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Cost Savings (cost + savings)
Kinds of Cost Savings Selected AbstractsCost savings in migraine associated with less chest pain on new triptan therapy.HEADACHE, Issue 3 2003JT Wang Am J Manag Care. 2002 Feb;8(3 Suppl):S102-S107 Objectives: This article constructs an economic model to estimate cost of chest-pain-related care in migraine patients receiving almotriptan 12.5 mg compared with those receiving sumatriptan 50 mg. Study Design: This population-based, retrospective cohort study used data from the MEDSTAT Marketscan database (Ann Arbor, Michigan) to quantify incidence and costs of chest-pain-related diagnoses and procedures. After a 6-month exclusion period, the study used a pre-post design, with baseline and treatment periods defined, respectively, as 5 months before and after receiving sumatriptan therapy. An economic model was constructed to estimate annual cost savings per 1,000 patients receiving almotriptan instead of sumatriptan as a function of differing rates of chest pain. Annual direct medical cost avoided was calculated for a hypothetical health plan covering 1 million lives. Results: Among a cohort of 1,390 patients, the incidence of chest-pain-related diagnoses increased significantly (43.6%) with sumatriptan, from 110 during the baseline period to 158 during the treatment period (P = .003). Aggregate costs for chest-pain-related diagnoses and procedures increased 33.1%, from $22,713 to $30,234. Payments for inpatient hospital services rose 10-fold; costs for primary care visits and outpatient hospital visits rose 53.1% and 14.4%, respectively. Payments for angiography increased from $0 to $462, and costs for chest radiographs and electrocardiograms increased 58.7% and 31.2%, respectively. Sumatriptan treatment was associated with a 3-fold increase in payments for services for painful respiration and other chest pain. The model predicted $11,215 in direct medical cost savings annually per 1000 patients treated with almotriptan instead of sumatriptan. Annual direct medical costs avoided for the health plan totaled $195,913. Conclusion: Using almotriptan instead of sumatriptan will likely reduce the cost of chest-pain-related care for patients with migraine headaches. Comment: In my view, this study takes conjecture a step too far. The lower reported chest adverse events (AEs) reported in clinical trials where all AEs are scrutinized will not necessarily lead to lower reporting in the clinic. This hypothesis remains to be proven in a well-designed post-marketing surveillance program, untarnished by commercial sponsorship. Until such an independent prospective study is carried out, the extrapolations described here and in similar papers are pure conjecture and should be classed as the lowest grade of evidence on a par with uncorroborated clinical opinion. DSM [source] The clinical nurse leader: a catalyst for improving quality and patient safetyJOURNAL OF NURSING MANAGEMENT, Issue 5 2008FAAN, JOAN M. STANLEY PhD Aim, The clinical nurse leader (CNL®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice. Background, Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources. Method, A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region. Results, Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model. Conclusions, With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs. Implications for nursing management, Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings. [source] Mobile Construction Supply Chain Management Using PDA and Bar CodesCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 4 2005H. Ping Tserng However, extending the construction project control system to job sites is not considered efficient because using notebooks in a harsh environment like a construction site is not particularly a conventional practice. Meanwhile, paper-based documents of the site processes are ineffective and cannot get the quick response from the office and project control center. Integrating promising information technologies such as personal digital assistants (PDA), bar code scanning, and data entry mechanisms, can be extremely useful in improving the effectiveness and convenience of information flow in construction supply chain control systems. Bar code scanning is appropriate for several construction applications, providing cost savings through increased speed and accuracy of data entry. This article demonstrates the effectiveness of a bar-code-enabled PDA application, called the mobile construction supply chain management (M-ConSCM) System, that responds efficiently and enhances the information flow between offices and sites in a construction supply chain environment. The advantage of the M-ConSCM system lies not only in improving the efficiency of work for on-site engineers, but also providing the Kanban-like visual control system for project participants to control the whole project. Moreover, this article presents a generic system architecture and its implementation. [source] Concepts for computer center power managementCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 2 2010A. DiRienzo Abstract Electrical power usage contributes significantly to the operational costs of large computer systems. At the Hypersonic Missile Technology Research and Operations Center (HMT-ROC) our system usage patterns provide a significant opportunity to reduce operating costs since there are a small number of dedicated users. The relatively predictable nature of our usage patterns allows for the scheduling of computational resource availability. We take advantage of this predictability to shut down systems during periods of low usage to reduce power consumption. With interconnected computer cluster systems, reducing the number of online nodes is more than a simple matter of throwing the power switch on a portion of the cluster. The paper discusses these issues and an approach for power reduction strategies for a computational system with a heterogeneous system mix that includes a large (1560-node) Apple Xserve PowerPC supercluster. In practice, the average load on computer systems may be much less than the peak load although the infrastructure supporting the operation of large computer systems in a computer or data center must still be designed with the peak loads in mind. Given that a significant portion of the time, systems loads can be less than full peak, an opportunity exists for cost savings if idle systems can be dynamically throttled back, slept, or shut off entirely. The paper describes two separate strategies that meet the requirements for both power conservation and system availability at HMT-ROC. The first approach, for legacy systems, is not much more than a brute force approach to power management which we call Time-Driven System Management (TDSM). The second approach, which we call Dynamic-Loading System Management (DLSM), is applicable to more current systems with ,Wake-on-LAN' capability and takes a more granular approach to the management of system resources. The paper details the rule sets that we have developed and implemented in the two approaches to system power management and discusses some results with these approaches. Copyright © 2009 John Wiley & Sons, Ltd. [source] Corporate social responsibility in Asian supply chainsCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 3 2006Richard Welford Abstract This research provides an overview of CSR practices in Asia, evaluates the usefulness of codes of conduct, reviews the benefits of CSR in supply chains and reviews obstacles for companies wishing to adopt good CSR practices. In order to achieve this, interviews were undertaken with CSR managers, factory managers and other experts, conducted in confidence and anonymously. Codes of conduct and associated inspections and audits are common practice but in most cases flawed. Labour issues and the rights of workers are generally seen as the most important aspect of CSR in the region. Benefits of CSR include risk reduction, staff recruitment and retention, cost savings and building good relationships with stakeholders. Obstacles include a lack of resources and skills, a lack of awareness of stakeholders' demands and inefficient production techniques. It is noted that larger firms are more able to overcome such obstacles, with clear adverse implications for smaller companies. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source] Performance of the Panleucogating protocol for CD4+ T cell enumeration in an HIV dedicated laboratory facility in Barbados,,CYTOMETRY, Issue S1 2008Namrata Sippy-Chatrani Abstract Objective: To compare the Panleucogating (PLG) protocol with the routinely used four-color protocol for CD4+ T cell count enumeration. Design and Methods: One hundred fifty-three blood samples were randomly selected from samples received at the National HIV Laboratory for routine immunological monitoring. Samples were prepared using Coulter CYTO-STAT® tetraCHROME monoclonal antibodies and FlowCAREÔ PLG CD4 reagent for four-color and PLG, respectively, and analyzed on the Beckman Coulter EPICS XL flow cytometer. The PLG protocol used a sequential gating strategy where CD4+ T cells were identified using side scatter properties of cells and CD45 staining. The four-color protocol used CD45 and CD3 to identify CD4+ T cells. Results: Absolute CD4+ T cell counts and percentages ranged from 4 to 1,285 cells/,L and 0.9 to 46.7%, respectively. Linear regression analyses revealed good correlation of PLG with the four-color protocol (absolute counts, R2 = 0.95; percentages, R2 = 0.98) over the entire range including the clinically relevant range. Bland Altman statistics revealed no bias for CD4 counts <500 cells/,L and a slight underestimation by PLG for counts >500 cells/,L (Bias = ,32.7 cells/,L; 95% agreement limits = ,151.3, +86.0). CD4+ T cell percentages were the similar over the entire range (Bias = 0.6%; 95% agreement limits = ,1.97 ± 3.18). Conclusions: PLG is an accurate method for enumerating CD4+ T cells and has resulted in major cost savings to the Government of Barbados. This has implications for the sustainability of the National HIV containment program in Barbados and the other resource limited Caribbean countries. The PLG technique is now being routinely used in Barbados. © 2008 Clinical Cytometry Society [source] The Value of Production Schedule Integration in Supply ChainsDECISION SCIENCES, Issue 4 2001Lee Krajewski Abstract This study explores the value of integrated production schedules for reducing the negative effects of schedule revisions in supply chains involving buyer and supplier firms. A stochastic cost model is developed to evaluate the total supply chain cost with integrated purchasing and scheduling policies. The model minimizes the costs associated with assembly rate adjustment, safety stock, and schedule changes for all supply chain members. Through experimentation, the paper examines the impact of several environmental factors on the value of schedule integration. This study finds that schedule integration can lead to overall cost savings in a supply chain, but some firms may have to absorb costs in excess of those they would incur with independent scheduling. Environments with high inventory holding costs and long supplier lead times may not find it beneficial to adopt an integrated schedule. Forecast effectiveness plays a critical role in realizing the benefits of schedule integration. The paper concludes with suggestions for future research. [source] Sterile Versus Nonsterile Gloves During Mohs Micrographic Surgery: Infection Rate is not AffectedDERMATOLOGIC SURGERY, Issue 2 2006BRANDON M. RHINEHART MC BACKGROUND: Mohs micrographic surgery (MMS) is an outpatient procedure, which has become the treatment of choice for certain cutaneous malignancies. Although the major steps in this procedure are relatively standardized, one difference involves the use of sterile or nonsterile, clean gloves during the tumor removal phase. OBJECTIVE: This retrospective, chart review study was performed to evaluate whether infection rates are affected by the use of sterile versus nonsterile gloves in the tumor extirpation phase of MMS. METHODS: This study evaluated the surgical records of 1,810 consecutive Mohs patients, of which 1,239 Mohs patients (1,400 Mohs procedures) met inclusion criteria. Age, sex, tumor diagnosis, anatomic location, number of Mohs stages, area of defect, closure type, cartilage exposure, and sterile versus nonsterile glove use were recorded and evaluated. RESULTS: Twenty-five infections were identified. Statistically significant infection rates were discovered for patients with cartilage fenestration with secondary healing and malignant melanoma diagnosis only. There was no statistical difference in infection rates with all other measured variables to include the use of sterile or clean, nonsterile gloves. CONCLUSION: Our study lends support that clean, nonsterile gloves are safe and effective for use in the tumor extirpation phase of MMS, at a significant cost savings. [source] Blood Cultures Do Not Change Management in Hospitalized Patients with Community-acquired PneumoniaACADEMIC EMERGENCY MEDICINE, Issue 7 2006Prasanthi Ramanujam MD Objectives: To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results. Methods: This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower-spectrum and less expensive alternatives based on the results. Results: A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower-spectrum alternatives was only 170. Conclusions: Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal. [source] Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trialDIABETIC MEDICINE, Issue 3 2006L. M. B. Laffel Abstract Aims Diabetic ketoacidosis (DKA), a life-threatening acute complication of Type 1 diabetes, may be preventable with frequent monitoring of glycaemia and ketosis along with timely supplemental insulin. This prospective, two-centre study assessed sick day management using blood 3-hydroxybutyrate (3-OHB) monitoring compared with traditional urine ketone testing, aimed at averting emergency assessment and hospitalization. Methods One hundred and twenty-three children, adolescents and young adults, aged 3,22 years, and their families received sick day education. Participants were randomized to receive either a blood glucose monitor that also measures blood 3-OHB (blood ketone group, n = 62) or a monitor plus urine ketone strips (urine ketone group, n = 61). All were encouraged to check glucose levels , 3 times daily and to check ketones during acute illness or stress, when glucose levels were consistently elevated (, 13.9 mmol/l on two consecutive readings), or when symptoms of DKA were present. Frequency of sick days, hyperglycaemia, ketosis, and hospitalization/emergency assessment were ascertained prospectively for 6 months. Results There were 578 sick days during 21 548 days of follow-up. Participants in the blood ketone group checked ketones significantly more during sick days (276 of 304 episodes, 90.8%) than participants in the urine ketone group (168 of 274 episodes, 61.3%) (P < 0.001). The incidence of hospitalization/emergency assessment was significantly lower in the blood ketone group (38/100 patient-years) compared with the urine ketone group (75/100 patient-years) (P = 0.05). Conclusions Blood ketone monitoring during sick days appears acceptable to and preferred by young people with Type 1 diabetes. Routine implementation of blood 3-OHB monitoring for the management of sick days and impending DKA can potentially reduce hospitalization/emergency assessment compared with urine ketone testing and offers potential cost savings. [source] Fine-needle aspiration of primary osseous lesions: A cost effectiveness studyDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010Lester J. Layfield M.D. Abstract Fine-needle aspiration (FNA) is not widely used in the work-up of osseous lesions because of concerns regarding its high incidence of nondiagnostic specimens. Although several studies have shown that FNA is less expensive than surgical biopsy, the authors are aware of only one prior study evaluating the cost effectiveness of FNA, which includes the cost of incisional or core needle biopsies necessary to establish a diagnosis when the initial FNA was noncontributory. A computerized search of the pathology records of three medical centers was performed to obtain all FNAs of primary osseous lesions. For each FNA case, all subsequent core needle, incisional or excisional biopsies were recorded as was the result of the definitive operative procedure. The cost of obtaining the definitive diagnosis was calculated for each case including the cost of FNA, imaging guidance utilized, and cost of subsequent surgical biopsy when necessary. The cost of an alternate approach using only surgical biopsy was calculated. The average per patient costs of these two protocols were compared. A total of 165 primary bone tumors underwent FNA. One hundred six of these yielded a definitive cytologic diagnosis. In 59 cases, FNA yielded a result insufficient for definitive therapy necessitating surgical biopsy. FNA investigation of the 165 bone lesions cost 575,932 (average of 3,490 per patient). Surgical biopsy alone would have cost 5,760 per patient. FNA resulted in a cost savings of 2,215 per patient. Diagn. Cytopathol. 2010 © 2009 Wiley-Liss, Inc. [source] SHARED SERVICES IN AUSTRALIAN LOCAL GOVERNMENT: A CASE STUDY OF THE QUEENSLAND LOCAL GOVERNMENT ASSOCIATION MODELECONOMIC PAPERS: A JOURNAL OF APPLIED ECONOMICS AND POLICY, Issue 4 2008BRIAN DOLLERY Professor of Economics, Director A host of recent public inquiries into Australian local government have recommended increased use of shared services and resource-sharing models between groups of local councils. While little is known about the extent and consequences of service sharing, emphasis has been fixed on ,horizontal' shared service models between different local councils in the same municipal jurisdictions. However, other models of shared services and resource sharing are possible. This paper considers the Queensland Local Government Association (LGAQ) model as a case study of a resource sharing between all councils in a given system of local government. This form of shared service and resource sharing seems to offer excellent prospects for cost savings and capacity enhancement. [source] Improved Prediction of Nonepileptic Seizures with Combined MMPI and EEG MeasuresEPILEPSIA, Issue 3 2000D. Storzbach Summary: Purpose: Nonepileptic seizures (NESs) are frequently mistaken for epileptic seizures (ESs). Improved detection of patients with NESs could lead to more appropriate treatment and medical cost savings. Previous studies have shown the MMPI/MMPI-2 to be a useful predictor of NES. We hypothesized that combining the MMPI-2 with a physiologic predictor of epilepsy (routine EEG; rEEG) would result in enhanced prediction of NES. Methods: Consecutive patients undergoing CCTV-EEG monitoring underwent rEEG evaluation and completed an MMPI-2. Patients were subsequently classified as having epilepsy (n = 91) or NESs (n = 76) by using standardized criteria. Logistic regression was used to predict seizure type classification. Results: Overall classification accuracy was 74% for rEEG, 71% for MMPI-2 Hs scale, and 77% for MMPI-2 Hy scale. The model that best predicted diagnosis included rEEG, MMPI-2, and number of years since the first spell, resulting in an overall classification accuracy of 86%. Conclusions: The high accuracy achieved by the model suggests that it may be useful for screening candidates for diagnostic telemetry. [source] Geographical Aspects of Food Industry FDI in the CEE Countries Geografische Aspekte ausländischer Direktinvestitionen (ADI) in der Lebensmittelindustrie in mittel- und osteuropäischen Ländern Les dimensions géographiques de l'IDE dans l'industrie alimentaire des pays d'Europe centrale et orientaleEUROCHOICES, Issue 1 2009Csaba Jansik Summary Geographical Aspects of Food Industry FDI in the CEE Countries Food industry FDI has favoured certain food processing sub-sectors over others and it has also been distributed rather unevenly in geographical terms both between countries and regionally within each country. As for the regional distribution, foreign investors have typically targeted locations with a relatively high density of consumers as opposed for instance to prioritising the proximity of agricultural raw materials. The capital city areas and their surrounding regions have attracted a much higher proportion of total food industry FDI than their contribution to agricultural and food processing output would warrant. FDI has contributed in many ways to the development of the regions and industries which have received capital inflows. There has been some levelling off in FDI between countries more recently, a trend driven by the tendency for multinational enterprises to shift their production capacity across national borders among their CEE subsidiaries in a search for greater economies of scale or cost savings. This realignment has helped certain branches of the food industry in some CEE countries perform better than others in competing for common EU food markets. Positive effects of the recent FDI inflows include rapid productivity improvements and enhancement of food export volumes. L'IDE dans l'industrie alimentaire a privilégié certains sous-secteurs de la transformation alimentaire plutôt que d'autres et sa répartition géographique, à la fois entre pays et entre régions au sein d'un même pays, a été plutôt inégale. En termes de répartition régionale, les investisseurs étrangers ont typiquement ciblé des zones où la densité des consommateurs est assez élevée plutôt que de donner, par exemple, la prioritéà la proximité des produits agricoles primaires. Les capitales et les régions qui les entourent ont attiré une proportion bien plus grande de l'ensemble de l'IDE dans l'industrie alimentaire que ce que leur contribution à la production agricole et alimentaire représenterait. L'IDE a contribué de maintes façons au développement des régions et des industries qui ont reçu des capitaux. Une certaine égalisation de l'IDE s'est produite plus récemment entre pays, ce phénomène étant entraîné par la tendance des entreprises multinationales à transférer leur capacité de production d'un pays à l'autre entre leurs filiales d'Europe centrale et orientale, à la recherche d'économies d'échelle et de coûts. Ce rééquilibrage a aidé certaines branches de l'industrie alimentaire de certains pays d'Europe centrale et orientale à réussir mieux que d'autres dans la compétition sur les marchés alimentaires de l'UE. Parmi les effets positifs des entrées de capitaux d'IDE récentes, figurent des améliorations rapides de la productivité et la croissance en volume des exportations de produits alimentaires. Ausländische Direktinvestitionen (ADI) in der Lebensmittelindustrie haben sich auf bestimmte Teilsektoren konzentriert. Außerdem ist die Konzentration der ADI sowohl geografisch zwischen den Ländern als auch den Regionen einzelner Länder ungleich. Bei der regionalen Konzentration haben die ausländischen Investoren ihre Wahl nicht etwa anhand der Entfernung zu landwirtschaftlichen Rohstoffen getroffen, sondern Orte mit einer relativ hohen Kundendichte bevorzugt. Auf die Hauptstadtregionen entfiel ein viel größerer Anteil an den gesamten ADI als es ihre Beteiligung an der Produktionsmenge in Landwirtschaft und Lebensmittelverarbeitung rechtfertigen würde. ADI haben in vielerlei Hinsicht zur Entwicklung der Regionen und Industrien beigetragen, die einen Kapitalzufluss erfahren haben. In letzter Zeit wurden ADI zwischen den Ländern etwas weniger konzentriert, da multinationale Unternehmen danach streben, ihre Produktionskapazitäten länderübergreifend auf ihre MOE-Tochtergesellschaften zu verlagern, um Skaleneffekte und Kosteneinsparungen besser nutzen zu können. Durch diese Neuorientierung konnten sich bestimmte Lebensmittelindustriezweige in einigen MOEL gegenüber anderen im Wettbewerb um die gemeinsamen Lebensmittelmärkte der EU behaupten. Zu den positiven Auswirkungen von ADI-Zuflüssen zählen eine rasche Steigerung der Produktivität sowie größere Mengen an Lebensmittelexporten. [source] Multi-Period Planning of Survivable WDM NetworksEUROPEAN TRANSACTIONS ON TELECOMMUNICATIONS, Issue 1 2000Mario Pickavet This paper presents a new heuristic algorithm useful for long-term planning of survivable WDM networks. A multi-period model is formulated that combines network topology design and capacity expansion. The ability to determine network expansion schedules of this type becomes increasingly important to the telecommunications industry and to its customers. The solution technique consists of a Genetic Algorithm that allows to generate several network alternatives for each time period simultaneously and shortest-path techniques to deduce from these alternatives a least-cost network expansion plan over all time periods. The multi-period planning approach is illustrated on a realistic network example. Extensive simulations on a wide range of problem instances are carried out to assess the cost savings that can be expected by choosing a multi-period planning approach instead of an iterative network expansion design method. [source] Stochastic Cost Optimization of Multistrategy DNAPL Site RemediationGROUND WATER MONITORING & REMEDIATION, Issue 3 2010Jack Parker This paper investigates numerical optimization of dense nonaqueous phase liquid (DNAPL) site remediation design considering effects of prediction and measurement uncertainty. Results are presented for a hypothetical problem involving remediation using thermal source reduction (TSR) and bioremediation with electron donor (ED) injection. Pump-and-treat is utilized as a backup measure if compliance criteria are not met. Remediation system design variables are optimized to minimize expected net present value (ENPV) cost. Adaptive criteria are assumed for real-time control of TSR and ED duration. Source zone dissolved concentration data enabled more reliable and lower cost operation of TSR than soil concentration data, but using both soil and dissolved data improved results sufficiently to more than offset the additional cost. Decisions to terminate remediation and monitoring or to initiate pump-and-treat are complicated by measurement noise. Simultaneous optimization of monitoring frequency, averaging period, and lookback periods to confirm decisions, in addition to remediation design variables, reduced ENPV cost. Results indicate that remediation design under conditions of uncertainty is affected by subtle interactions and tradeoffs between design variables, compliance rules, site characteristics, and uncertainty in model predictions and monitoring data. Optimized designs yielded cost savings of up to approximately 50% compared with a nonoptimized design based on common engineering practices. Significant improvements in accuracy and reductions in cost were achieved by recalibrating the model to data collected during remediation and re-optimizing design variables. Repeating this process periodically is advisable to minimize total costs and maximize reliability. [source] Cost savings in migraine associated with less chest pain on new triptan therapy.HEADACHE, Issue 3 2003JT Wang Am J Manag Care. 2002 Feb;8(3 Suppl):S102-S107 Objectives: This article constructs an economic model to estimate cost of chest-pain-related care in migraine patients receiving almotriptan 12.5 mg compared with those receiving sumatriptan 50 mg. Study Design: This population-based, retrospective cohort study used data from the MEDSTAT Marketscan database (Ann Arbor, Michigan) to quantify incidence and costs of chest-pain-related diagnoses and procedures. After a 6-month exclusion period, the study used a pre-post design, with baseline and treatment periods defined, respectively, as 5 months before and after receiving sumatriptan therapy. An economic model was constructed to estimate annual cost savings per 1,000 patients receiving almotriptan instead of sumatriptan as a function of differing rates of chest pain. Annual direct medical cost avoided was calculated for a hypothetical health plan covering 1 million lives. Results: Among a cohort of 1,390 patients, the incidence of chest-pain-related diagnoses increased significantly (43.6%) with sumatriptan, from 110 during the baseline period to 158 during the treatment period (P = .003). Aggregate costs for chest-pain-related diagnoses and procedures increased 33.1%, from $22,713 to $30,234. Payments for inpatient hospital services rose 10-fold; costs for primary care visits and outpatient hospital visits rose 53.1% and 14.4%, respectively. Payments for angiography increased from $0 to $462, and costs for chest radiographs and electrocardiograms increased 58.7% and 31.2%, respectively. Sumatriptan treatment was associated with a 3-fold increase in payments for services for painful respiration and other chest pain. The model predicted $11,215 in direct medical cost savings annually per 1000 patients treated with almotriptan instead of sumatriptan. Annual direct medical costs avoided for the health plan totaled $195,913. Conclusion: Using almotriptan instead of sumatriptan will likely reduce the cost of chest-pain-related care for patients with migraine headaches. Comment: In my view, this study takes conjecture a step too far. The lower reported chest adverse events (AEs) reported in clinical trials where all AEs are scrutinized will not necessarily lead to lower reporting in the clinic. This hypothesis remains to be proven in a well-designed post-marketing surveillance program, untarnished by commercial sponsorship. Until such an independent prospective study is carried out, the extrapolations described here and in similar papers are pure conjecture and should be classed as the lowest grade of evidence on a par with uncorroborated clinical opinion. DSM [source] Impact of Chest Pain on Cost of Migraine Treatment With Almotriptan and SumatriptanHEADACHE, Issue 2002Joseph T. Wang MS Chest-related symptoms occur with all triptans; up to 41% of patients with migraine who receive sumatriptan experience chest symptoms, and 10% of patients discontinue treatment. Thus, the cost of chest pain-related care was estimated in migraineurs receiving almotriptan 12.5 mg versus sumatriptan 50 mg. A population-based, retrospective cohort study used data to quantify the incidence and costs of chest pain-related diagnoses and procedures. An economic model was constructed to estimate annual cost savings per 1000 patients receiving almotriptan versus sumatriptan based on the reported rates of chest pain. Annual direct medical cost avoided was calculated for a hypothetical health plan covering 1 million lives. Among a cohort of 1390 patients, the incidence of chest pain-related diagnoses increased significantly by 43.6% with sumatriptan (P=.003). Aggregate costs for chest pain-related diagnoses and procedures increased from $22 713 to $30 234. Payments for inpatient hospital services, costs for primary care visits, and costs for outpatient hospital visits increased by over 100%, 53.1%, and 14.4%, respectively. The model predicted $11 215 in direct medical cost savings annually per 1000 patients treated with almotriptan versus sumatriptan. Annual direct medical costs avoided totaled $194 358, and when applied to recent estimates of 86 million lives currently covered by almotriptan treatment, translates into an annual cost savings of just under $17 million for chest pain and associated care. Thus, using almotriptan in place of sumatriptan will likely reduce the cost of chest pain-related care. [source] Health systems in East Asia: what can developing countries learn from Japan and the Asian Tigers?HEALTH ECONOMICS, Issue 5 2007Adam Wagstaff Abstract The health systems of Japan and the Asian Tigers (Hong Kong, Korea, Singapore and Taiwan), and the recent reforms to them, provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend on the design features of the system , the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals , rapid cost and price inflation, a race for the best technology, and so on , illustrates the difficulties of corporatization. Korea's experience with a narrow benefit package illustrates the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with DRGs in Korea and Taiwan point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more ,rational' prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists. Copyright © 2006 John Wiley & Sons, Ltd. [source] Maternal health: does prenatal care make a difference?HEALTH ECONOMICS, Issue 5 2006Karen Smith Conway Abstract This research attempts to close an important gap in health economics regarding the efficacy of prenatal care and policies designed to improve access to that care, such as Medicaid. We argue that a key beneficiary , the mother , has been left completely out of the analysis. If prenatal care significantly improves the health of the mother, then concluding that prenatal care is ,ineffective' or that the Medicaid expansions are a ,failure' is premature. This paper seeks to rectify the oversight by estimating the impact of prenatal care on maternal health and the associated cost savings. We first set up a joint maternal,infant health production framework that informs our empirical analysis. Using data from the National Maternal and Infant Health Survey, we estimate the effects of prenatal care on several different measures of maternal health such as body weight status and excessive hospitalizations. Our results suggest that receiving timely and adequate prenatal care may increase the probability of maintaining a healthy weight after the birth and, perhaps for blacks, of avoiding a lengthy hospitalization after the delivery. Given the costs to society of obesity and hospitalization, these are benefits worth exploring before making conclusions about the effectiveness of prenatal care , and Medicaid. Copyright © 2006 John Wiley & Sons, Ltd. [source] Time to Send the Preemie Home?HEALTH SERVICES RESEARCH, Issue 2p1 2009Additional Maturity at Discharge, Outcomes, Subsequent Health Care Costs Objective. To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs. Data Sources. One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002. Study Design/Methods. Using multivariate matching with a time-dependent propensity score we matched 701 "Early" babies to 701 "Late" babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes. Principal Findings. Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late,Early cost difference was $5,016 (p<.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate. Conclusions. In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes. [source] The Cost-Effectiveness of Independent Housing for the Chronically Mentally Ill: Do Housing and Neighborhood Features Matter?HEALTH SERVICES RESEARCH, Issue 5 2004Joseph Harkness Objective. To determine the effects of housing and neighborhood features on residential instability and the costs of mental health services for individuals with chronic mental illness (CMI). Data Sources. Medicaid and service provider data on the mental health service utilization of 670 individuals with CMI between 1988 and 1993 were combined with primary data on housing attributes and costs, as well as census data on neighborhood characteristics. Study participants were living in independent housing units developed under the Robert Wood Johnson Foundation Program on Chronic Mental Illness in four of nine demonstration cities between 1988 and 1993. Study Design. Participants were assigned on a first-come, first-served basis to housing units as they became available for occupancy after renovation by the housing providers. Multivariate statistical models are used to examine the relationship between features of the residential environment and three outcomes that were measured during the participant's occupancy in a study property: residential instability, community-based service costs, and hospital-based service costs. To assess cost-effectiveness, the mental health care cost savings associated with some residential features are compared with the cost of providing housing with these features. Data Collection/Extraction Methods. Health service utilization data were obtained from Medicaid and from state and local departments of mental health. Non-mental-health services, substance abuse services, and pharmaceuticals were screened out. Principal Findings. Study participants living in newer and properly maintained buildings had lower mental health care costs and residential instability. Buildings with a richer set of amenity features, neighborhoods with no outward signs of physical deterioration, and neighborhoods with newer housing stock were also associated with reduced mental health care costs. Study participants were more residentially stable in buildings with fewer units and where a greater proportion of tenants were other individuals with CMI. Mental health care costs and residential instability tend to be reduced in neighborhoods with many nonresidential land uses and a higher proportion of renters. Mixed-race neighborhoods are associated with reduced probability of mental health hospitalization, but they also are associated with much higher hospitalization costs if hospitalized. The degree of income mixing in the neighborhood has no effect. Conclusions. Several of the key findings are consistent with theoretical expectations that higher-quality housing and neighborhoods lead to better mental health outcomes among individuals with CMI. The mental health care cost savings associated with these favorable features far outweigh the costs of developing and operating properties with them. Support for the hypothesis that "diverse-disorganized" neighborhoods are more accepting of individuals with CMI and, hence, associated with better mental health outcomes, is mixed. [source] Internal audit outsourcing in AustraliaACCOUNTING & FINANCE, Issue 1 2006Peter Carey M42 Abstract The present study investigates the determinants of internal audit outsourcing using survey data on 99 companies listed on the Australian Stock Exchange, where 54.5 per cent fully rely on in-house facilities and 45.5 per cent outsource some or all of their internal audit function. Results from logistic regression analyses suggest that internal audit outsourcing is associated with perceived cost savings and the technical competence of the external provider. For a subsample of firms that have previously undertaken internal audit activities before outsourcing, contrary to expectations, the larger the organization the greater the propensity to outsource. In addition, smaller firms are found to be adopting internal audit for the first time, through outsourcing. These results suggest that internal audit outsourcing is an expanding business opportunity for professional accountants; but with 75 per cent of firms outsourcing to their external auditor, there are implications for external auditor independence. [source] The renaissance of home hemodialysis: Where we are, why we got here, what is happening in the United States and elsewhereHEMODIALYSIS INTERNATIONAL, Issue 2008Christopher R. BLAGG Abstract Home hemodialysis has been around since 1964, but its use has declined over the years in most countries, this despite its advantages, particularly improved patient survival and quality of life and significant cost savings. Experience has shown that home hemodialysis can be performed successfully by many more patients than at present. Recently, with the demonstration of even better results with more frequent hemodialysis that is obviously best performed at home and with the development of new, more patient-friendly machines, the use of home hemodialysis is beginning to increase again. [source] Modeling an HR shared services center: Experience of an MNC in the United KingdomHUMAN RESOURCE MANAGEMENT, Issue 2 2006Fang Lee Cooke An increasing number of large and multinational organizations are moving to shared services models in delivering the human resource function. It is commonly believed that the adoption of an HR shared services model can transform the role of HR by enabling the HR function to be more strategic at the corporate level and more cost-effective at the operational level. However, few academic studies have been carried out to investigate challenges to implementing an HR services center successfully and the impact of adopting an HR shared services model on different groups of employees. Through a case study of a multinational corporation, this article reveals that there remains a significant gap between literature espousing the efficacy and utility of HR shared services and the extent to which the adoption of such a model is successful. The financial and emotional cost of moving to a shared services model can outweigh the tangible cost savings predicted by firms. The idea of separating the HR function into strategic, operational, and administrative components may prove to be too simplistic, although it underpins the initiative of HR shared services. © 2006 Wiley Periodicals, Inc. [source] Cost optimization of composite floors using neural dynamics modelINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING, Issue 11 2001Hojjat Adeli Abstract The design of composite beams is complicated and highly iterative. Depending on the design parameters a beam can be fully composite or partially composite. In the case of design on the basis of the American Institute of Steel Construction (AISC) Load and Resistance Factor Design (LRFD) one has to consider the plastic deformations. As pointed out by Lorenz, the real advantage of the LRFD code can be realized in the minimum cost design. In this article, we present a general formulation for the cost optimization of composite beams based on the AISC LRFD specifications by including the costs of (a) concrete, (b) steel beam, and (c) shear studs. The problem is formulated as a mixed integer-discrete non-linear programming problem and solved by the recently patented neural dynamics model of Adeli and Park (U.S. patent 5,815,394 issued on September 29, 1998). It is shown that use of the cost optimization algorithm presented in this article results in substantial cost savings. Copyright © 2001 John Wiley & Sons, Ltd. [source] A Global Approach to Fiber nD Architectures and Self-Sealing Matrices: From Research to ProductionINTERNATIONAL JOURNAL OF APPLIED CERAMIC TECHNOLOGY, Issue 2 2005F. A. Christin Thermostructural composites (TSC) improvement is one of the key factors to ensure future competitiveness of aeronautical and space engines. The TSC technology developed in Snecma Propulsion Solide is based on continuous fiber-reinforced composites and carbon or ceramics matrices deposited by chemical vapor infiltration. This article presents a status of the latest improvements for cost savings of composite reinforcements (so-called texture) and specific matrices developed to increase both durability and temperature capability of previous ceramic composites, operating in oxidative environments. [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] Proxy-assisted P2P and multicast transmission schemes for layered-video streaming over wireless networksINTERNATIONAL JOURNAL OF COMMUNICATION SYSTEMS, Issue 9-10 2010Yung-Cheng Kao Abstract This work describes the process of efficiently streaming a set of layered-videos from a remote server via proxy of the base station to multiple heterogeneous and asynchronous clients in wireless networks, such as the WiMAX network, which are devices that request different layers of the video according to their profiles. The process focuses on that the transmission cost savings for caching X layers of a video are not only from requests on X layers, but also from requests on layers that are lower than X layers. A set of proxy-assisted transmission schemes are proposed for layered-video streaming by integrating the proxy caching with reactive transmission schemes, peer-to-peer mesh networks and base station multicast capability. The optimal proxy prefix cache allocation is calculated for each transmission scheme to identify the cache layer and cache length of each video to minimize the aggregate transmission cost. Experimental results demonstrate that an adaptive proxy-assisted transmission scheme can lead to significant transmission cost savings. Copyright © 2009 John Wiley & Sons, Ltd. [source] Operational cost savings in dairy plant water usage,INTERNATIONAL JOURNAL OF DAIRY TECHNOLOGY, Issue 2 2006P J WILLIAMS Public awareness and concern over food safety, together with intensified regulatory control over the impact of food processing operations on the environment, present new challenges to the industry. This paper outlines a systematic approach to water management that addresses both cost-reduction strategies and environmental performance improvement, which can enhance industry image while maintaining product and brand integrity. Many companies already operate a well-defined environmental management system (EMS), and some have already sought accreditation to ISO 14001. However, the implementation of, among others, the Integrated Pollution Prevention and Control (IPPC) Directive, the Water Directive and the Climate Change Levy (CCL) are raising new and important questions. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||