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Cost Estimates (cost + estimate)
Selected AbstractsCost estimate for biosynfuel production via biosyncrude gasificationBIOFUELS, BIOPRODUCTS AND BIOREFINING, Issue 1 2009Edmund Henrich Abstract Production of synthetic fuels from lignocellulose like wood or straw involves complex technology. There-fore, a large BTL (biomass to liquid) plant for biosynfuel production is more economic than many small facilities. A reasonable BTL-plant capacity is ,1 Mt/a biosynfuel similar to the already existing commercial CTL and GTL (coal to liquid, gas to liquid) plants of SASOL and SHELL, corresponding to at least 10% of the capacity of a modern oil refinery. BTL-plant cost estimates are therefore based on reported experience with CTL and GTL plants. Direct supply of large BTL plants with low bulk density biomass by trucks is limited by high transport costs and intolerable local traffic density. Biomass densification by liquefaction in a fast pyrolysis process generates a compact bioslurry or biopaste, also denoted as biosyncrude as produced by the bioliq® process. The densified biosyncrude intermediate can now be cheaply transported from many local facilities in silo wagons by electric rail over long distances to a large and more economic central biosynfuel plant. In addition to the capital expenditure (capex) for the large and complex central biosynfuel plant, a comparable investment effort is required for the construction of several dozen regional pyrolysis plants with simpler technology. Investment costs estimated for fast pyrolysis plants reported in the literature have been complemented by own studies for plants with ca. 100 MWth biomass input. The breakdown of BTL synfuel manufacturing costs of ca. 1 , /kg in central EU shows that about half of the costs are caused by the biofeedstock, including transport. This helps to generate new income for farmers. The other half is caused by technical costs, which are about proportional to the total capital investment (TCI) for the pyrolysis and biosynfuel production plants. Labor is a minor contribution in the relatively large facilities. © 2009 Society of Chemical Industry and John Wiley & Sons, Ltd [source] Pharmacotherapy of allergic rhinitis: a pharmaco-economic approachALLERGY, Issue 1 2009S. Simoens This article reports on a systematic literature review of the costs of allergic rhinitis (AR), the economic value of pharmacotherapy of AR, and the factors affecting costs and economic value of pharmacotherapy. Included studies had carried out a cost-of-illness analysis, cost analysis, cost-effectiveness, cost-utility or cost-benefit analysis. Allergic rhinitis imposes a substantial economic burden on society, with indirect costs of productivity loss being larger than the direct healthcare costs. Cost estimates were biased because of difficulties of diagnosis; exclusion of patients who do not seek healthcare; exclusion of over-the-counter medication; difficulties in estimating productivity loss. There is limited evidence on costs of seasonal/perennial and intermittent/persistent AR. Little is known of the economic value of pharmacotherapy of AR, although levocetirizine appears to be cost-effective as compared with placebo. Economic evaluations suffered limitations from small sample sizes, short trial duration, lack of standardized effectiveness measure, restricted scope of costs. Finally, the economic value of pharmacotherapy of AR is influenced by the perspective of the economic evaluation, relative effectiveness and costs of available drugs, patient compliance with treatment. [source] Cost estimates of spinal versus general anaesthesia for fractured neck of femur surgeryANAESTHESIA, Issue 8 2010A. Chakladar Summary It remains uncertain whether spinal anaesthesia is preferable to general anaesthesia for surgical repair of hip fracture, but one determining factor is the comparative cost. A detailed cost analysis relating to 20 consultants' intended anaesthetic practice (which provided information of consumables used) and data from the Brighton Hip Fracture Database was performed to quantify any difference in the costs of administering spinal versus general anaesthesia for patients with hip fracture. Although spinal anaesthesia took significantly longer to administer (mean (SD) time 31 (15) min vs 27 (16) min; p < 0.0001), the mean (SD) cost of spinal anaesthesia (£193.81 (37.49)) was significantly less than the cost of general anaesthesia (£270.58 (44.68); p < 0.0001). The mean percentage cost of anaesthesia was 3.8% of hospital income per hip fracture, and personnel contributed approximately 46% of this cost. While such considerations indicate that spinal anaesthesia is financially preferable, it is unknown whether differential clinical outcomes between regional and general anaesthesia may offset this apparent monetary advantage. [source] Acute treatment costs of intracerebral hemorrhage and ischemic stroke in ArgentinaACTA NEUROLOGICA SCANDINAVICA, Issue 4 2009M. C. Christensen Background and purpose,,, Stroke is the third leading cause of death in Argentina, yet little information exists on the acute treatment provided for stroke or its costs. This study estimates the national costs of the acute treatment of first-ever intracerebral hemorrhage (ICH) and ischemic stroke (IS) in Argentina. Methods,,, Retrospective hospital-based inception study design using data on resource use and costs from high-volume stroke centers in Argentina, and published population-based incidence data. Treatment provided at two large urban hospitals were evaluated in all patients admitted with a first-ever stroke between 1 January 2004 and 31 August 2006, and costs were assigned using appropriate unit cost data for all resource use. Cost estimates in Argentinian pesos were converted to US dollars ($) using the 2005 purchasing power parity index. National costs of acute treatment for incident strokes were estimated by extrapolation of average costs estimates to national incidence data. Assumptions of the average cost of stroke treatment on a national scale were examined in sensitivity analysis. Results,,, The acute care of 167 patients with stroke was thoroughly evaluated from hospital admission to hospital discharge. Mean length of hospital stay was 35.4 days for ICH and 13.0 days for IS. Ninety-one percent of the patients with ICH and 68% of the patients with IS were admitted to an ICU for a mean length of stay (LOS) of 12.9 ± 20.3 and 3.6 ± 5.9 days respectively. Mean total costs of initial hospitalization were $12,285 (SD ±14,336) for ICH and $3888 (SD ±4018) for IS. Costs differed significantly by Glasgow Coma Scale (GCS) score at admission, development of pneumonia and infections during hospitalization, and functional outcome at hospital discharge. Aggregate national healthcare expenditures for acute treatment of incident ICH were $194.2m (range 97.1,388.4) and $239.9m for IS (range 119.9,479.7). Conclusion,,, The direct hospital costs of incident ICH and IS in Argentina are substantial and primarily driven by stroke severity, in-hospital complications and clinical outcomes. With the expected increase in the incidence of stroke over the coming decades, these results emphasize the need for effective preventive and acute medical care. [source] Developing an intelligent system for teaching pre-tender cost estimating of office building projectsCOMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 1 2001Qiping Shen Abstract Pre-tender cost estimating of office building projects requires extensive knowledge and expertise. Due to the lack of design information in the early design stages, it is extremely difficult for cost engineers or quantity surveyors to arrive at an accurate cost estimate. This paper presents the design and testing of a knowledge-based system that enables students to learn cost estimating of building projects in the conceptual design stages. The system, embedded with knowledge from experts, has been proved to be a very useful teaching and learning tool. © 2001 John Wiley & Sons, Inc. Comput Appl Eng Educ 9: 26,36, 2001 [source] Heating and cooling energy recovery for an HVAC system: Economic analysis for the Italian climateINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 8 2001Adolfo Palombo Abstract In this paper the economic analysis of the energy recovery in all-outdoor-air HVAC systems for the Italian climate is performed. The energy recovery device considered here is the same for both heating and cooling periods. During the summer season, the energy saving is achieved by evaporative cooling. The performances of the hybrid innovative HVAC system and the traditional system are calculated hour by hour by following the test reference year (TRY) profile. Such analysis is carried out taking into account simultaneously, the trend of some climatic indexes computed in order to (i) better understand the influence of climate on the HVAC system behaviour, (ii) obtain a swift feasibility analysis of the energy recovery system and (iii) perform a rough operating cost estimate of the traditional HVAC system. Copyright © 2001 John Wiley & Sons, Ltd. [source] Economical Advantages of Low-Pressure Plasma Polymerization CoatingPLASMA PROCESSES AND POLYMERS, Issue 6 2005Hirotsugu Yasuda Abstract Summary: Low-pressure plasma polymerization coating, as described in this paper, is an ultimately green process that uses a minimum amount of substances and produces a minimum amount of effluent and hence does not require an environmental remediation process. The super-green aspect of the processing entirely changes the equation for the viability of the process in industrial applications. The main hampering factors for the low-pressure processes are 1) psychological fear of vacuum processes, 2) relatively high initial equipment costs, and 3) a lack of adequate cost estimate for the entire process. In many cases, the first two factors are enough for planners to shy away from this promising technology. However, when one examines the overall cost of processing as a whole, the cost of initial equipment often is not the decisive factor. Such cases are presented in the nano-film coating applied in corrosion protection of aluminum alloys, steel, and surface-state modification of contact lenses. The benefits of environmental friendliness, non-hazardous processing and superior performance of products that can be achieved only by low-pressure plasma polymerization coatings are more than enough to compensate the initial cost of the equipment. For nanofilm (20 nm) coatings, the most expensive annual operation cost is for wastewater treatment, which is much more than the initial cost of vacuum plasma polymerization reactor. [source] Site characterization to support permeable reactive barrier designREMEDIATION, Issue 4 2005Lynn A. Morgan Careful design studies and selection of an effective technique for the installation of permeable reactive barriers (PRBs) are important contributors to the overall success of zero-valent iron PRBs. This article provides a case study summarizing the successful design and construction of a PRB installed at the former Carswell Air Force Base located in Fort Worth, Texas. Expedited site characterization using a cone penetrometer rig equipped with a mass spectrometer was employed to provide real-time characterization and lithologic data. These data proved to be invaluable for the design of the PRB and allowed for the development of an accurate preconstruction cost estimate. Field data gained from the expedited water quality and geologic characterization along with aquifer testing and a bench-scale treatability study provided a comprehensive basis for the design. The biopolymer slurry construction technique provided additional unanticipated benefits to the designed zero- valent iron treatment by promoting the development of anaerobic conditions favorable for microbial degradation of trichloroethene. Postconstruction monitoring data are discussed to illustrate the successful performance of the PRB. © 2005 Wiley Periodicals, Inc. [source] Nutzungskosten: DIN 18960-2008 , Leistungsfähige Grundlage für die zielorientierte Planung der LebenszykluskostenBAUTECHNIK, Issue 7 2008Udo Blecken em. Die DIN 18960 , Nutzungskosten im Hochbau , ist in überarbeiteter Form im Februar 2008 herausgegeben worden. Sie ist durch Ergänzungen zu einem vollumfänglichen Controllingkonzept (Nutzungskostenvorgabe, -ermittlung, -kontrolle und -steuerung) weiterentwickelt worden, die dem Bauherrn eine kostengesicherte Nutzungskostenplanung ermöglicht. Mit dieser Norm liegt nun eine ökonomisch und ökologisch wichtige Grundlage für den Planungsprozess vor. Im Folgenden sollen die Neuerungen der Norm 18960 beschrieben, die angrenzenden Normen und wichtigen Merkmale erläutert, das Controllingkonzept inkl. eines Berechnungsbeispiels unter Einschluss von Risikoüberlegungen dargestellt und Planungsvertragsfragen besprochen werden. User costs of buildings DIN 18960 , a performance basis for planning of life cycle costs. An updated version of the DIN 18960 , user costs of buildings , has been published in February 2008. The norm has been further developed with supplements to a comprehensive controlling concept (usage cost estimate, usage cost calculation, usage cost monitoring and usage cost management), which provides the builder with the tools to plan the usage costs in a cost-controlled manner. This norm, furthermore, provides an economically and ecologically important basis for the planning process. The new aspects of the DIN 18960 are outlined, the related norms and important features are explained, the controlling concept including a calculation example that considers risk factors is described and questions regarding planning contracts are discussed. [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] Education for All: How Much Will It Cost?DEVELOPMENT AND CHANGE, Issue 1 2004Enrique Delamonica In 1990, a target of universal access to basic education by the year 2000 was set by two global conferences. Ten years later, however, it was clear that the target had not been met. Too many countries had made insufficient progress, and although many of the reasons for this inadequate progress were country-specific, one factor stood out in virtually all countries: inadequate public finance for primary education. In 2000, the Millennium Summit set a new target date for achieving ,education for all' of 2015. This article updates the global and regional cost estimates for reaching that target. The estimates are based on the most recent country-by-country data on budgetary expenditure, population and enrolment trends, and unit cost. The annual additional cost of achieving ,education for all' in developing countries by 2015 is estimated at US$ 9.1 billion. Although this is affordable at the global level, individual countries will need considerably more resources than are currently available. However, official development assistance (ODA) has been declining, and the share of ODA allocated to basic education has changed little over the past decade. Therefore, although affordable, the target of universal basic education by 2015 is likely to be missed, just as it was in 2000, without a major change both in ODA and national budgets. [source] Preservation of sight in diabetes: developing a national risk reduction programmeDIABETIC MEDICINE, Issue 9 2000L. Garvican SUMMARY Background Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre-symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera-based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk-reduction programme. Ophthalmoscopy Evidence indicates that direct ophthalmoscopy using a hand-held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill. Photographic schemes The principal advantage of camera-based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions. Cost issues Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late-presenting advanced retinopathy. Conclusion A systematic national programme based on digital photography is proposed. [source] The accuracy of regulatory cost estimates: a study of the London congestion charging schemeENVIRONMENTAL POLICY AND GOVERNANCE, Issue 2 2007Chris Sherrington Abstract This paper considers the accuracy of regulatory cost estimates using the London congestion charging scheme as a case study. In common with other regulations, ex ante estimates of the direct costs of the scheme were produced by the regulator, Transport for London. Reviews of a number of environmental and industrial regulations have shown that ex ante costs tend to exceed the ex post (or outturn) costs. This study finds that while Transport for London moderately overestimated the total costs of the scheme (by 16%) there was a significant overestimate of chargepayer compliance costs (by 64%). The main reasons for this were greater than expected reductions in traffic and unanticipated technological innovation. As the compliance cost is essentially the cost of transacting payment of the charge, these results have wider implications for other similar regulations. One example is the proposed national road user charging in the UK, where it could reasonably be expected that the ex post cost of compliance will again be lower than the ex ante estimate, and that compliance costs will continue to reduce over time. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [source] Estimating the Costs of Epilepsy: An International Comparison of Epilepsy Cost StudiesEPILEPSIA, Issue 5 2001Irene A. W. Kotsopoulos Summary: ,Purpose: To compare systematically the national and per capita estimates of the cost of epilepsy in different countries. Methods: Studies for this literature review were selected by conducting a Medline literature search from January 1966 to March 2000. Key methodologic, country-related, and monetary issues of the selected epilepsy cost studies were evaluated to compare their direct cost estimates and to explore their distribution. The results of the selected studies were made comparable by converting them with different types of conversion factors and expressing them as a proportion of the national expenditure on health care. Results: Ten epilepsy cost studies were reviewed. The proportion of national health care expenditure on epilepsy shows a range of 0.12,1.12% or 0.12,1.05% depending on the type of conversion factor. The list of cost components included in the estimation of the direct costs of epilepsy differs from study to study. A comprehensive list is associated with a decrease in the contribution of drug and hospital costs to the total direct costs of epilepsy. Conclusions: This study highlights the importance of studying the economic consequences of epilepsy and of interpreting the results on the international level. The results of epilepsy cost studies can provide insight into the distribution of the costs of epilepsy and the impact of epilepsy on the national expenditure on health care. [source] Comparison of haymaking strategies for cow-calf systems in the Salado Region of Argentina using a simulation model.GRASS & FORAGE SCIENCE, Issue 4 2005Abstract Risk and cost estimates, calculated using a weather-driven farm simulation model, were used to evaluate the impact of different haymaking strategies in dryland cow-calf systems such as those in the Salado region of Argentina. Based on a 100-ha farm, each strategy was simulated using twenty sequences of 50 years of random weather. A risk-efficiency methodology was used, using calf live weight sold and considering the economic value of the live weight produced per year minus the cost of haymaking, as a simple measure of profit. The analysis highlighted both production and risk advantages in using hay, especially when a flexible hay management approach was implemented, although some haymaking strategies performed worse than not using hay. When calf live weight sold was considered alone, the risk-efficient set included strategies with large proportions of the areas being harvested (0.42,1.05; paddocks could be cut more that once a year in some of the strategies) and high proportions of hay not being used. The amount of hay for maximizing risk efficiency for profit was notably lower than that for maximizing cattle production. When haymaking costs were included, the proportion of area harvested for risk-efficient profit ranged from 0.28 to 0.52, depending on the target stocking rate. [source] The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approachesHEALTH ECONOMICS, Issue 4 2009Fiona M. Clement (Nee Shrive) Abstract Background: Published guidelines on the conduct of economic evaluations provide little guidance regarding the use and potential bias of the different costing methods. Objectives: Using microcosting and two gross-costing methods, we (1) compared the cost estimates within and across subjects, and (2) determined the impact on the results of an economic evaluation. Methods: Microcosting estimates were obtained from the local health region and gross-costing estimates were obtained from two government bodies (one provincial and one national). Total inpatient costs were described for each method. Using an economic evaluation of sirolimus-eluting stents, we compared the incremental cost,utility ratios that resulted from applying each method. Results: Microcosting, Case-Mix-Grouper (CMG) gross-costing, and Refined-Diagnosis-Related grouper (rDRG) gross-costing resulted in 4-year mean cost estimates of $16,684, $16,232, and $10,474, respectively. Using Monte Carlo simulation, the cost per QALY gained was $41,764 (95% CI: $41,182,$42,346), $42,538 (95% CI: $42,167,$42,907), and $36,566 (95% CI: $36,172,$36,960) for microcosting, rDRG-derived and CMG-derived estimates, respectively (P<0.001). Conclusions: Within subject, the three costing methods produced markedly different cost estimates. The difference in cost,utility values produced by each method is modest but of a magnitude that could influence a decision to fund a new intervention. Copyright © 2008 John Wiley & Sons, Ltd. [source] Neonatal health care costs related to smoking during pregnancyHEALTH ECONOMICS, Issue 3 2002E. Kathleen Adams Abstract Research objective: Much of the work on estimating health care costs attributable to smoking has failed to capture the effects and related costs of smoking during pregnancy. The goal of this study is to use data on smoking behavior, birth outcomes and resource utilization to estimate neonatal costs attributable to maternal smoking during pregnancy. Study design: We use 1995 data from the Center for Disease Control's (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) database. The PRAMS collects representative samples of births from 13 states (Alabama, Alaska, California, Florida, Georgia, Indiana, Maine, Michigan, New York (excluding New York City), Oklahoma, South Carolina, Washington, and West Virginia), and the District of Columbia. The 1995 PRAMS sample is approximately 25 000. Multivariate analysis is used to estimate the relationship of smoking to probability of admission to an NICU and, separately, the length of stay for those admitted or not admitted to an NICU. Neonatal costs are predicted for infants ,as is' and ,as if' their mother did not smoke. The difference between these constitutes smoking attributable neonatal costs; this divided by total neonatal costs constitutes the smoking attributable fraction (SAF). We use data from the MarketScanÔ database of the MedStatÔ Corporation to attach average dollar amounts to NICU and non-NICU nursery nights and data from the 1997 birth certificates to extrapolate the SAFs and attributable expenses to all states. Principal findings: The analysis showed that maternal smoking increased the relative risk of admission to an NICU by almost 20%. For infants admitted to the NICU, maternal smoking increased length of stay while for non- NICU infants it appeared to lower it. Over all births, however, smoking increased infant length of stay by 1.1%. NICU infants cost $2496 per night while in the NICU and $1796 while in a regular nursery compared to only $748 for non-NICU infants. The combination of the increased NICU use, longer stays and higher costs result in a positive smoking attributable fraction (SAF) for neonatal costs. The SAF across all states is 2.2%. Across the states, the SAF varied from a low of 1.3% in Texas to a high of 4.6% in Indiana. Conclusions: These results further confirm the adverse effects of smoking. Among mothers who smoke, smoking adds over $700 in neonatal costs. The smoking attributable neonatal costs in the US represent almost $367 million in 1996 dollars; these costs vary from less than a million in smaller states to over $35 million in California. These costs are highly preventable since the adverse effects of maternal smoking occur in the short-run and can be avoided by even a temporary cessation of maternal smoking. These cost estimates can be used by managed care plans, state and local public health officials and others to evaluate alternative smoking cessation programs. Copyright © 2002 John Wiley & Sons, Ltd. [source] Estimated Time and Educational Requirements to Perform NIC InterventionsINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Gloria M. Bulechek PURPOSE To estimate the time to perform and type of personnel to deliver each of the 486 interventions listed and described in the third edition of NIC. METHODS Small groups of research team members rated selected interventions in their area of expertise on education and time needed for each intervention. Education needed was defined as the minimal educational level necessary to perform the intervention in most cases in most states. Rating categories were (a) nursing assistant (NA/LPN/LVN/technician), (b) RN (basic education whether baccalaureate, associate degree, or diploma), or (c) RN with post-basic education or certification. Time needed was defined as the average time needed to perform the intervention. Raters selected one of five possible time estimates: (a) <15 minutes, (b) 16,30 minutes, (c) 31,45 minutes, (d) 46,60 minutes, or (e) >1 hour. All ratings were reviewed across groups to ensure overall consistency. FINDINGS Results of this exercise provide beginning estimates of the time and education needed for 486 NIC interventions. Twenty percent required <15 minutes, 30% required 16,30 minutes, 17% required 31,45 minutes, 12% required 46,60 minutes, and 21% required >1 hour. More than 70% of the interventions were judged as needing basic RN education to perform. Raters judged RN post-basic education to be required to performi 16% of the interventions, and 14% were deemed appropriate for personnel with NA/LPN education to perform. A monograph, Estimated Time and Educational Requirements to Perform 486 Nursing Interventions, available from http://www.nursing@uiowa.ed/cnc, includes lists of interventions appropriate for each time and education category, as well as time and education ratings according to NIC domains and classes. DISCUSSION The estimates of time and education provided by expert ratings provide a good beginning for cost estimates, resource planning, and reimbursement. The results of this study add to the small but growing body of literature that demonstrates that estimates of time to perform interventions by nurses who are familiar with the interventions is an accurate and efficient method to determine time values. A description of how this information can be used in a costing model is in the July/August 2001 issue of Nursing Economics. CONCLUSIONS NIC has identified the interventions that nurses perform. This study of time to perform and type of personnel to deliver each of the NIC interventions can help nurse leaders make better-informed decisions about cost-effective nursing care. [source] How you count counts: the importance of methods research in applied ecologyJOURNAL OF APPLIED ECOLOGY, Issue 5 2008Chris S. Elphick Summary 1Methods papers play a crucial role in advancing applied ecology. Counting organisms, in particular, has a rich history of methods development with many key advances both in field sampling and the treatment of resulting data. 2Most counts, however, have associated errors due to portions of the population of interest being unavailable for detection (e.g. target population not fully sampled; individuals present but not detectable), detection mistakes (e.g. detectable individuals missed; non-existent individuals recorded), or erroneous counts (e.g. large groups miscounted; individuals misidentified). 3Developments in field methods focus on reducing biases in the actual counts. Simultaneously, statisticians have developed many methods for improving inference by quantifying and correcting for biases retrospectively. Prominent examples of methods used to account for detection errors include distance sampling and multiple-observer methods. 4Simulations, in which population characteristics are set by the investigator, provide an efficient means of testing methods. With good estimates of sampling biases, computer simulations can be used to evaluate how much a given counting problem affects estimates of parameters such as population size and decline, thereby allowing applied ecologists to test the efficacy of sampling designs. Combined with cost estimates for each field method, such models would allow the cost-effectiveness of alternative protocols to be assessed. 5Synthesis and applications. Major advances are likely to come from research that looks for systematic patterns, across studies, in the effects of different types of bias and assumption violation on the ecological conclusions drawn. Specifically, determining how often, and under what circumstances, errors contribute to poor management and policy would greatly enhance future application of ecological knowledge. [source] Directional asymmetry of long-distance dispersal and colonization could mislead reconstructions of biogeographyJOURNAL OF BIOGEOGRAPHY, Issue 5 2005Lyn G. Cook Abstract Aim, Phylogenies are increasingly being used to attempt to answer biogeographical questions. However, a reliance on tree topology alone has emerged without consideration of earth processes or the biology of the organisms in question. Most ancestral-state optimization methods have inherent problems, including failure to take account of asymmetry, such as unequal probabilities of losses and gains, and the lack of use of independent cost estimates. Here we discuss what we perceive as shortcomings in most current tree-based biogeography interpretation methods and show that consideration of processes and their likelihoods can turn the conventional biogeographical interpretation on its head. Location, Southern hemisphere focus but applicable world-wide. Methods, The logic of existing methods is reviewed with respect to their adequacy in modelling processes such as geographical mode of speciation and likelihood of dispersal, including directional bias. Published reconstructions of dispersal of three plant taxa between Australia and New Zealand were re-analysed using standard parsimony and maximum likelihood (ML) methods with rate matrices to model expected asymmetry of dispersal. Results, Few studies to date incorporate asymmetric dispersal rate matrices or question the simplistic assumption of equal costs. Even when they do, cost matrices typically are not derived independently of tree topology. Asymmetrical dispersal between Australia and New Zealand could be reconstructed using parsimony but not with ML. Main conclusions, The inadequacy of current models has important consequences for our interpretation of southern hemisphere biogeography, particularly in relation to dispersal. For example, if repeated directional dispersals and colonization in the direction of prevailing winds have occurred, with intervening periods of speciation, then there is no need to infer dispersals against those winds. Failure to take account of directionality and other biases in reconstruction methods has implications beyond the simple misinterpretation of the biogeography of a taxonomic group, such as calibration of molecular clocks, the dating of vicariance events, and the prioritization of areas for conservation. [source] Evaluating animal welfare with choice experiments: an application to Swedish pig productionAGRIBUSINESS : AN INTERNATIONAL JOURNAL, Issue 1 2008Carolina Liljenstolpe In this study, the demand for animal welfare attributes when buying pork fillet is investigated among Swedish respondents. The issue is of importance in order to ensure an economically viable pig industry while applying an increasing number of animal friendly practices. In order to obtain information about consumer demand, an indirect utility function and willingness to pay (WTP) for animal welfare attributes are estimated. The attributes are solely associated with animal friendly practices. An investigation of numerous housing and managerial practices of pig production has not yet been performed. The indirect utility function is estimated using a random parameter logit model. A realistic approach when modeling consumer choice is to allow for heterogeneity in preferences. The relevance of assuming randomness of some of the parameters is evaluated by using a specification test developed by McFadden and Train (2000). The WTP is also estimated at the individual level. The results indicate that WTP for animal welfare attributes may be negative or positive. The preferences are also heterogeneous among respondents, which may be explained by a segmentation of preferences. Finally, the WTP estimates for animal welfare practices are compared with cost estimates for such production systems. [Econlit subject codes: C010, C500, Q100] © 2008 Wiley Periodicals, Inc. [source] Resource Utilization, Cost, and Health Status Impacts of Coronary Stent Versus "Optimal" Percutaneous Coronary Angioplasty: Results from the OPUS-I TrialJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2002NANCY NEIL Ph.D. In the OPUS-I trial, primary coronary stent implantation reduced 6-month composite incidence of death, myocardial infarction, cardiac surgery, or target vessel revascularization relative to a strategy of initial PTCA with provisional s tenting inpatients undergoing single vessel coronary angioplasty. The purpose of this research was to compare the economic and health status impacts of each treatment strategy. Resource utilization data were collected for the 479 patients randomized in OPUS-I. Itemized cost estimates were derived from primary hospital charge data gathered in previous multicenter trials evaluating coronary stents, and adjusted to approximate 1997 Medicare-based costs for a cardiac population. Health status at 6 months was assessed using the Seattle Angina Questionnaire (SAQ). Initial procedure related costs for patients treated with a primary stent strategy were higher than those treated with optimal PTCA/provisional stent ($5,389 vs $4,339, P<0.001). Costs of initial hospitalization were also higher for patients in the primary stent group ($9,234 vs $8,434, P<0.01) chiefly because of the cost differences in the index revascularization. Mean 6-month costs were similar in the two groups; however, there was a slight cost advantage associated with primary stenting. Bootstrap replication of 6-month cost data sustained the economic attractiveness of the primary stent strategy. There were no differences in SAQ scores between treatment groups. In patients undergoing single vessel coronary angioplasty, routine stent implantation improves important clinical outcomes at comparable, or even reduced cost, compared to a strategy of initial balloon angioplasty with provisional stenting. [source] The Socioeconomic Impact of Atopic Dermatitis in the United States: A Systematic ReviewPEDIATRIC DERMATOLOGY, Issue 1 2008Anthony J. Mancini M.D. A search was performed using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the International Agency for Health Technology Assessment (INAHTA) database, and the Cochrane Library. All abstracts were reviewed for the following criteria: original cost data, studies performed in the United States, and English language. The search yielded 418 papers. Fifty-nine papers were reviewed in detail, and four studies were found that met the inclusion criteria. These cost-identification analyses estimated the cost of atopic dermatitis heterogeneously and could not be compared directly. National cost estimates ranged widely, from $364 million to $3.8 billion US dollars per year. The cost of atopic dermatitis is significant and will likely increase in proportion to increasing disease prevalence. Measurement of the cost of atopic dermatitis in the United States has been limited to direct cost-identification analyses, with few studies measuring the indirect cost of disease. [source] Financial Impact of Emergency Department UltrasoundACADEMIC EMERGENCY MEDICINE, Issue 7 2009Olanrewaju A. Soremekun MD Abstract Objectives:, There is limited information on the financial implications of an emergency department ultrasound (ED US) program. The authors sought to perform a fiscal analysis of an integrated ED US program. Methods:, A retrospective review of billing data was performed for fiscal year (FY) 2007 for an urban academic ED with an ED US program. The ED had an annual census of 80,000 visits and 1,101 ED trauma activations. The ED is a core teaching site for a 4-year emergency medicine (EM) residency, has 35 faculty members, and has 24-hour availability of all radiology services including formal US. ED US is utilized as part of evaluation of all trauma activations and for ED procedures. As actual billing charges and reimbursement rates are institution-specific and proprietary information, relative value units (RVUs) and reimbursement based on the Centers for Medicare & Medicaid Services (CMS) 2007 fee schedule (adjusted for fixed diagnosis-related group [DRG] payments and bad debt) was used to determine revenue generated from ED US. To estimate potential volume, assumptions were made on improvement in documentation rate for diagnostic scans (current documentation rates based on billed volume versus diagnostic studies in diagnostic image database), with no improvements assumed for procedural ED US. Expenses consist of three components,capital costs, training costs, and ongoing operational costs,and were determined by institutional experience. Training costs were considered sunken expenses by this institution and were thus not included in the original return on investment (ROI) calculation, although for this article a second ROI calculation was done with training cost estimates included. For the purposes of analysis, certain key assumptions were made. We utilized a collection rate of 45% and hospitalization rates (used to adjust for fixed DRG payments) of 33% for all diagnostic scans, 100% for vascular access, and 10% for needle placement. An optimal documentation rate of 95% was used to estimate potential revenue. Results:, In FY 2007, 486 limited echo exams of abdomen (current procedural terminology [CPT] 76705) and 480 limited echo cardiac exams were performed (CPT 93308) while there were 78 exams for US-guided vascular access (CPT 76937) and 36 US-guided needle placements when performing paracentesis, thoracentesis, or location of abscess for drainage (CPT 76492). Applying the 2007 CMS fee schedule and above assumptions, the revenue generated was 578 RVUs and $35,541 ($12,934 in professional physician fees and $22,607 in facility fees). Assuming optimal documentation rates for diagnostic ED US scans, ED US could have generated 1,487 RVUs and $94,593 ($33,953 in professional physician fees and $60,640 in facility fees). Program expenses include an initial capital expense (estimated at $120,000 for two US machines) and ongoing operational costs ($68,640 per year to cover image quality assurance review, continuing education, and program maintenance). Based on current revenue, there would be an annual operating loss, and thus an ROI cannot be calculated. However, if potential revenue is achieved, the annual operating income will be $22,846 per year with an ROI of 4.9 years to break even with initial investment. Conclusions:, Determining an ROI is a required procedure for any business plan for establishing an ED US program. Our analysis demonstrates that an ED US program that captures charges for trauma and procedural US and achieves the potential billing volume breaks even in less than 5 years, at which point it would generate a positive margin. [source] Control charts: a cost-optimization approach for processes with random shiftsAPPLIED STOCHASTIC MODELS IN BUSINESS AND INDUSTRY, Issue 3 2004András Zempléni Abstract In this paper we describe an approach for establishing control limits and sampling times which derives from economic performance criteria and a model for random shifts. The total cost related to both production and control is calculated, based on cost estimates for false alarms, for not identifying a true out of control situation, and for obtaining a data record through sampling. We describe the complete process for applying the method and compare with conventional procedures to real data from a Portuguese pulp and paper industrial plant. It turns out that substantial cost-reductions may be obtained. Copyright © 2004 John Wiley & Sons, Ltd. [source] Insurer and out-of-pocket costs of osteoarthritis in the US: Evidence from national survey dataARTHRITIS & RHEUMATISM, Issue 12 2009Harry Kotlarz Objective Osteoarthritis (OA) is a major debilitating disease affecting ,27 million persons in the US. Yet, the financial costs to patients and insurers remain poorly understood. The purpose of this study was to quantify by multivariate analyses the relationships between OA and annual health care expenditures borne by patients and insurers. Methods Data from the Medical Expenditure Panel Survey (MEPS) for the years 1996,2005 were used. MEPS is a large, nationally representative US database that includes information on health care expenditures, medical conditions, health insurance status, and sociodemographic characteristics. Individual and nationally aggregated cost estimates are provided. Results OA was found to contribute substantially to health care expenditures. Among women, OA increased out-of-pocket (OOP) expenditures by $1,379 per annum (2007 dollars) and insurer expenditures by $4,833. Among men, OA increased OOP expenditures by $694 per annum and insurer expenditures by $4,036. Given the high prevalence of OA, the aggregate effects on health care expenditures were very large. OA raised aggregate annual medical care expenditures by $185.5 billion. Of that amount, insurer expenditures were $149.4 billion and OOP expenditures were $36.1 billion. Because of the greater prevalence of OA in women and their more intensive use of health care, total expenditures for this group accounted for $118 billion, or almost two-thirds of the total increase in health care expenditures resulting from OA. Conclusion The health care cost burden associated with OA is quite large for all groups examined and is disproportionately higher for women. Although insurers bear the brunt of treatment costs for OA, the OOP costs are also substantial. [source] Direct medical costs and their predictors in patients with rheumatoid arthritisARTHRITIS & RHEUMATISM, Issue 10 2003527 patients, A three-year study of Objective To estimate total direct medical costs in persons with rheumatoid arthritis (RA) and to characterize predictors of these costs. Methods Patients (n = 7,527) participating in a longitudinal study of outcome in RA completed 25,050 semiannual questionnaires from January 1999 through December 2001. From these we determined direct medical care costs converted to 2001 US dollars using the consumer price index. We used generalized estimating equations to examine potential predictors of the costs. Monte Carlo simulations and sensitivity analyses were performed to evaluate the varying prevalence and cost of biologic therapy. Results The mean total annual direct medical care cost in 2001 for a patient with RA was $9,519. Drug costs were $6,324 (66% of the total), while hospitalization costs were only $1,573 (17%). Approximately 25% of patients received biologic therapy. The mean total annual direct cost for patients receiving biologic agents was $19,016 per year, while the cost for those not receiving biologic therapy was $6,164. RA patients who were in the worst quartile of functional status, as measured by the Health Assessment Questionnaire, experienced direct medical costs for the subsequent year that were $5,022 more than the costs incurred by those in the best quartile. Physical status as determined by the Short Form 36 physical component scale had a similar large effect on RA costs, as did comorbidity. Medical insurance type played a more limited role. However, those without insurance had substantially lower service utilization and costs, and health maintenance organization patients had lower drug costs and total medical costs. Increased years of education, increased income, and majority ethnic status were all associated with increased drug costs but not hospitalization costs. Costs in all categories decreased after age 65 years. Conclusion Estimates of direct medical costs for patients with RA are substantially higher than cost estimates before the biologic therapy era, and costs are now driven predominantly by the cost of drugs, primarily biologic agents. RA patients with poor function continue to incur substantially higher costs, as do those with comorbid conditions, and sociodemographic characteristics also play an important role in determination of costs. [source] Role of credence and health information in determining US consumers' willingness-to-pay for grass-finished beefAUSTRALIAN JOURNAL OF AGRICULTURAL & RESOURCE ECONOMICS, Issue 4 2009Wendy J. Umberger Consumer demand for forage- or grass-finished beef is rapidly emerging in the US. This research uses data elicited from consumer surveys and experimental auctions to provide insight on product attributes (taste/flavour, credence and nutritional characteristics) and socio-demographic factors that are most important in determining US consumers' preferences and willingness to pay premiums for grass-finished versus grain-finished beef. Information related to beef production processes increased the probability consumers would be willing to pay a premium for grass-fed beef. However, it appears that health-related messages are more important drivers of willingness-to-pay, on average, than the absence of antibiotics and supplemental hormones and traceability. Labelling information regarding grass-fed beef's nutritional content and related production processes is vital for maintaining and growing premium niche markets for grass-fed beef in the US. The relative size of the willingness to pay estimates compared to previous cost estimates suggest that the Australian beef industry may have a comparative advantage for finishing beef on forage and marketing premium grass-fed differentiated beef products in the US market. [source] Large-scale gasification-based coproduction of fuels and electricity from switchgrassBIOFUELS, BIOPRODUCTS AND BIOREFINING, Issue 2 2009Eric D. Larson Abstract Large-scale gasification-based systems for producing Fischer-Tropsch (F-T) fuels (diesel and gasoline blendstocks), dimethyl ether (DME), or hydrogen from switchgrass , with electricity as a coproduct in each case are assessed using a self-consistent design, simulation, and cost analysis framework. We provide an overview of alternative process designs for coproducing these fuels and power assuming commercially mature technology performance and discuss the commercial status of key component technologies. Overall efficiencies (lower-heating-value basis) of producing fuels plus electricity in these designs ranges from 57% for F-T fuels, 55,61% for DME, and 58,64% for hydrogen. Detailed capital cost estimates for each design are developed, on the basis of which prospective commercial economics of future large-scale facilities that coproduce fuels and power are evaluated. © 2009 Society of Chemical Industry and John Wiley & Sons, Ltd [source] Cost estimate for biosynfuel production via biosyncrude gasificationBIOFUELS, BIOPRODUCTS AND BIOREFINING, Issue 1 2009Edmund Henrich Abstract Production of synthetic fuels from lignocellulose like wood or straw involves complex technology. There-fore, a large BTL (biomass to liquid) plant for biosynfuel production is more economic than many small facilities. A reasonable BTL-plant capacity is ,1 Mt/a biosynfuel similar to the already existing commercial CTL and GTL (coal to liquid, gas to liquid) plants of SASOL and SHELL, corresponding to at least 10% of the capacity of a modern oil refinery. BTL-plant cost estimates are therefore based on reported experience with CTL and GTL plants. Direct supply of large BTL plants with low bulk density biomass by trucks is limited by high transport costs and intolerable local traffic density. Biomass densification by liquefaction in a fast pyrolysis process generates a compact bioslurry or biopaste, also denoted as biosyncrude as produced by the bioliq® process. The densified biosyncrude intermediate can now be cheaply transported from many local facilities in silo wagons by electric rail over long distances to a large and more economic central biosynfuel plant. In addition to the capital expenditure (capex) for the large and complex central biosynfuel plant, a comparable investment effort is required for the construction of several dozen regional pyrolysis plants with simpler technology. Investment costs estimated for fast pyrolysis plants reported in the literature have been complemented by own studies for plants with ca. 100 MWth biomass input. The breakdown of BTL synfuel manufacturing costs of ca. 1 , /kg in central EU shows that about half of the costs are caused by the biofeedstock, including transport. This helps to generate new income for farmers. The other half is caused by technical costs, which are about proportional to the total capital investment (TCI) for the pyrolysis and biosynfuel production plants. Labor is a minor contribution in the relatively large facilities. © 2009 Society of Chemical Industry and John Wiley & Sons, Ltd [source] | |||||||||||||||||||||||||