) method. Both methods are described in this article and then evaluated in terms of their ability to recreate a known population of firms, using limited data extracted from the parent population of the firms. Testing a synthetic population against a known population is seldom done, because obtaining an entire population usually is too difficult. The case presented here uses a small, complete population of firms for the City of Hamilton, Ontario, for the year 1990; firm attributes compiled are number of employees, 3-digit standard industrial classification, and geographic location. Results are summarized for experiments based upon various combinations of sample size and tabulation detail designed to maximize the accuracy of resulting synthetic populations while holding input data costs to a minimum. The output from both methods indicates that increases in sample size and tabulation detail result in higher quality synthetic populations, although the quality of the generated population is more sensitive to increases in tabular detail. Finally, most tests conducted with the created synthetic populations suggest that the CO method is superior to the IPFSR method. Los modelos desagregados basados en micro data han recibido la atención relativamente reciente de los círculos académicos y de aplicación. La colección de dicha data es una tarea difícil por cuestiones de accesibilidad, confidencialidad, datos incompletos o altos costos de adquisición. Por esta razón se han creado indicadores sintéticos como a alternativa a la recolección directa de datos. Los dos indicadores sintéticos mas discutidos/conocidos son el método de Reconstrucción Sintética (Sytnthetic Reconstruction method) (IPFSR) que hace uso de técnicas de Ajuste Proporcional Iterativo (IPF); y el método Optimización Combinatoria (CO). Ambos métodos son descritos en este artículo y luego evaluados en base a su habilidad de recrear una población de empresas ya conocidas o preestablecidas. Contrastar una población sintética versus una población conocida es una operación poco frecuente porque la obtención de una población entera es por lo general bastante difícil. El caso presentado en este estudio utiliza una población pequeña y completa de empresas en la ciudad de Hamilton, Ontario (Canadá) para el año 1990. Las variables recopiladas son el número de empleados, SIC (código estandarizado de clasificación industrial), y ubicación geográfica. Los resultados que se reportan en el presente estudio son producto de varios experimentos basados en varias combinaciones del tamaño de la muestra, y del detalle en la tabulación diseñados, los mismos que fueron diseñados para maximizar la exactitud de las poblaciones sintéticas calculadas y al mismo tiempo minimizar los costos de datos necesarios. Los resultados obtenidos por ambos métodos indica que los incrementos en el tamaño de la muestra y en el detalle de la tabulación resultan en un estimado de poblaciones mejor, aunque este estimado es particularmente sensible a incrementos en el detalle de las tabulaciones. Finalmente, la mayoría de pruebas realizadas con las poblaciones sintéticas generadas para este estudio sugieren que el método CO es superior al método IPFSR. [source] Making Financial Goals and Reporting Policies ServeJOURNAL OF APPLIED CORPORATE FINANCE, Issue 4 2004Corporate Strategy: The Case of Progressive Insurance The main. nancial goal of Progressive Insurance, the third largest underwriter of auto insurance in the U.S., has remained the same since the late 1960s. Expressed in three words, "96 and grow," the goal tells the company's managers to pursue all growth opportunities while maintaining a "combined ratio" no higher than 96, or what amounts to a minimum 4% spread between revenues (premiums) and costs (including expected losses). Thanks in part to the clarity of mission provided by this goal, the company has produced an average 15% rate of growth in revenues and earnings, along with a remarkably stable 15% return for its shareholders, since going public in 1971. Progressive's simplicity and clarity of mission is also partly responsible for another of the company's distinctive policies: product pricing that, while disciplined, is aggressive and highly decentralized. Having invested some $500 million per year developing statistical models for pricing individual customer risks and acquisition costs, the company was among the. rst in its industry to underwrite "non-standard" risks. And aided by sophisticated pricing models, each of Progressive's 100 or so local product managers are charged with adapting those models to come up with premiums for their own regions. To go along with its strategic and organizational innovations, Progressive also has an innovative disclosure policy. Apart from SEC reports, the company's communications seldom mention earnings or earnings per share, and the company has never provided earnings guidance. With the passage of Reg. FD in late 2000, the company brie. y considered offering guidance. But in the spring of 2001, the board decided instead to provide monthly releases of its realized combined ratio. Since adoption of this new disclosure policy, Progressive has seen a 50% drop in the volatility of its stock price. [source] The Cost Effectiveness of Duplicate Genotyping for Testing Genetic AssociationANNALS OF HUMAN GENETICS, Issue 3 2009Nathan Tintle Summary We consider a modification to the traditional genome wide association (GWA) study design: duplicate genotyping. Duplicate genotyping (re-genotyping some of the samples) has long been suggested for quality control reasons; however, it has not been evaluated for its statistical cost-effectiveness. We demonstrate that when genotyping error rates are at least m%, duplicate genotyping provides a cost-effective (more statistical power for the same price) design alternative when relative genotype to phenotype/sample acquisition costs are no more than m%. In addition to cost and error rate, duplicate genotyping is most cost-effective for SNPs with low minor allele frequency. In general, relative genotype to phenotype/sample acquisition costs will be low when following up a limited number of SNPs in the second stage of a two-stage GWA study design, and, thus, duplicate genotyping may be useful in these situations. In cases where many SNPs are being followed up at the second stage, duplicate genotyping only low-quality SNPs with low minor allele frequency may be cost-effective. We also find that in almost all cases where duplicate genotyping is cost-effective, the most cost-effective design strategy involves duplicate genotyping all samples. Free software is provided which evaluates the cost-effectiveness of duplicate genotyping based on user inputs. [source] The responsibility of the pharmaceutical industryCLINICAL MICROBIOLOGY AND INFECTION, Issue 2001C. Durrant The pharmaceutical industry plays an active role in policy surrounding the research, discovery and development of new medicines. Along with this commitment, the pharmaceutical industry must also take an active role in helping to ensure that appropriate patients receive access to state-of-the-art scientific advancements. The various players involved in drug development and introduction, including the pharmaceutical industry, clinicians, advocacy groups and regulatory bodies, need to work together to ensure patient access to quality care. While issues such as drug acquisition costs and marketing are often given a high profile, this may cloud perceptions of the industry's commitment to deliver important new medicines to the patients and healthcare systems that need them. [source] | |||||||||||||