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Cost Analysis (cost + analysis)
Selected AbstractsCost Analyses of Home Care and Nursing Home Services in the Southern Taiwan AreaPUBLIC HEALTH NURSING, Issue 5 2000Lian Chiu Sc.D. This study compares the cost of long-term care provided at patient homes with that of long-term care provided in nursing homes in southern Taiwan. Caring for a patient with a high degree of dependence at home is more expensive than caring for a patient in a nursing home facility when family costs and provider costs are considered together. This phenomenon is not demonstrated for patients with medium degrees of dependence. To be cost-effective, home care services should target patients with medium physical disability, and nursing home care should focus on patients with high levels of dependence. [source] Cost Analysis of the Geriatric Resources for Assessment and Care of Elders Care Management InterventionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2009Steven R. Counsell MD OBJECTIVES: To provide, from the healthcare delivery system perspective, a cost analysis of the Geriatric Resources for Assessment and Care of Elders (GRACE) intervention, which is effective in improving quality of care and outcomes. DESIGN: Randomized controlled trial with physicians as the unit of randomization. SETTING: Community-based primary care health centers. PARTICIPANTS: Nine hundred fifty-one low-income seniors aged 65 and older; 474 participated in the intervention and 477 in usual care. INTERVENTION: Home-based care management for 2 years by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions. MEASUREMENTS: Chronic and preventive care costs, acute care costs, and total costs in the full sample (n=951) and predefined high-risk (n=226) and low-risk (n=725) groups. RESULTS: Mean 2-year total costs for intervention patients were not significantly different from those for usual care patients in the full sample ($14,348 vs $11,834; P=.20) and high-risk group ($17,713 vs $18,776; P=.38). In the high-risk group, increases in chronic and preventive care costs were offset by reductions in acute care costs, and the intervention was cost saving during the postintervention, or third, year ($5,088 vs $6,575; P<.001). Mean 2-year total costs were higher in the low-risk group ($13,307 vs $9,654; P=.01). CONCLUSION: In patients at high risk of hospitalization, the GRACE intervention is cost neutral from the healthcare delivery system perspective. A cost-effectiveness analysis is needed to guide decisions about implementation in low-risk patients. [source] Cost Analysis: Concepts and ApplicationPUBLIC HEALTH NURSING, Issue 1 2001Christine A Brosnan Dr.P.H., R.N.C. Public health nurses are increasingly called upon to justify the cost of care or to decide which of two alternative programs is more cost-effective. Cost studies can be complex and difficult to conduct, but an understanding of the basic techniques allows nurses to fully participate in planning, implementing, and evaluating programs that greatly impact the health of the community. This article defines some of the basic terms used in health economics, discusses standard methods of cost analysis, and provides an example of neonatal screening to illustrate methods of describing, measuring, and assigning a value to cost items. [source] Laryngeal Cancer Cost Analysis: Association of Case-Mix and Treatment Characteristics With Medical Charges,THE LARYNGOSCOPE, Issue 1 2000David J. Arnold MD Abstract Objectives: To examine the relationship of various pretreatment case-mix characteristics and treatment modalities with medical charges incurred during diagnosis, treatment, and 2-year follow-up for patients with laryngeal cancer. Design: Retrospective chart review and billing record analysis. Methods: The charts and billing records of patients diagnosed with laryngeal cancer at the University of Iowa Hospitals and Clinics (UIHC) between January 1, 1991 and December 31, 1994 were reviewed. The independent variables included various pretreatment patient-mix and tumor characteristics (age, AJCC TNM clinical stage, smoking history, ASA class, and comorbidity as defined by Kaplan-Feinstein grade) as well as type of treatment. The dependent variables included total physician, office, and university hospital-based charges incurred during the pretreatment evaluation and 0- to 3-, 3- to 12-, and 12- to 24-month billing periods after the initiation of cancer-directed therapy. Total 1-year and 2-year charges were also evaluated. Univariate and multivariate analyses were used to investigate the relationships between dependent and independent variables and to develop models predictive of management charges during the individual and total billing periods. Results: Pretreatment charges showed no significant associations (P < .05) with any of the independent variables. Multiple regression analyses indicated that comorbidity, stage, and initial treatment modality were significant variables in one or more of the models predicting charges incurred during the 0- to 3-month, 3- to 12-month, total 1-year, and total 2-year billing periods. The models yielded R2 values for the total 1- and 2-year billing periods of 0.5246 and 0.5055, respectively. Conclusions: This work supports continued study of measures that may result in earlier detection of laryngeal cancer as a potential means of reducing management charges. These results also indicate that a more accurate method of stratifying the disease severity of laryngeal cancer patients for reimbursement purposes would include measurements of the severity of the index disease as well as comorbid diseases. [source] Screening to Prevent Polyoma Virus Nephropathy in Kidney Transplantation: A Cost AnalysisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009F. Smith Polyoma virus nephropathy is an important cause of graft dysfunction in kidney transplant recipients and screening to prevent disease has been advocated. Although screening incurs new costs, our hypothesis is that savings from less immunosuppression in those with positive screening tests could pay for overall costs of screening. In 134 consecutive recipients, polyoma virus (positive decoy cells) was detected in the urine of 34 (25.4%) individuals over a 2-year follow-up. Of these 34, 11 had a plasma BK PCR of >7700 copies/mL. Immunosuppression was reduced stepwise in these patients until viral loads fell <1000/mL. Overall screening costs (including extra plasma PCR testing) were estimated at $33 450. Those with positive PCR had greater reductions in annual immunosuppression costs by year 2 ($6452 vs. $2799, p = 0.0015) compared to those with negative screens. At the end of the 2-year period, 61% of the screening costs were covered by less immunosuppressant costs. At the end of 30 months there were net savings. In summary, reductions in immunosuppression cover the cost of screening for polyoma viral infection. Longer-term follow-up is needed to ensure patient outcomes remain acceptable. [source] Coated Prostheses Are Associated With Prolonged Inflammation in Aortic Surgery: A Cost AnalysisARTIFICIAL ORGANS, Issue 3 2008Shunya Shindo Abstract:, This prospective study was conducted to compare inflammatory responses between patients receiving coated and uncoated vascular prostheses, and to examine their effect on length of stay and cost of patients undergoing abdominal aortic aneurysmectomy. Patients undergoing elective vascular reconstruction of an abdominal aortic aneurysm were assigned randomly to coated-graft or uncoated-graft groups (n = 20, for each group). Interleukin (IL)-6, granulocyte elastase, white blood cell count, C-reactive protein (CRP), and body temperature (BT) were prospectively recorded preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. In-hospital stay and hospitalized costs were also analyzed. IL-6 and CRP concentrations in the coated-graft group were higher than those in the uncoated-graft group (P = 0.01 and 0.05). BT was more frequently elevated >37°C at POD 14 in the coated-graft group than in the uncoated-graft group (P =0.03). Discharge was delayed, and overall hospitalization cost was higher in the coated-graft group than in the uncoated group (17.6 vs. 13.5 days, and 2 010 000 vs. 1 780 000 yen, P = 0.006 and P = 0.002, respectively). Coated vascular prosthesis demonstrated more profound inflammatory reaction than noncoated prosthesis, postoperatively. [source] Cost analysis of the treatment of acute childhood lymphocytic leukaemia according to Nordic protocolsACTA PAEDIATRICA, Issue 4 2000J Rahiala Some attempts have been made to reduce the costs incurred in the therapy of leukaemia, but no studies are available regarding costs of the entire treatment in children with acute lymphocytic leukaemia (ALL). We analysed all the direct costs of treatment of 11 children with ALL diagnosed and treated in Kuopio University Hospital. The follow-up continued from diagnosis until the end of treatment for each patient. Patient treatment on the ward lasted for 84-210 d and in the outpatient clinic for 24-66 d, depending on the risk group. From 11-54 of the inpatient days were required for the treatment of infections. Total mean cost of the entire treatment was US $103 250 (US $55 196-166 039) per patient, 53% of which were basic hospital costs and 47% patient-specific costs. Laboratory tests and radiology accounted for 18% of all direct costs and cytostatic drugs for 13%, but blood products accounted for only 4% of the total. Infections were the most important extra cause of costs, accounting for 18% of the mean total costs per patient. The complete treatment of a child with ALL came to a total of US $103 250. However, since 80% of children with ALL are long-term survivors, the cost must be regarded as a good investment. [source] Using cost-analysis techniques to measure the value of nurse practitioner careINTERNATIONAL NURSING REVIEW, Issue 4 2002D. Vincent PhD Abstract Nurse practitioners are in a unique position to deliver high-quality care to a variety of populations and are being utilized in many countries worldwide. Although certain aspects of the nurse practitioner role may differ from country to country, limited financial support and competition for access to patients make it incumbent on nurse practitioners to document the cost-effectiveness of their care. Cost analysis, a business tool that can be used by any practitioner in any health care system, was used to examine business practices of an academic-based nurse-managed centre. In order for this tool to be effective, nurse practitioners must become comfortable with using cost-analysis techniques in their practices. Linking outcome data with cost data was found to be one method for explicating the value of nurse practitioner practice. Nurse practitioners must also recognize that they are competing with primary-care physician practices and other primary health-care practices. It is vital for nurse practitioners to document both the quality and the costs of their care in order to compete with physicians and other health care providers, in order to influence policy and other health-care decision makers. [source] A Cost-Effectiveness Analysis of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Diabetic NephropathyJOURNAL OF CLINICAL HYPERTENSION, Issue 10 2007Panagiotis C. Stafylas MD The aim of this study was to estimate the cost-effectiveness of renin-angiotensin-aldosterone system blockers in patients with diabetic nephropathy. A cost-effectiveness analysis was performed based on a meta-analysis of studies investigating the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) as part of a treatment regimen on the incidence of end-stage renal disease (ESRD) in patients with diabetic nephropathy. The primary outcome was the cost to prevent 1 patient from developing ESRD. Cost analysis was performed from a third-party payer perspective in 2006 US dollars. As part of a treatment regimen, ARBs significantly reduced the incidence of ESRD and doubling of serum creatinine concentration (P<.05) but not total mortality. The cost to prevent 1 patient from developing ESRD was $31,729 (95% confidence interval, $19,443,$85,442; P<.01), $189,190 (P=.13) and $51,585 (P=.068) for patients receiving ARBs, ACE inhibitors, or either of them, respectively. This study demonstrates that blocking the RAAS, which delays the progression to ESRD, appears to be cost-effective. The current analysis favors ARBs in terms of cost-effectiveness. [source] Cost analysis of proton exchange membrane fuel cell systemsAICHE JOURNAL, Issue 7 2008Ai-Jen Hung Abstract Tradeoff between capital cost and the operating cost can be seen in the design of proton exchange membrane fuel cell systems. The polarization curve indicates that operating in the region of lower current densities implies less operating cost (hydrogen fuel) and higher capital cost (larger membrane electrode assembly area). The opposite effects are observed when one operates in the region of higher current densities. Therefore, an appropriate design should take both factors into account and the optimality depends on the corresponding costs of hydrogen and membrane area. An analytical cost model is constructed to describe such an economic balance in a proton exchange membrane fuel cell system. The objective function of the optimization is the total annual cost. Six scenarios are used to illustrate the optimal design based on the total annual cost as cost and materials factors fluctuate. © 2008 American Institute of Chemical Engineers AIChE J, 2008 [source] Training subspecialty nurses in developing countries: Methods, outcome, and costPEDIATRIC BLOOD & CANCER, Issue 2 2003Judith A. Wilimas MD Abstract Background As infections are controlled in developing countries, other pediatric subspeciality programs such as oncology become increasingly important. A major impediment to the development of such programs is a lack of trained nurses. Therefore, education of pediatric subspecialty nurses becomes a priority. Procedure We describe three models we have used for education of pediatric oncology nurses: a short series of classes or lectures with additional training of key nurses, an expanded 12 week series of classes at centers combining didactic and clinical instruction and a regional residential school offering regular 12 week courses in theory and clinical practice. Results Cost analysis showed that the cost per nurse trained was, respectively, $3,700; $4,350; and $5,500. Early effectiveness indicators show that retention rates are high, home institutions are satisfied, and nurses trained shared their knowledge with other nurses and improved nursing practices. Conclusions Programs to teach subspecialty nursing in developing countries are effective and can improve medical care. Such programs should be based on past experience and evaluated as to cost and effectiveness. Med Pediatr Oncol 2003;41:136,140. © 2003 Wiley-Liss, Inc. [source] Antibiotics for Reduction of Posttonsillectomy Morbidity: A Meta-Analysis,THE LARYNGOSCOPE, Issue 6 2005Collin M. Burkart BS Abstract Objective: To reconcile conflicting published reports regarding the clinical efficacy of postoperative antibiotics for reduction of posttonsillectomy morbidity. Study Design: Systematic review (meta-analysis). Methods: Meta-analysis of seven randomized controlled trials of postoperative oral antibiotics in patients undergoing tonsillectomy or adenotonsillectomy. Postoperative pain and time to return to normal activity and diet were studied as distinct end points using a random effects model with weighted mean difference (RevMan 4.2). Search strategy included electronic searches of PubMed and Cochrane library databases; cross-referencing textbooks, reviews, and original trials; and contacting experts in the field. Results: Subjects treated with antibiotics experienced an earlier return to a normal diet (,1.22 days; 95% confidence interval [CI] = ,1.97, ,0.48; P = .001) and an earlier return to normal activity (,0.99 days; 95% CI = ,1.80, ,0.17; P = .02). Evaluation of mean pain visual analogue scores (VAS 0,10) over the first 5 and 7 postoperative days failed to demonstrate any significant effect of antibiotic therapy (VAS difference over 5 days = 0.41; ,1.18, 2.00; P = .61) (VAS difference over 7 days = ,0.64; ,3.46, 2.18; P = .66). Cost analysis suggests routine therapy may be cost-effective but did not include analysis of side effects or resistance resulting from antibiotic usage. Conclusion: The results of this systematic meta-analysis suggest that postoperative oral antibiotics do not significantly reduce posttonsillectomy pain but result in an earlier return to normal activity and diet by approximately 1 day. Given the frequency that tonsillectomy is performed, this possible benefit should be weighed against the cost and potential side effects of routine antibiotic therapy. [source] Health economics of treating haemophilia A with inhibitorsHAEMOPHILIA, Issue 2005C. KNIGHT Summary., Haemophilia is a rare, inherited blood disorder in which blood clotting is impaired such that patients suffer from excessive internal and external bleeding. At present there is no cure for haemophilia A and patients require expensive, life-long treatment involving clotting factor replacement therapy. Treatment costs are perceived to be higher for patients who have developed inhibitory antibodies to factor VIII, the standard therapy for haemophilia A. However, initial cost analyses suggest that clotting factor therapy with alternative haemostatic agents, such as recombinant activated factor VII or activated prothrombin complex concentrate, is no more expensive for the majority of haemophilia A patients with inhibitors than for those without inhibitors. With the availability of effective alternative haemostatic agents, orthopaedic surgery for haemophilia A patients with inhibitors is now a clinical option, and initial cost analyses suggest this may be a cost-effective treatment strategy for patients with inhibitors whose quality of life (QoL) is severely impaired by joint arthropathy. In an era of finite healthcare resourcing it is important to determine whether new treatments justify higher unit costs compared with standard therapies and whether such higher costs are justified from an individual perspective in terms of improved QoL, and from a societal perspective in terms of improved productivity and reduced overall healthcare costs. This paper examines current data on the health economics of treating haemophilia A patients with inhibitors, focusing on the overall costs of clotting factor replacement therapy and the cost consequences of joint replacement. [source] Nocturnal Haemodialysis , A Preliminary Cost Comparison with Conventional Haemodialysis in AustraliaHEMODIALYSIS INTERNATIONAL, Issue 1 2003JWM Agar A 6 night/wk, home-based, government funded nocturnal haemodialysis (NHDx) program, believed to be the first outside North America, commenced in July 2001. Previously published Canadian and US costs suggest NHDx to be more cost-efficient than conventional haemodialysis (CHDx) as, although consumable-expensive, NHDx is home-based and is thus highly infrastructure, wage and hospital inpatient bed-day efficient. Comparable Australian cost evaluation is essential, however, before NHDx is widely encouraged as a new modality here. Cost comparisons for 3 × wk CHDx vs preliminary costs for 9/12 pts on 6 × wk NHDx (3 excluded for inadequate program time) include: consumables/fluids CHDx @$A8781/pt/yr vs NHDx @$A17562/pt/yr; estimated nursing costs CHDx (62.25 nurse hrs/wk with a nurse/pt ratio of 3:9)@$A12666/pt/yr vs NHDx (40 nurse hrs/wk with a nurse/pt ratio of 1:9)@$A8111/pt/yr with projected reduction to A$4866 for nurse/pt ratio of 1:15; pharmaceutical costs (includes all medication & Fleet® for dialysate but excludes EPO/iron polymaltose) CHDx one month prior to NHDx @$A1412/pt/yr vs NHDx costs after one month starting home-based treatment @$A1273/pt/yr. Though the NHDx pts have been carefully selected, only 3 hospitalizations for a total of 4 bed-days have been necessary in 348.5 pt wks of experience to September 2002. Our preliminary cost analyses confirm prior North American data. Cumulative financial modeling shows NHDx is more costly than CHDx at low pt numbers, reaching approximate equivalence @ 12 pts and progressively dropping below CHDx costs thereafter. NHDx appears cost-competitive with CHDx whilst yielding superior biochemical, life-style and rehabilitation results (see accompanying clinical data abstract). [source] Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic reviewJOURNAL OF ADVANCED NURSING, Issue 4 2009Ruth Lewis Abstract Title.,Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic review. Aim., This paper is a report of a systematic review of the effectiveness and cost-effectiveness of nurse-led follow-up for patients with cancer. Background., As cancer survivorship increases, conventional follow-up puts a major burden on outpatient services. Nurse-led follow-up is a promising alternative. Data sources., Searches were conducted covering a period from inception to February 2007 of 19 electronic databases, seven online trial registries, five conference proceedings reference lists of previous reviews and included studies. Review methods., Standard systematic review methodology was used. Comparative studies and economic evaluations of nurse-led vs. physician-led follow-up were eligible. Studies comparing different types of nurse-led follow-up were excluded. Any cancer was considered; any outcome measure included. Results., Four randomised controlled trials were identified, two including cost analyses. There were no statistically significant differences in survival, recurrence or psychological morbidity. One study showed better HRQL measures for nurse-led follow-up, but one showed no difference, two showed a statistically significant difference for patient satisfaction, but two did not. Patients with lung cancer were more satisfied with nurse-led telephone follow-up and more were able to die at home. Patients with breast cancer thought patient-initiated follow-up convenient, but found conventional follow-up more reassuring. One study showed the cost of nurse-led follow-up to be less than that of physician-led follow-up, but no statistical comparison was made. Conclusion., Patients appeared satisfied with nurse-led follow-up. Patient-initiated or telephone follow-up could be practical alternatives to conventional care. However, well-conducted research is needed before equivalence to physician-led follow-up can be assured in terms of survival, recurrence, patient well-being and cost-effectiveness. [source] Quality and Outcomes of Heart Failure Care in Older Adults: Role of Multidisciplinary Disease-Management ProgramsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Ali Ahmed MD, FACP PURPOSE: To determine whether the management of heart failure by specialized multidisciplinary heart failure disease-management programs was associated with improved outcomes. BACKGROUND: The advent of angiotensin-converting enzyme inhibitors, beta-blockers, and spironolactone has revolutionized the management of heart failure. Randomized double-blind studies have demonstrated survival benefits of these drugs in heart failure patients. Nevertheless, in spite of these advances, heart failure continues to be a syndrome of poor outcomes.1,4 There is also evidence that a significant portion of heart failure patients does not receive this evidence-based therapy that reduces morbidity and mortality.5,7 Various disease-management programs have been proposed and tested to improve the quality of heart failure care. Most of these programs are specialized multidisciplinary heart failure clinics lead by cardiologists or heart failure specialists and conducted by nurses or nurse practitioners. Similar to the Department of Veterans Affairs (VA) multidisciplinary geriatric assessment clinics, these clinics also use many other services, including pharmacists, dietitians, physical therapists, and social workers. Some of these programs also have an affiliated home health service. Several observation studies, using mostly pre- and postcomparison designs, have demonstrated the effectiveness of these programs in the process of care, resource use, healthcare costs, and clinical outcomes in patients with heart failure.8 Risk of hospitalization was reduced by 50% to 85% in six of the studies.8 Subsequently, several randomized trials were conducted to determine the effectiveness of these programs. The purpose of this systematic review was to determine the effectiveness of these programs on mortality and hospitalization rates of heart failure patients. METHODS: Published articles on human randomized trials involving specialized heart failure disease-management programs in all languages were searched using Medline from 1966 to 1999 and other online databases using the following terms and Medical Subject Headings: case management (exp); comprehensive health care (exp); disease management (exp); health services research (exp); home care services (exp); clinical protocols (exp); patient care planning (exp); quality of health care (exp); nurse led clinics; special clinics; and heart failure, congestive (exp). In addition, a manual search of the bibliographies of searched articles was performed to identify articles otherwise missed in the above search. Personal communications were made with three authors to obtain further data on their studies. Using a data abstraction tool, two of the investigators separately abstracted data from the selected articles. Data from the selected studies were combined using the DerSimonian and Laird random effects model and the Mantel-Haenszel-Peto fixed effects model. Meta-Analyst 0.998 software (J. Lau, New England Medical Center, Boston, MA) was used to determine risk ratios (RRs) with 95% confidence intervals (CIs) of mortality and hospitalization for patients receiving care through these specialized programs compared with those receiving usual care. The Cochran Q test was used to test heterogeneity among the studies, and sensitivity analyses were performed to examine the effect of various covariates, such as duration of intervention, and other characteristics of the disease-management programs. RESULTS: The original search resulted in 416 published articles, of which 35 met preliminary selection criteria. Of these, 11 were randomized trials and were selected for the meta-analysis. Studies that were not randomized trials, did not involve heart failure patients or disease-management programs, or had missing outcomes were excluded. Of the 11 studies selected, nine involved specialized follow-up using multidisciplinary teams and the remaining two involved follow-up by primary care physicians and telephone. These studies involved 1,937 heart failure patients with a mean age of 74. The follow-up period ranged from no follow-up (one study) to 1 year (one study). Patients receiving care from specialized heart failure disease-management programs had a 13% lower risk of hospitalization than those receiving usual care (summary RR = 0.87; 95% CI = 0.79,0.96), but the Cochran Q test demonstrated significant heterogeneity among the studies (P = .003). Subgroup analysis of the nine studies using specialized follow-up by a multidisciplinary team showed similar results (summary RR = 0.77, 95% CI = 0.68,0.86; test of heterogeneity, P> .50). Seven of the nine studies did not show any significant association between intervention and reduced hospitalization, but the two studies that used follow up by primary care physicians and telephone failed to show any significant reduction in hospitalization (summary RR = 0.94, 95% CI = 0.75,1.19). In fact, one of the studies demonstrated a higher risk of hospitalization for patients receiving intervention (RR = 1.26, 95% CI = 1.04,1.52). Of the 11 studies, only six reported mortality as an outcome. None of these studies found any association between intervention and mortality (summary RR = 1.15, 95% CI = 0.96,1.37; test of heterogeneity, P> .15). Five of the studies used quality of life or functional status as outcomes, and, of them, only one demonstrated significant positive association. The results of the sensitivity analyses were negative for any significant association with duration of intervention or follow-up or year of study. Eight studies performed cost analyses and seven demonstrated cost-effectiveness of the intervention. CONCLUSIONS: The authors concluded that specialized disease-management programs were cost-effective, and heart failure patients cared for by these programs were more likely to undergo fewer hospitalizations, but the study did not provide any conclusive association between these programs and quality of care or mortality. The authors recommend that disease-management programs involve patient education and specialized follow-up by a multidisciplinary team including home health care. [source] Legitimacy and quality of multi-criteria environmental policy analysis: a meta analysis of five MCE studies in NorwayJOURNAL OF MULTI CRITERIA DECISION ANALYSIS, Issue 2 2001Fred Wenstøp Abstract This paper argues for multi-criteria decision analysis (MCDA) as a tool in environmental policy analysis. From an ethical point of view, neither rule-based methods, nor benefit,cost analyses (BCA) are sufficient. Multi-criteria decision analysts need, however, to be concerned about the legitimacy and quality of their applications. Neuro-physiological evidence indicates that a necessary, but not sufficient, criterion for quality is that the decision-makers experience emotions in the valuation process. Without emotions, and in contrast to popular belief, its valuation part is liable to be out of proportion with the range of values held by reasonable selections of the society. This paper proposes criteria for evaluation of legitimacy and quality, reviews five applications in Norway of MCDA for environmental policy, but finds that there is no clear relationship between the legitimacy and quality of the studies and their significance for decision-makers. Copyright © 2001 John Wiley & Sons, Ltd. [source] The costs of heparin-induced thrombocytopenia: a patient-based cost of illness analysisJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2009T. WILKE Summary.,Background and objectives:,Due to the complexity of heparin-induced thrombocytopenia (HIT), currently available cost analyses are rough estimates. The objectives of this study were quantification of costs involved in HIT and identification of main cost drivers based on a patient-oriented approach. Methods:,Patients diagnosed with HIT (1995,2004, University-hospital Greifswald, Germany) based on a positive functional assay (HIPA test) were retrieved from the laboratory records and scored (4T-score) by two medical experts using the patient file. For cost of illness analysis, predefined HIT-relevant cost parameters (medication costs, prolonged in-hospital stay, diagnostic and therapeutic interventions, laboratory tests, blood transfusions) were retrieved from the patient files. The data were analysed by linear regression estimates with the log of costs and a gamma regression model. Mean length of stay data of non-HIT patients were obtained from the German Federal Statistical Office, adjusted for patient characteristics, comorbidities and year of treatment. Hospital costs were provided by the controlling department. Results and conclusions:,One hundred and thirty HIT cases with a 4T-score ,4 and a positive HIPA test were analyzed. Mean additional costs of a HIT case were 9008 ,. The main cost drivers were prolonged in-hospital stay (70.3%) and costs of alternative anticoagulants (19.7%). HIT was more costly in surgical patients compared with medical patients and in patients with thrombosis. Early start of alternative anticoagulation did not increase HIT costs despite the high medication costs indicating prevention of costly complications. An HIT cost calculator is provided, allowing online calculation of HIT costs based on local cost structures and different currencies. [source] Using health information technology to improve drug monitoring: a systematic reviewPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 12 2009Geoffrey L. Hayward MD Abstract Purpose To conduct a systematic review of current evidence regarding the use of health information technology (HIT) interventions to improve drug monitoring in ambulatory care. Methods We searched PubMed, CINAHL, the Cochrane Library, and other computerized databases from 1 January 1998 to 30 June 2008 using the key words "drug monitoring," "medical records systems, computerized," "ambulatory care," and "outpatients." We manually reviewed reference lists of articles identified through computer searches and asked experts in the field to review our search strategy and results for completeness. Results Seven relevant studies were identified. Four of these studies assessed real-time interventions that used alerts to physicians at the time of medication ordering to ensure adequate monitoring, only one of which showed an improvement in monitoring. Of three studies using HIT outside the physician encounter, two suggested some improvement in monitoring rates. Methodological limitations were apparent in all studies identified. Conclusions Few studies have assessed the effectiveness of HIT interventions to improve drug monitoring, and among them, there is no clear consensus regarding the most consistently effective approaches to reducing drug monitoring errors. There is a clear need for well designed randomized trials to evaluate possible interventions to reduce drug monitoring errors. Such studies should incorporate health outcomes and detailed cost analyses to further characterize the feasibility of successful interventions. Copyright © 2009 John Wiley & Sons, Ltd. [source] Measuring function in rheumatoid arthritis: Identifying reversible and irreversible componentsARTHRITIS & RHEUMATISM, Issue 9 2006Daniel Aletaha Objective Measurement of physical function at one point in time cannot distinguish impairment caused by the active disease process from chronic irreversible impairment. We aimed to dissect these two components of functional limitation in rheumatoid arthritis (RA) by using the disability index of the Health Assessment Questionnaire (HAQ) as the measure of function. Methods We performed a secondary analysis of data from 6 contemporary clinical trials of RA (2,763 patients). Patients in whom remission was achieved in the trials, based on a simplified disease activity index, were identified. In an individual patient, HAQ scores at trial entry represented both reversible and irreversible impairments, while HAQ scores at the time of RA remission represented the mostly irreversible component, and the difference between these corresponded to the component related to disease activity. We tested the concept that the HAQ has a reversible and an irreversible component by associating the HAQ score during remission with 2 measures associated with the degree of accrued damage: duration of RA and radiographic severity. Results Among patients in whom clinical remission was achieved (n = 295), average HAQ scores despite clinical remission increased progressively with the duration of RA, from 0.19 (<2 years of RA) to 0.36 (2,<5 years) to 0.38 (5,<10 years) to 0.55 (,10 years) (P < 0.001). The reversibility of HAQ scores decreased with the duration of RA (median 100%, 83.3%, 81.9%, and 66.7%, respectively; P < 0.001). Findings were similar in patients subgrouped by quartile of radiographic scores. Conclusion Differences in the sources of functional limitations should be considered in the interpretation of functional measures, and in their use for prediction and in cost analyses. [source] A Decision Support System Specification for Cost Escalation in Heavy Engineering IndustryCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 5 2002Nashwan N. Dawood The heavy civil engineering industry (railways, sewage-treatment, chemical and pharmaceutical facilities, oil and gas facilities, etc.) is one of the major contributors to the British economy and generally involves a high level of investment. Clients in this industry are demanding accurate cost estimates, proper analysis of out-turn cost and cost escalation, and a high quality risk analysis throughout the construction processes. Current practices in the industry have suggested that there is a lack of structured methodologies and systematic cost escalation approaches to achieve an appropriate cost analysis at the outset of projects and throughout the construction processes. In this context the prime objective of this research work is to develop a structured cost escalation methodology for improving estimating management and control in the heavy engineering industry construction processes. The methodology is composed of a forecasting model to predict cost indices of major items in industry and a risk knowledge-base model for identifying and quantifying causes of cost escalations. This paper reviews and discusses a knowledge-based model for applying a cost escalation factor. The cost escalation factor is made up of market variation, a risk element, and a component for bias. A knowledge elicitation strategy was employed to obtain the required knowledge for the model. The strategy included questionnaires, interviews, and workshops, and deliverables came in the form of influences and their effect on project cost escalation. From these deliverables, a decision support system and specifications for applying cost escalation to base estimates are presented. [source] Diabetic retinopathy screening: a systematic review of the economic evidenceDIABETIC MEDICINE, Issue 3 2010S. Jones Diabet. Med. 27, 249,256 (2010) Abstract This paper systematically reviews the published literature on the economic evidence of diabetic retinopathy screening. Twenty-nine electronic databases were searched for studies published between 1998 and 2008. Internet searches were carried out and reference lists of key studies were hand searched for relevant articles. The key search terms used were ,diabetic retinopathy', ,screening', ,economic' and ,cost'. The search identified 416 papers of which 21 fulfilled the inclusion criteria, comprising nine cost-effectiveness studies, one cost analysis, one cost-minimization analysis, four cost,utility analyses and six reviews. Eleven of the included studies used economic modelling techniques and/or computer simulation to assess screening strategies. To date, the economic evaluation literature on diabetic retinopathy screening has focused on four key questions: the overall cost-effectiveness of ophthalmic care; the cost-effectiveness of systematic vs. opportunistic screening; how screening should be organized and delivered; and how often people should be screened. Systematic screening for diabetic retinopathy is cost-effective in terms of sight years preserved compared with no screening. Digital photography with telemedicine links has the potential to deliver cost-effective, accessible screening to rural, remote and hard-to-reach populations. Variation in compliance rates, age of onset of diabetes, glycaemic control and screening sensitivities influence the cost-effectiveness of screening programmes and are important sources of uncertainty in relation to the issue of optimal screening intervals. There is controversy in relation to the economic evidence on optimal screening intervals. Further research is needed to address the issue of optimal screening interval, the opportunities for targeted screening to reflect relative risk and the effect of different screening intervals on attendance or compliance by patients. [source] Optimal seismic design of steel frame buildings based on life cycle cost considerationsEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 9 2003Min Liu Abstract A multi-objective optimization procedure is presented for designing steel moment resisting frame buildings within a performance-based seismic design framework. Life cycle costs are considered by treating the initial material costs and lifetime seismic damage costs as two separate objectives. Practical design/construction complexity, important but difficult to be included in initial cost analysis, is taken into due account by a proposed diversity index as another objective. Structural members are selected from a database of commercially available wide flange steel sections. Current seismic design criteria (AISC-LRFD seismic provisions and 1997 NEHRP provisions) are used to check the validity of any design alternative. Seismic performance, in terms of the maximum inter-storey drift ratio, of a code-verified design is evaluated using an equivalent single-degree-of-freedom system obtained through a static pushover analysis of the original multi-degree-of-freedom frame building. A simple genetic algorithm code is used to find a Pareto optimal design set. A numerical example of designing a five-storey perimeter steel frame building is provided using the proposed procedure. It is found that a wide range of valid design alternatives exists, from which a decision maker selects the one that balances different objectives in the most preferred way. Copyright © 2003 John Wiley & Sons, Ltd. [source] Comparative response analysis of conventional and innovative seismic protection strategiesEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 5 2002S. Bruno Abstract The paper presents a numerical investigation aimed at evaluating the improvements achievable through devices for passive seismic protection of buildings based on the use of shape memory alloys (SMA) in place of conventional steel or rubber devices. To get some generality in the results, different resisting reinforced concrete plane frames were analysed, either protected or not. ,New' and ,existing' buildings were considered depending on whether seismic provisions are adopted in the building design or not. Base isolation and energy dissipation were equally addressed for both conventional and innovative SMA-based devices. Fragility analyses were performed using specific damage measures to account for comparisons among different damage types; the results were then used to estimate quantitatively the effectiveness of the various protection systems. More specifically, the assessment involved a direct comparison of the damage reduction provided by each protection system with respect to the severe degradation experienced by the corresponding non-protected frame. Structural damage, non-structural damage and damage to contents were used on purpose and included in a subsequent phase of cost analysis to evaluate the expected gains also in terms of economic benefits and life loss prevention. The results indicate that base isolation, when applicable, provides higher degrees of safety than energy dissipation does; moreover, the use of SMA-based devices generally brings about better performances, also in consideration of the reduced functional and maintenance requirements. Copyright © 2002 John Wiley & Sons, Ltd. [source] A cost analysis of ranked set sampling to estimate a population meanENVIRONMETRICS, Issue 3 2005Rebecca A. Buchanan Abstract Ranked set sampling (RSS) can be a useful environmental sampling method when measurement costs are high but ranking costs are low. RSS estimates of the population mean can have higher precision than estimates from a simple random sample (SRS) of the same size, leading to potentially lower sampling costs from RSS than from SRS for a given precision. However, RSS introduces ranking costs not present in SRS; these costs must be considered in determining whether RSS is cost effective. We use a simple cost model to determine the minimum ratio of measurement to ranking costs (cost ratio) necessary in order for RSS to be as cost effective as SRS for data from the normal, exponential, and lognormal distributions. We consider both equal and unequal RSS allocations and two types of estimators of the mean: the typical distribution-free (DF) estimator and the best linear unbiased estimator (BLUE). The minimum cost ratio necessary for RSS to be as cost effective as SRS depends on the underlying distribution of the data, as well as the allocation and type of estimator used. Most minimum necessary cost ratios are in the range of 1,6, and are lower for BLUEs than for DF estimators. The higher the prior knowledge of the distribution underlying the data, the lower the minimum necessary cost ratio and the more attractive RSS is over SRS. Copyright © 2005 John Wiley & Sons, Ltd. [source] Success of activity management practices: the influence of organizational and cultural factorsACCOUNTING & FINANCE, Issue 1 2007Kevin Baird M40 Abstract This study examines the success of activity management practices and the organizational and cultural factors affecting success at each of Gosselin's (1997) three levels of activity analysis (AA), activity cost analysis (ACA) and activity-based costing (ABC). Data were collected by survey questionnaire from a random sample of managers of Australian business units. The results indicate that activity management is moderately successful in Australian organizations, with greater use associated with higher levels of success. Two organizational factors (top management support and link to quality) were associated with success at each of Gosselin's three levels, whereas training was associated at the AA and ACA levels. The cultural factor of outcome orientation was associated with success at each level, with attention to detail important at the ABC level. Organizational factors were more strongly associated with activity management success than cultural factors. [source] Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in AustraliaHIV MEDICINE, Issue 4 2009D Guinot Objective The aim of the study was to determine the cost-effectiveness of HIV nonoccupational post-exposure prophylaxis (NPEP) in Australia. Methods A retrospective cost analysis of a population-based observational cohort of 1601 participants eligible for NPEP in Australia between 1998 and 2004 was carried out. We modelled NPEP treatment costs and combined them with effectiveness outcomes to calculate the cost per seroconversion avoided. We estimated the cost-utility of the programme, and sensitivity and threshold analysis was performed on key variables. Results The average NPEP cost per patient was A$1616, of which A$848 (52%) was for drugs, A$331 (21%) for consultations, A$225 (14%) for pathology and A$212 (13%) for other costs. The cost per seroconversion avoided in the cohort was A$1 647 476 in our base case analysis, and A$512 410 when transmission rates were set at their maximal values. The cost per quality-adjusted life-year (QALY) was between A$40 673 and A$176 772, depending on the risks of HIV transmission assumed. Conclusions In our base case, NPEP was not a cost-effective intervention compared with the widely accepted Australian threshold of A$50 000 per QALY. It was only cost-effective after receptive unprotected anal intercourse exposure to an HIV-positive source. Although NPEP was a relatively well-targeted intervention in Australia, its cost-effectiveness could be improved by further targeting high-risk exposures. [source] The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature reviewINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2008N. Muszbek Summary Objectives:, To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions. Methods:, English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively. Results:, Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified. Conclusions:, Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue. [source] Cost Analysis of the Geriatric Resources for Assessment and Care of Elders Care Management InterventionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2009Steven R. Counsell MD OBJECTIVES: To provide, from the healthcare delivery system perspective, a cost analysis of the Geriatric Resources for Assessment and Care of Elders (GRACE) intervention, which is effective in improving quality of care and outcomes. DESIGN: Randomized controlled trial with physicians as the unit of randomization. SETTING: Community-based primary care health centers. PARTICIPANTS: Nine hundred fifty-one low-income seniors aged 65 and older; 474 participated in the intervention and 477 in usual care. INTERVENTION: Home-based care management for 2 years by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions. MEASUREMENTS: Chronic and preventive care costs, acute care costs, and total costs in the full sample (n=951) and predefined high-risk (n=226) and low-risk (n=725) groups. RESULTS: Mean 2-year total costs for intervention patients were not significantly different from those for usual care patients in the full sample ($14,348 vs $11,834; P=.20) and high-risk group ($17,713 vs $18,776; P=.38). In the high-risk group, increases in chronic and preventive care costs were offset by reductions in acute care costs, and the intervention was cost saving during the postintervention, or third, year ($5,088 vs $6,575; P<.001). Mean 2-year total costs were higher in the low-risk group ($13,307 vs $9,654; P=.01). CONCLUSION: In patients at high risk of hospitalization, the GRACE intervention is cost neutral from the healthcare delivery system perspective. A cost-effectiveness analysis is needed to guide decisions about implementation in low-risk patients. [source] Comparative analysis of cost factors in sturgeon fingerling production in Iranian hatcheries (2000,2004)JOURNAL OF APPLIED ICHTHYOLOGY, Issue 5 2009H. Salehi Summary Production cost analysis in aquaculture is an essential exercise to assist farm managers. Economic assessment of a farm operation also provides the basis to formulate governmental aquaculture and enhancement policies in many regions. The present study employed questionnaires and interviewed managers while also using governmental statistics to gain insight into production cost variables in Iranian sturgeon hatcheries. Within a decade, production of sturgeon fingerlings for release and stock enhancement increased in Iran to more than 21 million fingerlings by 2004. Costs and contributions of various production factors were determined using data obtained from a questionnaire involving all hatcheries between 2000 and 2004. A team of experts completed the questionnaire data sets while conducting interviews at all sturgeon centres and other related departments. From 2000 to 2004 the contribution of A. persicus was 79% of the total number of sturgeon fingerlings produced followed by A. nudiventris with 7.5% and Huso huso with 6.6%. Among the various expenditures between 2000 and 2004, the costs for permanent and part-time employees contributed the greatest share of total costs, averaging 44%, with a noticeable declining trend from 51% in 2000 to 36% in 2004. Obtaining and incubating fertilized eggs averaged 22% of total costs, increasing during the same time period from 6 to 35%, respectively. On average, the 2000,2004 production cost for a single sturgeon fingerling was estimated at Rials 1667 (US$ 0.20), increasing from Rials 992 (US$ 0.12) to Rials 2623 (US$ 0.29) over these 4 years. Permanent staff at a hatchery was determined as being the principal cost, followed by costs for obtaining fertilized eggs (including broodstock handling). Over the 5-year study period the results indicated that costs for part-time labour declined yearly and, conversely, the costs of obtaining broodstocks as well as fertilizing and incubating eggs increased. Considering the background of hatchery production and stock enhancement of sturgeon species and the results of fishing data, it is possible to arrive at a first estimate of the potential contribution of Persian sturgeon farming to the total catch in Iranian waters; it is assumed that these increases were most likely through stock enhancement. [source] | ||||||||||||||||||||||||||||||||||||||||