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Annual Cost (annual + cost)
Kinds of Annual Cost Selected AbstractsAutomatic design of conventional distillation column sequence by genetic algorithmTHE CANADIAN JOURNAL OF CHEMICAL ENGINEERING, Issue 3 2009Ramin Bozorgmehry Boozarjomehry Abstract Synthesis of the optimum conventional (with non-sharp separations) distillation column sequence (DCS) is a challenging problem, in the field of chemical process design and optimization, due to its huge search space and combinatorial nature. In this paper, a novel procedure for the synthesis of optimum Conventional Distillation Column Sequence is proposed. The proposed method is based on evolutionary algorithms. The main criterion used to screen alternative DCS's is the Total Annual Cost (TAC). In order to estimate the TAC of each DCS alternative all columns that exist in the DCS are designed using short-cut methods. The performance of the proposed method and other alternatives are compared based on the results obtained for four standard benchmark problems used by researchers working in this area. Based on the results of the comparison, the proposed method outperforms the other methods and is also more flexible than other existing methods. La synthèse de la séquence de colonne de distillation (SCD) traditionnelle optimale (caractérisée par des séparations non tranchantes) représente un problème difficile à régler, dans le domaine de la conception et de l'optimisation de procédés chimiques, en raison de son immense espace de recherche et de sa nature combinatoire. Ce document propose une procédure nouvelle en vue de la synthèse de la séquence de colonne de distillation traditionnelle optimale. La méthode proposée est fondée sur des algorithmes évolutionnistes. Le critère principal utilisé pour présélectionner les autres possibilités de SCD est le coût total annuel (CTA). Pour estimer le CTA de chaque option de SCD, toutes les colonnes qui existent dans la SCD sont conçues en utilisant des méthodes abrégées. On compare ensuite le rendement de la méthode proposée et des autres possibilités en s'appuyant sur les résultats obtenus dans le cadre de quatre problèmes d'évaluation standard utilisés par les chercheurs oeuvrant dans ce domaine. En s'appuyant sur les résultats de la comparaison, la méthode proposée donne un meilleur rendement que les autres méthodes et est également plus souple que les autres méthodes qui existent. [source] Resource use and costs in a Swedish cohort of patients with Parkinson's diseaseMOVEMENT DISORDERS, Issue 6 2002Peter Hagell RN Abstract We estimated resource use and costs in patients with Parkinson's disease (PD), thereby providing baseline data for future economic evaluations of therapeutic interventions. Data were collected from medical records of a South Swedish cohort of 127 PD patients during 1 year (1996) and a mailed questionnaire inquiring about cost-related consequences and resource use in 1996 and in 2000. Annual costs were calculated based on prevalence and expressed in SEK (monetary value of the year 2000). Direct health care costs averaged approximately SEK 29,000 (,USD 2,900; EUR 3,200) per patient per year, of which drugs were the most costly component. Nonmedical direct costs were higher than direct health care costs, averaging approximately SEK 43,000 (,USD 4,300; EUR 4,800) per patient per year, and costs due to lost production were approximately SEK 52,000 (,USD 5,200; EUR 5,800) per patient per year. The mean total annual cost for PD in our sample approximated SEK 124,000 (,USD 12,400; EUR 13,800) per patient. These findings are roughly within the same range as estimates from other countries and show that PD causes a considerable societal burden. In addition to other outcomes, evaluations of the economic implications of new therapeutic interventions are highly warranted. In this perspective, the present study provides valuable baseline data. © 2002 Movement Disorder Society [source] Informing policy for the Australian context , Costs, outcomes and cost savings of prenatal carrier screening for cystic fibrosisAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Susannah MAXWELL Aims:, To examine the costs, outcomes and cost savings of three models of prenatal cystic fibrosis (CF) carrier screening compared to no screening from a public health sector perspective. Methods:, A decision tree was generated to estimate costs and outcomes for each screening model for a hypothetical cohort of 38 000 pregnancies. Sensitivity analysis assessed the impact of model parameter variation. Results:, Under baseline assumptions, the initial annual cost to provide a prenatal CF carrier-screening programme is Au$5.32 million, Au$3.35 million and $2.93 million for one-step, two-step simultaneous and two-step sequential screening respectively. Annual costs are significantly lower for an established programme. No screening model provides a net saving over a lifetime horizon; however, the results were sensitive to variation in lifetime cost of care, screening test costs and number of pregnancies per carrier couple. Conclusions:, Under some scenarios, prenatal CF carrier screening is cost saving to the health system; however, this is not conclusive and depends on several factors. Cost remains a potential barrier due to the substantial level of funding required in the short term. Feasibility and psychosocial, ethical and legal implications of screening need to be considered. Additionally, consultation is required with the Australian community on the acceptability and/or desire for prenatal CF carrier screening. [source] FS07.1 A survey of occupational hand eczema in DenmarkCONTACT DERMATITIS, Issue 3 2004Rikke Skoet Background:, The need for prevention to reduce the number of occupational hand eczema is high. Occupational hand eczema is the most frequently recognised work-related disease in Denmark. Previous findings have shown that almost half of all cases develop a chronic condition with persistent dermatitis, and the annual cost to society is immense. Aims:, The aim of this study was to survey the trends and development of occupational hand eczema in Denmark and thereby help to ensure future successful prevention of chronic disabling occupational hand eczema. Methods:, 758 patients with recognised occupational hand eczema were included prospectively in the period October 2001- November 2002. Data on diagnoses, disease duration, severity, absence from work and occupation was obtained from The Danish National Board of Industrial Injuries and an additional questionnaire was administered by mail. Results:, 621 patients answered the questionnaire (response rate 82%). Irritant contact dermatitis was the most frequent diagnosis and the female/male ratio was 2:1. High prevalence was found in particularly wet occupations. 19 per cent had sick leave more than 5 weeks per year and the mean disease duration was 4.8 years (median 2.1 years). 68.2% had chronic changes. Conclusion:, The results showed a marked gender difference in the pattern of diagnosis and occupation. The impact of occupational hand eczema is still high with prolonged absence from work and a high percentage of chronic disease. The results of the study give important suggestions for future preventive strategies for health authorities. [source] Baghouse system design based on economic optimizationENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 4 2000Antonio C. Caputo In this paper a method is described for using economic optimization in the design of baghouse systems. That is, for a given emission control problem, the total filtration surface area, the overall pressure drop, fabric material effects, and the cleaning cycle frequency, may all be evaluated simultaneously. In fact, as baghouse design parameters affect capital and operating expenses in interrelated and counteracting manners, a minimum total cost may be searched defining the best arrangement of dust collection devices. With this in mind, detailed cost functions have been developed with the aim of providing an overall economic model. As a result, a discounted total annual cost has been obtained that may be minimized by allowing for optimal baghouse characterization. Finally, in order to highlight the capabilities of the proposed methodology, some optimized solutions are also presented, which consider the economic impact of both bag materials and dust properties. [source] An economic model of haemophilia in MexicoHAEMOPHILIA, Issue 1 2004C. Martínez-Murillo Summary., A model was developed to assess the lifetime costs and outcomes associated with haemophilia in Mexico. A retrospective chart review of 182 type A haemophiliacs was conducted for patients aged 0,34 years receiving one of three treatments: (i) cryoprecipitate at clinic; (ii) concentrate at home; or (iii) concentrate at clinic. Patients treated at home experienced 30% less joint damage, used 13,54% less factor VIII, had four times fewer clinic visits, and utilized half as many hospital days than those treated at a clinic. For cryoprecipitate at clinic patients, the annual incidence rates of HCV and HIV were calculated to be 3.6% and 1.4% respectively. The life expectancy for patients receiving cryoprecipitate and those receiving concentrate was estimated to be 49 years and 69 years respectively, with 58% of cryoprecipitate patients predicted to die of AIDS before age 69. Across the lifespan, the average annual cost of care was US$11 677 (MN$110 464) for cryoprecipitate at clinic patients, US$10 104 (M$95 580) for concentrate at home patients and US$18 819 (MN$178 027) for concentrate at clinic patients. Using a 5% discount rate, the incremental lifetime cost per year of life added for treatment with concentrate at home compared with cryoprecipitate at a clinic was US$738 (MN$6981). Rank order stability analysis demonstrated that the model was most sensitive to the cost of fVIII. These results indicate that treatment with concentrate at home compared with cryoprecipitate at a clinic substantially improves clinical outcomes at reduced annual cost levels. [source] Thermoeconomic optimization for a finned-tube evaporator configuration of a roof-top bus air-conditioning systemINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 4 2008M. Khamis Mansour Abstract This paper presents a methodology of a design optimization technique that can be useful in assessing the best configuration of a finned-tube evaporator, using a thermoeconomic approach. The assessment has been carried out on a direct expansion finned-tube evaporator of a vapor compression cycle for a roof-top bus air-conditioning (AC) system at a specified cooling capacity. The methodology has been conducted by studying the effect of some operational and geometrical design parameters for the evaporator on the entire cycle exergy destruction or irreversibility, AC system coefficient of performance (COP), and total annual cost. The heat exchangers for the bus AC system are featured by a very compact frontal area due to the stringent space limitations and structure standard for the system installation. Therefore, the current study also takes in its account the effect of the variation of the design parameters on the evaporator frontal area. The irreversibility due to heat transfer across the stream-to-stream temperature difference and due to frictional pressure drops is calculated as a function of the design parameters. A cost function is introduced, defined as the sum of two contributions, the investment expense of the evaporator material and the system compressor, and the operational expense of AC system that is usually driven by an auxiliary engine or coupled with the main bus engine. The optimal trade-off between investment and operating cost is, therefore, investigated. A numerical example is discussed, in which a comparison between the commercial evaporator design and optimal design configuration has been presented in terms of the system COP and evaporator material cost. The results show that a significant improvement can be obtained for the optimal evaporator design compared with that of the commercial finned-tube evaporator that is designed based on the conventional values of the design parameters. Copyright © 2007 John Wiley & Sons, Ltd. [source] Thermoeconomic optimization of the geometry of an air conditioning precooling air reheater dehumidifierINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 4 2006Rahim K. Jassim Abstract Exergy method of optimization for the geometrical parameters of an air conditioning precooling air reheater with turbulent flow is developed in this paper. The method is based on exergy, economic analysis and optimization theory. As there are humid air streams involved in the heat transfer process, then there are irreversibilities or exergy destruction, which is due to pressure losses, temperature difference and specific humidity gradient. These principle components of total irreversibility are not independent and there is a trade-off between them. Therefore, the purpose of this research paper is to study the effect of the geometry and the specific humidity of the two streams on the irreversibilities of a crossflow precooling air reheater dehumidifier. Also, the optimum balance between the three components of irreversibility is determined thereby giving the optimum solution for heat exchanger area. The total cost function is expressed on an annualized basis of the sum of the precooler capital cost and the running cost attributable to the precooler irreversibility. This total cost function is optimized in this paper according to the optimum heat transfer area and the total irreversibilities. Two optimum heat transfer areas were found for minimum total irreversibility and minimum total annual cost for a specific example. Finally, the relations between the typical operational variables such as heat transfer area, Reynolds numbers and the total annual cost for the precooler is developed and presented in graphs, which allow the calculation of the optimal heat transfer area, which gives the optimum irreversibility and minimum total annual cost. Copyright © 2005 John Wiley & Sons, Ltd. [source] The economic costs of dementia in Korea, 2002INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2006Guk-Hee Suh Abstract Objective To estimate the economic costs of dementia in 2002 using an economic evaluation model for dementia care. Methods Data were from the Korea National Survey of the Long-Term Care Need (LTC survey) (n,=,5058), two prospective 1-year studies [one clinical trial (n,=,234), one naturalistic community cohort study (n,=,107)], and two epidemiologic community studies for prevalence of dementia (n,=,1037,+,1481). Daily costs and proportions of different levels of institutional service provided were collected from the LTC survey. Resource use in the community included health care services, social care services, out-of-pocket purchase for self-support, caregiver time and missed work of caregiver. Costs in community were calculated based on resource utilization multiplied by the unit costs for each resource. Results Total annual costs of dementia were estimated to be over 2.4 billion US$ for 272,000 dementia sufferers. Costs in community represent 96% of the total annual costs, while costs of informal care and missed work of caregivers were 1.3 billion US$, or 55% of total annual cost. Average annual costs of full time care (FTC) and pre-FTC in community LTC were 44,121 US$ and 13,273 US$ per person, whereas cost per patient who did not need community LTC was 3986 US$. Conclusion Given that the number of dementia sufferers is projected to increase in the near future and that larger part of the costs are subsidized by the government, the economic and social costs of dementia is significant not only for dementia sufferers and their caregivers, but also for society. Copyright © 2006 John Wiley & Sons, Ltd. [source] Operations Research and public policy for Africa: harnessing the revolution in management science instructionINTERNATIONAL TRANSACTIONS IN OPERATIONAL RESEARCH, Issue 2 2008Jonathan P. Caulkins Abstract Operations Research (OR) has made major contributions in the developed world to public policy domains that are of great relevance to Africa. Inasmuch as OR has failed to live up to its potential for addressing such issues in Africa, a principal barrier may have been distance between OR analysts and decision makers. However, the revolution in management science instruction and potential to train end-user modelers has democratized OR. This makes training for policy makers and managers in the public and non-profit sectors in Africa both feasible and highly beneficial. Existing management science courses for public and non-profit leaders, such as those taught at Carnegie Mellon's Heinz School, could be adapted to fit the needs of educators and policy makers in Africa and disseminated via a "train the trainers" approach. A plan is sketched whereby 800,000 end-user modelers might be trained in Africa (one for every 1000 people) at an annual cost of about $5 million/year. Such budgets are well within the range of investments in human capital formation currently being made in Africa. [source] A Cost-Benefit Analysis of External Hip Protectors in the Nursing Home SettingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Lisa A. Honkanen MD Objectives: To estimate potential cost savings generated by a program of hip protectors in the nursing home from a Medicare perspective. Design: A state-transition Markov model considering short-term and long-term outcomes of hip protectors for a hypothetical nursing home population, stratified by age, sex, and functional status. Costs, transition probabilities between health states, and estimates of hip protectors' effectiveness were derived from published secondary data. Setting: Nursing home facilities in the United States. Participants: Hypothetical cohort of permanent nursing home residents aged 65 and older without a previous hip fracture. Intervention: Program of hip protectors reimbursed by Medicare. Measurements: Number of fractures, life years, and dollars saved. Results: Three pairs of hip protectors replaced annually would result in a weighted average lifetime absolute risk reduction for hip fracture of 8.5%, with net lifetime savings to Medicare of $223 per resident. When the annual cost of hip protectors is less than $151 per person, relative risk of fracture is less than or equal to 0.65 with hip protectors, or adherence is greater than 42%, hip protectors are cost saving to Medicare over a wide range of assumptions. Extrapolating these results to the estimated population of U.S. nursing home residents without a previous hip fracture, Medicare could save $136 million in the first year of a hip-protector reimbursement program. Conclusion: From a Medicare perspective, hip protectors are a cost-saving intervention in the nursing home setting when hip protector effectiveness is less than or equal to 0.65 over the remaining lifetime of subjects. [source] Informal Caregiving Time and Costs for Urinary Incontinence in Older Individuals in the United StatesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2002Kenneth M. Langa MD OBJECTIVES: To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals. DESIGN: Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443). SETTING: Community-dwelling older people. PARTICIPANTS: National population-based sample of community-dwelling older people. MEASUREMENTS: Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads. RESULTS: Thirteen percent of men and 24% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours (P < .001). Women in these groups received 5.9, 7.6, and 10.7 hours (P < .001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care. CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition. [source] Cost Comparison of Catheter Ablation and Medical Therapy in Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2007F.R.C.P.C., YAARIV KHAYKIN M.D. Introduction: There is emerging evidence for clinical superiority of catheter ablation over rate and rhythm control strategies in paroxysmal atrial fibrillation (PAF). The objective of this study was to compare costs related to medical therapy versus catheter ablation for PAF in Ontario (Canada). Methods: Costs related to medical therapy in the analysis included the cost of anticoagulation, rate and rhythm control medications, noninvasive testing, physician follow-up visits, and hospital admissions, as well as the cost of complications related to this management strategy. Costs related to catheter ablation were assumed to include the cost of the ablation tools (electroanatomic mapping or intracardiac echocardiography-guided pulmonary vein ablation), hospital and physician billings, and costs related to periprocedural medical care and complications. Costs related to these various elements were obtained from the Canadian Registry of Atrial Fibrillation (CARAF), government fee schedules, and published data. Sensitivity analyses looking at a range of initial success rates (50,75%) and late attrition rates (1,5%), prevalence of congestive heart failure (CHF) (20,60%), as well as discounting varying from 3% to 5% per year were performed. Results: The cost of catheter ablation ranged from $16,278 to $21,294, with an annual cost of $1,597 to $2,132. The annual cost of medical therapy ranged from $4,176 to $5,060. Costs of ongoing medical therapy and catheter ablation for PAF equalized at 3.2,8.4 years of follow-up. Conclusion: Catheter ablation is a fiscally sensible alternative to medical therapy in PAF with cost equivalence after 4 years. [source] Patient and physician predictors of inappropriate acid-suppressive therapy (AST) use in hospitalized patients,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Jagdish S. Nachnani MD Abstract BACKGROUND: The use of acid suppressive therapy (AST) in prevention of stress ulcers has been well defined in critical care patients, though its use has become increasingly common in general medicine patients, with little to no supportive evidence. None of the previous studies has examined the patient and physician characteristics of inappropriate AST initiation and use in hospitalized patients. The aim of our study was to identify: (1) the appropriateness of AST in hospitalized patients and the cost associated with inappropriate use; and (2) patient and physician characteristics predicting inappropriate initiation and use of AST. METHODS: All discharges over a period of 8 consecutive days were selected. RESULTS: There were 207 patients discharged over a period of 8 days. AST was inappropriately initiated in 92 of 133 (69.2%) patients included in our study. On univariate analysis, higher hemoglobin value, postgraduate year 1 (PGY-1) residents, physicians with an MD degree, international medical graduates (IMGs), and internal medicine physicians were more likely to prescribe AST inappropriately. On multivariate analysis, a higher hemoglobin value, PGY-1 residents, and MD physicians were factors associated with inappropriate AST use. The total direct patient cost for this inappropriate use was $8026, with an estimated annual cost of approximately $366,000. CONCLUSIONS: AST was inappropriately initiated in 69.2% of patients with increased direct costs of $8026. Residents in their first year of training as well physicians with a MD degree are more likely to initiate AST inappropriately. Curtailing the inappropriate use of AST therapy may reduce overall costs for the patient and institution. Journal of Hospital Medicine 2009;4:E10,E14. © 2009 Society of Hospital Medicine. [source] On the appropriate modeling of process plant water systemsAICHE JOURNAL, Issue 3 2010Débora C. Faria Abstract The definition of the water/wastewater allocation problem is discussed as it was originally defined by Takama et al.1 how this concept was modified, and sometimes simplified, through time, as well as additional issues that is believed are still not properly addressed. A few attempts are reviewed where parts are pointed out, and the addition of water pretreatment units are discussed, and further investigation in to the impact that proper modeling has on predictions of freshwater consumption, total annual cost and zero discharge cycles. © 2009 American Institute of Chemical Engineers AIChE J, 2010 [source] A property-based optimization of direct recycle networks and wastewater treatment processesAICHE JOURNAL, Issue 9 2009José María Ponce-Ortega Abstract This article presents a mathematical programming approach to optimize direct recycle-reuse networks together with wastewater treatment processes in order to satisfy a given set of environmental regulations. A disjunctive programming formulation is developed to optimize the recycle/reuse of process streams to units and the performance of wastewater treatment units. In addition to composition-based constraints, the formulation also incorporates in-plant property constraints as well as properties impacting the environment toxicity, ThOD, pH, color, and odor. The MINLP model is used to minimize the total annual cost of the system, which includes the cost for the fresh sources, the piping cost for the process integration and the waste stream treatment cost. An example problem is used to show the application of the proposed model. The results show that the simultaneous optimization of a recycle network and waste treatment process yields significant savings with respect to a commonly-used sequential optimization strategy. © 2009 American Institute of Chemical Engineers AIChE J, 2009 [source] Cost analysis of proton exchange membrane fuel cell systemsAICHE JOURNAL, Issue 7 2008Ai-Jen Hung Abstract Tradeoff between capital cost and the operating cost can be seen in the design of proton exchange membrane fuel cell systems. The polarization curve indicates that operating in the region of lower current densities implies less operating cost (hydrogen fuel) and higher capital cost (larger membrane electrode assembly area). The opposite effects are observed when one operates in the region of higher current densities. Therefore, an appropriate design should take both factors into account and the optimality depends on the corresponding costs of hydrogen and membrane area. An analytical cost model is constructed to describe such an economic balance in a proton exchange membrane fuel cell system. The objective function of the optimization is the total annual cost. Six scenarios are used to illustrate the optimal design based on the total annual cost as cost and materials factors fluctuate. © 2008 American Institute of Chemical Engineers AIChE J, 2008 [source] Design of reactive distillations for acetic acid esterificationAICHE JOURNAL, Issue 6 2005Yeong-Tarng Tang Abstract The reactive distillation provides an attractive alternative for reaction/separation processes with reversible reactions, especially for etherification and esterification. The discrete nature of chemical species and the complexity of phase equilibria seem to cloud the picture in understanding reactive distillation. The esterifications of acetic acid with five different alcohols, ranging from C1 to C5, are studied. First, qualitative relationships between macroscopic process flowsheet and microscopic phase equilibria are established, and the process flowsheets are classified into type I, II, and III for these five systems. Next, a systematic design procedure is devised to optimize the design, based on the total annual cost (TAC) and dominant design variables are identified for different flowsheets. Once quantitative design is available, process characteristic are analyzed and potential problems in process operation are identified. Finally, the economic potentials of these three different flowsheets are explored and explanations are given. The results clearly indicate that it is possible to systemize the design of reactive distillation by qualitatively generating flowsheet from phase equilibria and by quantitatively completing the process flow diagram from a sequential design procedure. Moreover, some of the flowsheets presented in this work cannot be found elsewhere in the open literature. © 2005 American Institute of Chemical Engineers AIChE J, 2005 [source] Annual Direct and Indirect Health Costs of the Congenital IchthyosesPEDIATRIC DERMATOLOGY, Issue 4 2010Andrew R. Styperek M.B.A. We conducted a cost analysis through an online survey posted on the Foundation for Ichthyosis and Related Skin Types Website. We assessed cutaneous disease severity, via the previously validated Congenital Ichthyosis Severity Index (CISIÔ), demographics, and CI type. We estimated direct health care costs: prescription and over-the-counter medications, outpatient visits, and emergency department and hospital visit costs; and indirect costs: earnings lost owing to absences from work because of CI-related illness. The CI subjects of our study (n = 224) consumed a mean (SD) of $3,192 ($7,915) annually. Direct costs accounted for 90%, whereas indirect costs accounted for 10%. These costs resulted in an estimated annual cost of $37MM/year (excluding ichthyosis vulgaris) of which $17MM is borne out-of-pocket by patients. Depending on the CI diagnosis, patients were responsible for 30,51 cents of every dollar of mean annual medical care costs. Our estimated annual CI costs are comparable to cutaneous lymphoma. More effective treatments for CI would help minimize this burden. Traditional insurance products do not appear to substantially alleviate the financial burden of disease, as a significant amount is from out-of-pocket expenses. [source] Informing policy for the Australian context , Costs, outcomes and cost savings of prenatal carrier screening for cystic fibrosisAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Susannah MAXWELL Aims:, To examine the costs, outcomes and cost savings of three models of prenatal cystic fibrosis (CF) carrier screening compared to no screening from a public health sector perspective. Methods:, A decision tree was generated to estimate costs and outcomes for each screening model for a hypothetical cohort of 38 000 pregnancies. Sensitivity analysis assessed the impact of model parameter variation. Results:, Under baseline assumptions, the initial annual cost to provide a prenatal CF carrier-screening programme is Au$5.32 million, Au$3.35 million and $2.93 million for one-step, two-step simultaneous and two-step sequential screening respectively. Annual costs are significantly lower for an established programme. No screening model provides a net saving over a lifetime horizon; however, the results were sensitive to variation in lifetime cost of care, screening test costs and number of pregnancies per carrier couple. Conclusions:, Under some scenarios, prenatal CF carrier screening is cost saving to the health system; however, this is not conclusive and depends on several factors. Cost remains a potential barrier due to the substantial level of funding required in the short term. Feasibility and psychosocial, ethical and legal implications of screening need to be considered. Additionally, consultation is required with the Australian community on the acceptability and/or desire for prenatal CF carrier screening. [source] Physical activity, Body Mass Index and health care costs in mid-age Australian womenAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2008Wendy J. Brown Abstract Objective: This study examined the relationships between combined categories of physical activity (PA) and Body Mass Index (BMI) with health care costs in women and assessed the potential cost savings of improving PA and BMI in sedentary mid-age women. Methods: Cross-sectional analysis of 2001 survey data linked to health service use data for the same year from 7,004 mid-age women (50-55 years) participating in the Australian Longitudinal Study on Women's Health. Results: The mean (median; interquartile range) annual cost of Medicare-subsidised services was $542 (355; 156-693) per woman. Costs were 17% higher in obese than in healthy-weight women and 26% higher in sedentary than in moderately active women. For sedentary obese women, mean costs were 43% higher than in healthy weight, moderately active women. After adjustment for potential confounders, the relative risk of ,high' claims (,15 claims per year) for overweight women who reported ,moderate' or ,high' PA were lower than for women with healthy BMI who reported no PA. Conclusions and Implications: Lower PA and higher BMI are both associated with higher health care costs, but costs are lower for overweight active women than for healthy-weight sedentary women. At the population level these data suggest that there would be significant cost savings if all sedentary mid-age women could achieve at least ,low' levels of PA (60-150 minutes a week). [source] Suppression of populations of Australian sheep blowfly, Lucilia cuprina (Wiedemann) (Diptera: Calliphoridae), with a novel blowfly trapAUSTRALIAN JOURNAL OF ENTOMOLOGY, Issue 2 2009Rudolf Urech Abstract The Australian sheep blowfly, Lucilia cuprina, initiates more than 85% of fly strikes on sheep in Australia with an estimated average annual cost of A$280 million to the Australian sheep industry. LuciTrap® is a commercially available, selective trap for L. cuprina consisting of a plastic bucket with multiple fly entry cones and a synthetic attractant. The impact of LuciTrap on populations of L. cuprina on sheep properties in five Australian states was evaluated by comparing L. cuprina populations on paired properties with and without LuciTraps over seasons when significant fly populations could be expected. Twenty-four comparisons (trials) were conducted over 4 years. During times of ,higher fly density' (when the 48 h geometric mean of trap catches on the control property was greater than five L. cuprina), the overall geometric mean trap catches for control and trapped properties differed significantly (P < 0.001) with mean trap catches of 19.4 and 7.74 L. cuprina, respectively. The selectivity of the LuciTrap was confirmed with 59% of all trapped flies being L. cuprina. Chrysomya spp. and Calliphora spp. constituted 9.3% and 1.1% of the catches with a variety of other flies (mainly Sarcophagidae and Muscidae) providing the remainder (31%). Lucilia sericata was only trapped in Tasmania and made up 7.7% of the Lucilia spp. catch in that state. Seventy-two per cent of the trapped L. cuprina were female. The deployment of LuciTrap on sheep properties at one trap per 100 sheep from the beginning of the anticipated fly season suppressed the populations of L. cuprina by 60% compared with matched control properties. The LuciTrap is a selective and easy to use fly trap and constitutes an effective, non-insecticidal tool for use in integrated management programs for L. cuprina. [source] The economic impact of overactive bladder syndrome in six Western countriesBJU INTERNATIONAL, Issue 2 2009Debra E. Irwin OBJECTIVE To calculate up-to-date estimates of the economic impact of overactive bladder syndrome (OAB) with and without urgency urinary incontinence (UUI) on the health sector of six countries (Canada, Germany, Italy, Spain, Sweden and the UK), as OAB is a significant health concern for adults aged >18 years living in Western countries. MATERIALS AND METHODS The prevalence data derived from the EPIC study were combined with healthcare resource-use data to derive current direct and indirect 1-year or annual cost of illness estimates for OAB including UUI in Canada, Germany, Italy, Spain, Sweden and the UK. This model estimates the direct healthcare costs attributed to OAB, as well as the impact of work absenteeism. RESULTS The estimated average annual direct cost of OAB per patient ranged between ,262 in Spain and ,619 in Sweden. The estimated total direct cost burden for OAB per country ranges between ,333 million in Sweden and ,1.2 billion in Germany and the total annual direct cost burden of OAB in these six countries is estimated at ,3.9 billion. In addition, nursing home costs were estimated at ,4.7 billion per year and it was estimated that work absenteeism related to OAB costs ,1.1 billion per year. CONCLUSIONS The cost of illness for OAB is a substantial economic and human burden. This study may under-estimate the true economic burden, as not all costs for sequelae associated with OAB have been included. Cost-effective treatments and management strategies that can reduce the burden of OAB and in particular UUI have the potential to significantly reduce this economic burden. [source] Dividing Wall Distillation Columns: Optimization and Control PropertiesCHEMICAL ENGINEERING & TECHNOLOGY (CET), Issue 9 2008F. I. Gómez-Castro Abstract The optimal design of dividing wall columns is a non-linear and multivariable problem, and the objective function used as optimization criterion is generally non-convex with several local optimums. Considering this fact, in this paper, we studied the design of dividing wall columns using as a design tool, a multi-objective genetic algorithm with restrictions, written in MatlabTM and using the process simulator Aspen PlusTM for the evaluation of the objective function. Numerical performance of this method has been tested in the design of columns with one or two dividing walls and with several mixtures to test the effect of the relative volatilities of the feed mixtures on energy consumption, second law efficiency, total annual cost, and theoretical control properties. In general, the numerical performance shows that this method appears to be robust and suitable for the design of sequences with dividing walls. [source] Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysisDIABETIC MEDICINE, Issue 2 2006R. F. Dijkstra Abstract Aims Economic evaluations of diabetes interventions do not usually include analyses on effects and cost of implementation strategies. This leads to optimistic cost-effectiveness estimates. This study reports empirical findings on the cost-effectiveness of two implementation strategies compared with usual hospital outpatient care. It includes both patient-related and intervention-related cost. Patients and methods In a clustered-randomized controlled trial design, 13 Dutch general hospitals were randomly assigned to a control group, a professional-directed or a patient-centred implementation programme. Professionals received feedback on baseline data, education and reminders. Patients in the patient-centred group received education and diabetes passports. A validated probabilistic Dutch diabetes model and the UKPDS risk engine are used to compute lifetime disease outcomes and cost in the three groups, including uncertainties. Results Glycated haemoglobin (HbA1c) at 1 year (the measure used to predict diabetes outcome changes over a lifetime) decreased by 0.2% in the professional-change group and by 0.3% in the patient-centred group, while it increased by 0.2% in the control group. Costs of primary implementation were < 5 Euro per head in both groups, but average lifetime costs of improved care and longer life expectancy rose by 9389 Euro and 9620 Euro, respectively. Life expectancy improved by 0.34 and 0.63 years, and quality-adjusted life years (QALY) by 0.29 and 0.59. Accordingly, the incremental cost per QALY was 32 218 Euro for professional-change care and 16 353 for patient-centred care compared with control, and 881 Euro for patient-centred vs. professional-change care. Uncertainties are presented in acceptability curves: above 65 Euro per annum the patient-directed strategy is most likely the optimum choice. Conclusion Both guideline implementation strategies in secondary care are cost-effective compared with current care, by Dutch standards, for these patients. Additional annual costs per patient using patient passports are low. This analysis supports patient involvement in diabetes in the Netherlands, and probably also in other Western European settings. [source] European comparison of costs and quality in the prevention of secondary complications in Type 2 diabetes mellitus (2000,2001)DIABETIC MEDICINE, Issue 7 2002A. Gandjour Abstract Aims To compare the out-patient costs and process quality of preventing secondary complications in patients with Type 2 diabetes mellitus in France, Germany, Italy, The Netherlands, Sweden, Switzerland, and the UK. Methods A total of 188 European physician practices assessed annual services for one hypothetical average patient (cost evaluation) and 178 practices reported retrospective data on one or two real patients (quality evaluation) in 2000/2001. In countries with a detailed fee-for-service schedule (Germany, Italy, and Switzerland) reimbursement fees were used to approximate costs. These fee-for-service schedules were also used to develop index (average) fees for all countries, in order to measure resource utilization. The following process quality indicators were evaluated: control of HbA1c; control of lipids; urine test for (micro)albuminuria; control of blood pressure; foot examination; neurological examination; eye examination; and patient education. For each country an average quality rating was calculated by weighting the response to each quality indicator with the level of scientific evidence. Results Average quality ratings ranged from 0.40 in The Netherlands to 0.62 in the UK (0 = lowest rating; 1 = highest rating). Total annual costs for secondary prevention were higher in Switzerland than in Germany and Italy (EUR475, EUR381, and EUR283, respectively). Resource utilization was highest in Germany and lowest in the UK. Conclusions The overall quality of preventive services documented was found to be poor in the seven European countries studied. The UK rated as both the most effective and the most efficient country in providing secondary prevention in Type 2 diabetes. [source] Positive health-care effects of an alcohol ignition interlock programme among driving while impaired (DWI) offendersADDICTION, Issue 11 2007Bo Bjerre ABSTRACT Aims To compare the costs of hospital care and sick leave/disability pensions between two groups of driving while impaired (DWI) offenders: participants in an alcohol ignition interlock programme (AIIP) and controls with revoked licences, but with no comparable opportunity to participate in an AIIP. Setting As an alternative to licence revocation DWI offenders can participate in a voluntary 2-year AIIP permitting the offender to drive under strict regulations entailing regular medical check-ups. The participants are forced to alter their alcohol habits and those who cannot demonstrate sobriety are dismissed from the programme. Participants are liable for all costs themselves. Design Quasi-experimental, with a non-equivalent control group used for comparison; intent-to-treat design. Based on the number of occasions/days in hospital and on sick leave/disability pension, the health-care costs for public insurance have been calculated. Finding Average total health-care costs were 25% lower among AIIP participants (1156 individuals) than among controls (815 individuals) during the 2-year treatment period. This corresponds to over ,1000 (SEK9610) less annual costs per average participant. For those who complete the 2-year programme the cost reduction was more pronounced; 37% during the treatment and 20% during the post-treatment period. Conclusions The positive health-care effects were due apparently to reduced alcohol consumption. The social benefit of being allowed to drive while in the AIIP may also have contributed. The reduction in health-care costs was significant only during the 2-year treatment period, but among those who completed the entire AIIP sustained effects were also observed in the post-treatment period. The effects were comparable to those of regular alcoholism treatment programmes. [source] The economic costs of dementia in Korea, 2002INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2006Guk-Hee Suh Abstract Objective To estimate the economic costs of dementia in 2002 using an economic evaluation model for dementia care. Methods Data were from the Korea National Survey of the Long-Term Care Need (LTC survey) (n,=,5058), two prospective 1-year studies [one clinical trial (n,=,234), one naturalistic community cohort study (n,=,107)], and two epidemiologic community studies for prevalence of dementia (n,=,1037,+,1481). Daily costs and proportions of different levels of institutional service provided were collected from the LTC survey. Resource use in the community included health care services, social care services, out-of-pocket purchase for self-support, caregiver time and missed work of caregiver. Costs in community were calculated based on resource utilization multiplied by the unit costs for each resource. Results Total annual costs of dementia were estimated to be over 2.4 billion US$ for 272,000 dementia sufferers. Costs in community represent 96% of the total annual costs, while costs of informal care and missed work of caregivers were 1.3 billion US$, or 55% of total annual cost. Average annual costs of full time care (FTC) and pre-FTC in community LTC were 44,121 US$ and 13,273 US$ per person, whereas cost per patient who did not need community LTC was 3986 US$. Conclusion Given that the number of dementia sufferers is projected to increase in the near future and that larger part of the costs are subsidized by the government, the economic and social costs of dementia is significant not only for dementia sufferers and their caregivers, but also for society. Copyright © 2006 John Wiley & Sons, Ltd. [source] A model for optimisation of water management in rice polders in Thailand,IRRIGATION AND DRAINAGE, Issue 5 2005Preecha Wandee modèle mathématique; polders de riz; polder système de gestion de l'eau; optimisation Abstract This paper presents a mathematical model for the determination of optimal values for the main components of water management systems in rice polders in Thailand. The aim of the water management system in a rice area is to create good growing conditions for the crops. Under the hydrological conditions of Thailand the average rainfall during the rainy season is more than enough for growing rice or other crops. However, during the dry season there is a very small amount of rainfall. Thus the farmers are confronted with two quite different conditions and water management has to deal with irrigation and drainage issues. The main components of the water management system in a rice polder are the water level in the canals, the percentage of open surface water, discharge capacity from the field and discharge capacity of the pumping station or sluice. A model has been developed that takes into account damage due to flooding and drought as well as construction and maintenance cost for irrigation and drainage systems based on the hydrological conditions. Optimising of such a water management system means determining the main components in such a way that the equivalent annual costs are minimal. A case study has been done for a rice polder in Suphanburi province. It was found that the polder water level for rice under rainfed conditions could be kept above ground level to minimise loss of water from the rice field, whereas under irrigated conditions the polder water level has to be kept below ground level to get good drainage conditions. Copyright © 2005 John Wiley & Sons, Ltd. Cet article présente un modèle mathématique pour l'optimisation des composants principaux du système de gestion de l'eau dans des polders de riz en Thaïlande. Le but du système de gestion de l'eau dans un secteur de riz est de créer de bonnes conditions de croissance pour les récoltes. Dans la situation hydrologique de la Thaïlande les précipitations moyennes pendant la saison des pluies sont plus que suffisantes pour cultiver du riz croissant ou d'autres récoltes. Cependant, durant la saison sèche il y a très peu de précipitations. Ainsi les fermiers sont confrontés à deux conditions tout à fait différentes. Par conséquent la gestion de l'eau doit prendre en compte des problèmes d'irrigation et de drainage. Les composants principaux du système de gestion de l'eau dans un polder de riz sont le niveau d'eau dans les canaux, le pourcentage de l'eau ouverte, la capacité de décharge du champ et capacité de décharge de la station de pompage ou d'écluse. On a développé un modèle qui tient compte des dommages dus à l'inondation et à la sécheresse aussi bien que du coût de construction et d'entretien pour l'irrigation et à la canalisation basée sur les conditions hydrologiques. La linéarisation d'un tel système de gestion de l'eau implique de déterminer les composants principaux de telle manière que le système entier ait le coût équivalent annuel minimum. Une étude de cas a été faite pour un polder de riz dans la province de Suphanburi. On a constaté que le niveau d'eau du polder pour le riz irrigué à l'eau de pluie pouvait être gardé au-dessus du niveau du sol pour réduire au minimum la perte d' eau de la rizière, tandis que dans des conditions irriguées le niveau d'eau de polder doit être gardé au-dessous du niveau du sol pour obtenir de bonnes conditions de drainage. Copyright © 2005 John Wiley & Sons, Ltd. [source] Health Economics Perspective of the Components of the Cardiometabolic SyndromeJOURNAL OF CLINICAL HYPERTENSION, Issue 7 2010Leonardo Tamariz MD J ClinHypertens (Greenwich). 2010;12:549,555. © 2010 Wiley Periodicals, Inc. The components of the cardiometabolic syndrome (CMS) increase the risk of coronary artery disease (CAD). The authors compared 12-month costs of subjects with different number of components of the CMS. In claims data from a large health benefits company, 383,420 individuals with the first International Classification of Diseases, Ninth Revision codes for hypertension, diabetes, lipid abnormalities, and obesity were identified. Patients were stratified according to presence of CAD and the number of components of the CMS. Twelve-month costs were added after the identification of the risk factor. Mean annual costs increased with the number of components of CMS both in those with and without CAD, even after adjusting for age, sex, and comorbidities (P<.01). Similar trends were seen for medical and pharmacy costs. The adjusted total annual health care cost in those with an isolated component of the CMS was $5564 (95% confidence interval: $5491,$5631) while in those with 4 components was $12,287 (95% confidence interval: $11,987,$12,587). Individuals with accumulating components of the CMS have higher health care costs regardless of age, sex, and other comorbidities. [source] | ||||||||||||||||||||||||||||