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Average Cost (average + cost)
Selected AbstractsValuation Accuracy and Infinity Horizon Forecast: Empirical Evidence from EuropeJOURNAL OF INTERNATIONAL FINANCIAL MANAGEMENT & ACCOUNTING, Issue 2 2009Lucio Cassia This paper focuses on the assumptions of infinite-horizon forecasting in the field of firm valuation. The estimate of long-run continuing values is based on the hypothesis that companies should have reached the steady state at the end of the period of explicit forecasts. It is argued that the equivalence between cash accounting and accrual accounting is the way of verifying the steady-state assumption, defined as the state when a firm earns exactly its cost of capital, i.e., what we would expect in pure-competition settings. From this definition, we derive that the "ideal" growth rate to use in steady state is equal to the reinvestment rate times Weighted Average Cost of Capital. To validate our approach, we collect a sample of 784 analyst valuations and compare how the implied target prices deviate from what the target prices would have been using the "ideal" steady-state growth rates. Using Logit and Cox regression models, we find that this deviation has predictive value over the probability that actual market price reaches the target price over the following 12-month period,the smaller the deviation the greater is the likelihood that the market price reaches the target price. [source] The cost of health care for children and adults with sickle cell diseaseAMERICAN JOURNAL OF HEMATOLOGY, Issue 6 2009Teresa L. Kauf Although sickle cell disease (SCD) is marked by high utilization of medical resources, the full cost of care for patients with SCD, including care not directly related to SCD, is unknown. The purpose of this study was to estimate the total cost of medical care for a population of children and adults with SCD. We used data from individuals diagnosed with SCD enrolled in the Florida Medicaid program during 2001,2005 to estimate total, SCD-related, and non-SCD-related cost per patient-month based on patient age at the time of health care use. Across the 4,294 patient samples, total health care costs generally rose with age, from $892 to $2,562 per patient-month in the 0,9- and 50,64-year age groups, respectively. Average cost per patient-month was $1,389. Overall, 51.8% of care was directly related to SCD, the majority of which (80.5%) was associated with inpatient hospitalizations. Notably, non-SCD-related costs were substantially higher than those reported for the general US population. These results suggest a discounted (3% discount rate) lifetime cost of care averaging $460,151 per patient with SCD. Interventions designed to prevent SCD complications and avoid hospitalizations may reduce the significant economic burden of the disease. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] Statistical optimization of octree searchesCOMPUTER GRAPHICS FORUM, Issue 6 2008Rener Castro Abstract This work emerged from the following observation: usual search procedures for octrees start from the root to retrieve the data stored at the leaves. But as the leaves are the farthest nodes to the root, why start from the root? With usual octree representations, there is no other way to access a leaf. However, hashed octrees allow direct access to any node, given its position in space and its depth in the octree. Search procedures take the position as an input, but the depth remains unknown. This work proposes to estimate the depth of an arbitrary node through a statistical optimization of the average cost of search procedures. As the highest costs of these algorithms are obtained when starting from the root, this method improves on both the memory footprint by the use of hashed octrees, and execution time through the proposed optimization. [source] Capital Cash Flows, APV and ValuationEUROPEAN FINANCIAL MANAGEMENT, Issue 1 2007Laurence Booth G31; G32 Abstract This paper examines three different methods of valuing companies and projects: the adjusted present value (APV), capital cash flows (CCF) and weighted average cost of capital (WACC) methods. It develops the appropriate WACC and beta leveraging formulae appropriate for each valuation model, so that given a particular valuation model the correct APV and CCF values can be determined from the WACC value and vice versa. Further it goes on to show when the perpetuity formulae give poor estimates of the value of individual cash flows, even though the overall values are correct. The paper cautions that the APV and CCF models require more information than is currently known, such as the value of the corporate use of debt, and consequently can give misleading results, particularly in sensitivity analyses. [source] DRG prospective payment systems: refine or not refine?HEALTH ECONOMICS, Issue 10 2010Elin Johanna Gudrun Hafsteinsdottir Abstract We present a model of contracting between a purchaser of health services and a provider (a hospital). We assume that hospitals provide two alternative treatments for a given diagnosis: a less intensive one (for example, a medical treatment) and a more intensive one (a surgical treatment). We assume that prices are set equal to the average cost reported by the providers, as observed in many OECD countries (yardstick competition). The purchaser has two options: (1) to set one tariff based on the diagnosis only and (2) to differentiate the tariff between the surgical and the medical treatment (i.e. to refine the tariff). We show that when tariffs are refined, the provider has always an incentive to overprovide the surgical treatment. If the tariff is not refined, the hospital underprovides the surgical treatment (and overprovides the medical treatment) if the degree of altruism is sufficiently low compared with the opportunity cost of public funds. Our main result is that price refinement might not be optimal. Copyright © 2009 John Wiley & Sons, Ltd. [source] The economics and practicality of t-PA vs tunnel catheter replacement for hemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2005Cairoli O. Kaiser Permanente Introduction:,Thrombolytic therapy is an important treatment modality for thrombosis-related catheter occlusion. Central venous access devices (CAVDs) are essential tools for the administration of many therapeutic modalities, especially for patients requiring lifetime therapy like hemodialysis. There are several reasons to salvage the occluded catheter. Catheter replacement results in an interruption of therapy delivery. This interruption may result in complications such as life-threatening metabolic and physiologic states. In addition, the patient's future access sites for CAVDs may be affected. The data released in the 2001 Annual Report , ESRD Clinical Performance Measures Project (Department of Health and Human Services, December 2001) shows 17% of prevalent patients were dialyzed with a chronic catheter continuously for 90 days or longer. In the pediatric population the data shows that 31% were dialyzed with a chronic catheter. The most common reasons for catheter placement included: no fistula or graft created (42%) and fistula and graft were maturing, not ready to cannulate (17%). Five percent of patients were not candidates for fistula or graft placement as all sites had been exhausted. Methods:,A short study was done in our medical center to evaluate the results of t-PA vs. changing the tunnel catheter. On an average a catheter costs about $400.00. If you add the cost of specialty personnel such as an interventional radiologist, radiology technician, radiology nurse, and the ancillaries such as the room, sutures, gauze, and tape, the total could reach $2000.00 easily. CathfloÔ Activase® costs around $60.00 for a single dose. T-PA was reconstituted by pharmacy personnel in single vials containing 2 mg/2 ml. Now with Cathflo, vials are stored in the renal clinic's refrigerator and when the need arises, the RN reconstitutes the medication. The RN, using established protocols, will instill Cathflo in the catheter following the volume requirements of the various tunnel catheters. After the t-PA is placed, the patient is sent home with instructions to return to their dialysis center the next day (arrangements are made by the RN as needed). In seventeen patients (17) with tunnel catheter malfunctions due to inadequate flow, not related to placement, t-PA was used. Of those 17 patients 2 were unable to use their catheter on their next dialysis treatment date, yielding an 88% success rate. This compares with clinical trials in which there is an 83% success rate with a dwell time of 4 hours, or an 89% rate on patients having a 2 hour dwell time (t-PA was repeated a second time if flow was not successfully restored. Results:,15/17 patients in our retrospective study showed that Cathflo worked successfully in restoring blood flow. Two catheters needed to be exchanged. The cost savings were significant when we compared the average cost of an exchange ($2000) versus using t-PA ($170 including nursing time). Conclusion:,Cathflo is not just safe and practical to use but also cost effective. [source] Performance optimization of object comparisonINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 10 2009Axel Hallez Comparing objects can be considered as a hierarchical process. Separate aspects of objects are compared to each other, and the results of these comparisons are combined into a single result in one or more steps by aggregation operators. The set of operators used to compare the objects and the way these operators are related with each other is called the comparison scheme. If a threshold is applied to the final result of the object comparison, the mathematical properties of the operators in the comparison scheme can be used to derive thresholds on the intermediate results. These derived threshold can be used to break of a comparison early, thus offering a reduction of the comparison cost. Using this information, we show that the order in which the operators are evaluated has an influence on the average cost of comparing two objects. Next, we proceed with a study of the properties that allow us to find an optimal order, such that this average cost is minimized. Finally, we provide an algorithm that calculates an optimal order efficiently. Although specifically developed for object comparison, the algorithm can be applied to all kinds of selection processes that involve the combination of several test results. © 2009 Wiley Periodicals, Inc. [source] The question of rent: the emerging urban housing crisis in the new centuryINTERNATIONAL JOURNAL OF URBAN AND REGIONAL RESEARCH, Issue 4 2004Michael Turk The emergence of a new housing crisis in the United States for low-income renter households at the outset of the twenty-first century can be traced to an increasing lack of affordability, where the average cost of housing as a portion of income has risen steadily over the last half-century. In turn, this rise in housing costs can be attributed to a growing and dramatic shortage of low-cost rental housing. Ultimately, the evocation of homeownership as the embodiment of the ,American Dream' has made renting the ,stepchild' of housing options, and this has had hidden, but nonetheless deleterious effects upon US cities, which remain major concentrations of rental housing and financially-strapped tenants. Aux Etats-Unis, on peut imputer la nouvelle crise du logement du début du vingt-et-unième siècle touchant les ménages locataires à faibles revenus à une impossibilité croissante d'accessibilité financière, la part du coût moyen d'un logement dans le revenu ayant progressé constamment au cours du demi-siècle précédent. Par ailleurs, cette élévation des coûts du logement peut être attribuée à une pénurie accrue et dramatique de l'habitat à loyer modéré. Enfin, évoquer l'accession à la propriété comme incarnation du ,Rêve américain' a fait de la location le ,parent pauvre' des possibilités de logement, ce qui a eu des effets latents, quoique néfastes, sur les grandes villes américaines, lesquelles restent des concentrations dominantes de logements locatifs et d'occupants désargentés. [source] An Explicit Solution of a Generalized Optimum Requirement Spanning Tree Problem With a Property Related to MongeINTERNATIONAL TRANSACTIONS IN OPERATIONAL RESEARCH, Issue 3 2001Tsutomu Anazawa The paper considers a generalization of the optimum requirement spanning tree problem (ORST problem) first studied by Hu in 1974. Originally, ORST was regarded as a communication network of tree type with the minimum average cost, and it is obtained by the well-known Gomory,Hu algorithm when the degrees of vertices are not restricted. The ORST problem is generalized by (i) generalizing the objective function and (ii) imposing maximum degree constraints. The generalized ORST problem includes some practical problems, one of which is proposed in this paper, but is not efficiently solvable in general. However, I show that a particular tree (which is obtained by a sort of greedy algorithm but is explicitly definable) is a solution of the generalized problem when a certain practical condition is satisfied. The condition is closely related to the Monge property, which is originally discussed in the Hitchcock transportation problem, and is known to make some NP-hard problems efficiently solvable. [source] CREATING VALUE IN THE OIL INDUSTRYJOURNAL OF APPLIED CORPORATE FINANCE, Issue 1 2004Nick Antill In contrast with current thinking that conglomerates are inefficient, this article begins by presenting arguments in favor of the size and structure of the large integrated oil companies, also known as "the supermajors." Among the advantages are tax efficiency, information flow, political and technological know-how, broad supplier and customer relationships, scale economies, cross-business economies of scope, brand power, and the ability to coordinate strategic initiatives across businesses. These advantages all translate into a lower cost of capital. One problem, however, is that this lower cost of capital does not seem to be reflected in the target returns on capital currently set by the supermajors. Observing that the financial goal of a corporation is to maximize not its return on capital but rather the net present value of expected future cash flows and earnings, the authors argue that the majors need to make two major changes to current practice. First, their investment hurdle rates should be reduced from their current level of 14,15% to the weighted average cost of capital, which is estimated to run about 8,9%. Second, the actual returns on capital reported in published accounts are largely meaningless; and when evaluating new investments and existing operations alike, the companies must find an annual performance measure that better reflects the economic realities of the business. This paper recommends use of a performance measurement framework based on economic profit that should serve two critical purposes: it will encourage managers to undertake all value-increasing projects (not just those that will maintain or increase reported return on capital), and it will help the companies communicate their strategy and results to the investment community. [source] Service Use and Costs of Support 12 Years after Leaving HospitalJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2006Angela Hallam Background, There have been major changes in the provision and organization of services for people with intellectual disabilities in England over the last 30 years, particularly deinstitutionalization and the development of the mixed economy of care. The experiences of the people who participated in the Care in the Community Demonstration Programme in the mid-1980s provide evidence of the immediate and longer-term effects of the reprovision policy. Methods, Cross-sectional and longitudinal evidence was gathered on service use and costs for over 250 people 12 years after they left long-stay hospitals for community living arrangements. Comparisons were made with the situation in hospital, and 1 and 5 years after leaving. Relationships between costs after 12 years and individual characteristics assessed before people left hospital were explored. Results, Community care at the 12-year follow-up remained more expensive than hospital-based support, although the average cost was lower than at either of the 1- or 5-year community follow-up points. Service users were living in a wide variety of accommodation settings. Management responsibility fell on National Health Service (NHS) trusts, local authorities, voluntary agencies, or to private organizations or individuals. After standardizing for users' skills and abilities, costs in minimum support accommodation were significantly lower than those in residential and nursing homes, costs in staffed group homes significantly higher, and costs in hostels slightly lower. When looking at differences between individuals, no relationship was found between costs and outcomes although, overall, people were better off in the community than they had been when in hospital. Conclusions, Reprovision planning for hospital and other institutional modes of care requires major and long-term commitment of resources. Quality of life improvements can be achieved at a cost little different in the long-run from that for hospital care. The link between needs and costs (reflecting the services intended to meet those needs) would be made stronger through the individualization of care. [source] First-trimester Down syndrome screening in women younger than 35 years old and cost-effectiveness analysis in Taiwan populationJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2009Ching-Yu Chou MD Summary Objectives, Outcome of the first-trimester Down syndrome screening in younger population was less reported before. We present the outcome of this screening in Taiwanese women younger than 35 years old. We also test whether or not the first-trimester Down syndrome screening of women <35 years of age and women >35 years old routinely receiving amniocentesis is cost-effective compared with all pregnant women screened with this test in the setting of increased maternal age. Methods, From 1999 to 2007, the first-trimester Down syndrome screening including nuchal thickness, pregnancy-associated plasma protein A and free ,-hCG are provided to 10 811 singleton women <35 years of age with the cut-off of 1/270. A cost-effectiveness analysis of young women receiving this screening and older women undergo amniocentesis versus all women undergo this screening was performed in Taiwan population from 1987 to 2006, in which advanced age pregnancies increased from 2.8% to 11.6% of total pregnancies. Results, Detection rates of trisomy 21, trisomy 18, Turner syndrome and other chromosome anormalies in women <35 years of age are 87.5% (14/16), 50% (2/4), 80% (8/10) and 63% (12/19), respectively, with a false-positive rate of 5.5% (590/10 811). As advanced age pregnancies reached 11.6%, the average cost per one case averted for all women screened ranged from $77 204 to $98 421, while the cost ranged from $99 647 to $116 433 for only women <35 years of age receiving this screening. Conclusions, In an aging population, the first-trimester Down syndrome screening should be implemented for all pregnant women when it is available. [source] Cost-effectiveness analysis of triple test in second-trimester maternal serum screening for Down's syndrome: an experience from Taiwan with decreasing birth rate but increasing population of old pregnant womenJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2008Hsiao-Lin Hwa PhD Objectives, We intended to assess the cost-effectiveness of adding unconjugated oestriol (uE3) in maternal serum screening for Down's syndrome in Taiwan, where there is a decreasing birth rate but an increasing trend of old women having pregnancies. Methods, We used logistic regressions to estimate the risk of Down's syndrome with maternal age and different combinations of biomarkers. Cost-effectiveness analysis was presented in terms of the average and incremental cost-effectiveness ratios. Sensitivity analyses with different parameters were performed. Results, Given a cut-off point of 1:270 for the confirmation of Down's syndrome with amniocentesis, the average cost per case averted for maternal age above 35 years only, double test [alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG)] and triple test (AFP, hCG and uE3) were estimated as $14 561, $42 367 and $37 424. The additional costs per case averted for double test and triple test (compared with maternal age above 35 years) were $135 950 and $77 394, respectively. The additional cost per case averted for triple test was $15 199 compared with double test. Conclusions, The performance of triple test is not only more effective in detecting Down's syndrome cases but also more cost-effective than double test in this study. [source] The Costs and Quality-of-Life Outcomes of Drug-Eluting Coronary Stents: A Systematic ReviewJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2007M.S., PETER W. GROENEVELD M.D. Objectives: While the efficacy of drug-eluting coronary stents (DES) has been demonstrated by several clinical trials, the impact of DES on health-care costs and recipient quality of life (QOL) is controversial. We performed a systematic review of the published literature on DES costs and the QOL effects of restenosis and target vessel revascularization (TVR). Methods: Among 536 potential articles initially identified by a broad search, 12 publications ultimately met inclusion criteria. Data were independently abstracted, evaluated for quality and relevance, and summarized by two reviewers. Excessive heterogeneity among these studies prevented formal meta-analysis, thus a narrative synthesis of the literature was performed. Results: In four economic studies, DES recipients had $1,600,$3,200 higher up-front costs than recipients of bare metal stents, but the differences in total costs after 1 year were less pronounced ($200,$1,200), and estimates of the average cost of an avoided revascularization ranged widely ($1,800,$36,900). All eight QOL studies indicated that restenosis was associated with lower QOL, but only two studies quantified this in terms of quality-adjusted life years (QALYs), with estimates ranging from 0.06 to 0.08. An additional study estimated that the median willingness to pay to prevent restenosis was $2,400,$3,600. Conclusions: There is a lack of convergence in the literature on the cost of DES in avoiding TVR. There is more agreement that the average QALY benefit of an avoided revascularization is 0.04,0.08. This implies that use of DES in patients where the average cost per avoided revascularization exceeds $8,000 may be less likely to be cost-effective. [source] Economies of scale after deregulation in LTL trucking: a test case for the survivor techniqueMANAGERIAL AND DECISION ECONOMICS, Issue 4 2008James N. GiordanoArticle first published online: 4 MAR 200 Early critics of motor carrier deregulation believed that the policy was unwise because strong economies of scale would lead to harmful market concentration, particularly in the industry's LTL segment. Using two methodologies, the survivor technique and the trans-log cost function, this study finds that economies of scale do extend across the entire spectrum of firm sizes in LTL trucking. Long-run average cost appears to decline mildly and at a diminishing rate with increases in firm size, however, such that any cost advantage for larger firms has been insufficient to eliminate new entry and competition from smaller rivals. As a result, after the first 20 years of deregulation, the corresponding increase in market concentration has also been mild. Moreover, the consistency of results from the two methodologies gives credibility to the survivor technique as an empirical method of identifying economies of scale. Copyright © 2008 John Wiley & Sons, Ltd. [source] Probabilistic solution and bounds for serial inventory systems with discounted and average costsNAVAL RESEARCH LOGISTICS: AN INTERNATIONAL JOURNAL, Issue 6 2007Xiuli Chao Abstract We consider the infinite horizon serial inventory system with both average cost and discounted cost criteria. The optimal echelon base-stock levels are obtained in terms of only probability distributions of leadtime demands. This analysis yields a novel approach for developing bounds and heuristics for optimal inventory control polices. In addition to deriving the known bounds in literature, we develop several new upper bounds for both average cost and discounted cost models. Numerical studies show that the bounds and heuristic are very close to optimal.© 2007 Wiley Periodicals, Inc. Naval Research Logistics, 2007 [source] Cost and mortality associated with hospitalizations in patients with immune thrombocytopenic purpura,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009Mark D. Danese Immune thrombocytopenic purpura (ITP) is associated with low platelet counts and, consequently, a high risk of adverse events leading to hospitalization. However, there are few data on the clinical and economic burden of hospitalizations for ITP. The Nationwide Inpatient Sample (NIS) database of discharges, a stratified 20% sample of all United States (US) community hospitals across all payers, was used to evaluate discharges in ITP patients. We developed nationally representative numbers of discharges in ITP patients from 2003 to 2006 based on diagnosis codes. Using appropriate weights for each NIS discharge, we created national estimates of average cost, length of stay, and in-hospital mortality for specific groups of ITP-related hospitalizations. Approximately 129,000 discharges occurred between 2003 and 2006 in ITP patients. The average cost associated with all discharges in 2008 dollars was 16,476, with a 6.4-day length of stay and in-hospital mortality of 3.8%. In contrast, the average cost of all hospitalizations in the US population during the same period was 10,039, the average length of stay was 4.8 days, and in-hospital mortality was 2.5%. Mortality risk was higher for ITP patients than for the standard US population adjusted for age and gender, with a relative mortality ratio of 1.5 (95% CI: 1.4,1.6). On the basis of a nationally representative sample of US discharge records from 2003 to 2006, hospitalization with ITP represents an economically and clinically important event. ITP was associated with higher costs, longer stays, and more in-hospital deaths on average than all other hospitalized patients combined. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] An assessment of the effects of increased regulatory enforcement and legislative reform on occupational hearing loss workers' compensation claims: Oregon 1984,1998AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2004Brian P. McCall PhD Abstract Background Hearing loss from occupational exposures is a serious and widespread problem. This study measured the outcomes that increased enforcement of regulations and legislative interventions had on hearing loss workers' compensation claims. Methods Workers' compensation claim data from Oregon was analyzed for the period of 1984,1998 to examine trends and severity of hearing loss claims. In 1987 and 1990, Oregon enacted legislative reforms to improve enforcement and promulgation of safety standards in the state. This study examined hearing loss claims between the periods of pre- and post-legislative reforms. Results It was found that hearing loss claims decreased significantly following the legislative reforms, although the average cost per claim increased. Age and tenure effects, and evidence of moral hazard were also discovered. Conclusions Increased enforcement of regulations and legislative interventions by Oregon improved working conditions leading to occupational hearing loss. Nevertheless, hearing loss remains problematic, and continued efforts are required to improve worker safety. Am. J. Ind. Med. 45:417,427, 2004. © 2004 Wiley-Liss, Inc. [source] Specials: a financial warning!PRESCRIBER, Issue 19 2008Leslie Klein MSc, MB ChB An analysis of specials prescribing in one PCT found the average cost to be £102, with prices reaching over £2000. The authors suggest how the expense of prescribing specials can be kept to a minimum. Copyright © 2008 Wiley Interface Ltd [source] The Entry Cost Shock and the Re-rating of Power Prices in New South Wales, AustraliaTHE AUSTRALIAN ECONOMIC REVIEW, Issue 2 2010Paul Simshauser Australia has long been the beneficiary of low, stable power prices. A decade-long state of oversupply underpinned this result and while plant capital costs had been rising, the cost of capital had been declining. These offsetting effects locked the wholesale market into an average cost of $35,$40/MWh. However, from 2007, a simultaneous and sharp rise in new entrant plant capital costs and the cost of capital occurred. The combined effects crept up on the industry while it was in a state of oversupply. This ,entry cost shock' disrupted a 7 year long equilibrium price, with average power system cost rising to $60/MWh. [source] Public Hospital Costs in Two Australian StatesTHE AUSTRALIAN ECONOMIC REVIEW, Issue 2 2000Jerome Fahrer This study examines the long-run and short-run behaviour of public hospital average costs in two Australian States: Victoria and Queensland. Using adjusted weighted inlier-equivalent separations as a measure of hospital output, and floor area as a measure of capacity, the study finds a hump- or ,,'-shaped long-run average cost curve at the 5 per cent significance level in both data sets. The study also finds a saucer- or ,,'-shaped relationship between capacity utilisation and short-run average cost at the 5 per cent level. [source] Resource Use and Cost of Diagnostic Workup of Women with Suspected Breast CancerTHE BREAST JOURNAL, Issue 1 2009David W. Lee PhD Abstract:, We estimated resource use and costs associated with a diagnostic workup for suspected breast cancer among Medicare beneficiaries. Using Medicare claims data, we found that the average cost of a diagnostic workup for suspected breast cancer,whether it eventuated in a breast cancer diagnosis or not,was $361, and did not vary by presentation (signs/symptoms or screening mammography). In the aggregate, we estimate that Medicare spends approximately $679 million annually on diagnostic workups for women with suspected breast cancer, and that false positive mammograms result in diagnostic costs of approximately $250 million. [source] Automated high-level disinfection of nonchanneled flexible endoscopes: Duty cycles and endoscope repair,,§THE LARYNGOSCOPE, Issue 10 2010Melissa McCarty Statham MD Abstract Purpose: Guidelines issued by the Association of Operating Room Nurses and the Association of Professionals in Infection Control and Epidemiology recommend high-level disinfection (HLD) for semicritical instruments, such as flexible endoscopes. We aim to examine the durability of endoscopes to continued use and automated HLD. We report the number of duty cycles a flexible endoscope can withstand before repairs should be anticipated. Methods: Retrospective review. Results: A total of 4,336 endoscopic exams and subsequent disinfection cycles were performed with 60 flexible endoscopes in an outpatient tertiary pediatric otolaryngology practice from 2005 to 2009. All endoscopes were systemically cleaned with mechanical cleansing followed by leak testing, enzymatic cleaning, and exposure to Orthophthaldehyde (0.55%) for 5 minutes at a temperature of at least 25°C, followed by rinsing for 3 minutes. A total of 77 repairs were performed, 48 major (average cost $3,815.97), and 29 minor (average cost $326.85). On average, the 2.2-mm flexible endoscopes were utilized for 61.9 examinations before major repair was needed, whereas the 3.6 mm endoscopes were utilized for 154.5 exams before needing minor repairs. No major repairs have been needed to date on the 3.6-mm endoscopes. Conclusions: Automated endoscope reprocessor use for HLD is an effective means to disinfect and process flexible endoscopes. This minimizes variability in the processing of the endoscopes and maximizes the rate of successful HLD. Even when utilizing standardized, automated HLD and limiting the number of personnel processing the endoscopes, smaller fiberoptic endoscopes demonstrate a shortened time interval between repairs than that seen with the larger endoscopes. Laryngoscope, 2010 [source] Stochastic analysis in life office management: applications to large annuity portfoliosAPPLIED STOCHASTIC MODELS IN BUSINESS AND INDUSTRY, Issue 1 2003Mariarosaria Coppola Abstract The paper deals with the riskiness analysis for a large portfolio of life annuities. By means of the limiting distribution of the present value of the portfolio, in the first part of the paper a model for evaluating the investment and the projection risks is presented. In the second part, with regard to the investment risk's effects, the insolvency risk is measured considering the cumulative probability distribution function of the discounted average cost per policy. Copyright © 2003 John Wiley & Sons, Ltd. [source] The Vabra aspirator versus the Pipelle device for outpatient endometrial samplingAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2007Norzilawati M. NAIM Abstract Objective:, To compare the effectiveness of the Vabra aspirator and the Pipelle device as an outpatient endometrial assessment tool. Method:, This was a randomised, prospective trial conducted for a period of one year. Results:, A total of 147 patients were recruited, of which 71 were in the Vabra group and 76 were in the Pipelle arm. The procedure success rate in the Pipelle group was significantly higher than the Vabra arm (98.7 vs 88.7%, P = 0.02). Adequate tissue yield was also significantly more in the Pipelle arm (73.3 vs 52.4%, P = 0.02). Cost,benefit analysis revealed a higher average cost per patient in the Vabra group compared to the Pipelle arm. Conclusion:, This study proved that the Vabra aspirator was not as effective as the Pipelle device in obtaining endometrial tissue for histological diagnosis. Despite its higher price per unit, the Pipelle device was a more cost-effective tool for outpatient endometrial assessment. [source] Acute treatment costs of intracerebral hemorrhage and ischemic stroke in ArgentinaACTA NEUROLOGICA SCANDINAVICA, Issue 4 2009M. C. Christensen Background and purpose,,, Stroke is the third leading cause of death in Argentina, yet little information exists on the acute treatment provided for stroke or its costs. This study estimates the national costs of the acute treatment of first-ever intracerebral hemorrhage (ICH) and ischemic stroke (IS) in Argentina. Methods,,, Retrospective hospital-based inception study design using data on resource use and costs from high-volume stroke centers in Argentina, and published population-based incidence data. Treatment provided at two large urban hospitals were evaluated in all patients admitted with a first-ever stroke between 1 January 2004 and 31 August 2006, and costs were assigned using appropriate unit cost data for all resource use. Cost estimates in Argentinian pesos were converted to US dollars ($) using the 2005 purchasing power parity index. National costs of acute treatment for incident strokes were estimated by extrapolation of average costs estimates to national incidence data. Assumptions of the average cost of stroke treatment on a national scale were examined in sensitivity analysis. Results,,, The acute care of 167 patients with stroke was thoroughly evaluated from hospital admission to hospital discharge. Mean length of hospital stay was 35.4 days for ICH and 13.0 days for IS. Ninety-one percent of the patients with ICH and 68% of the patients with IS were admitted to an ICU for a mean length of stay (LOS) of 12.9 ± 20.3 and 3.6 ± 5.9 days respectively. Mean total costs of initial hospitalization were $12,285 (SD ±14,336) for ICH and $3888 (SD ±4018) for IS. Costs differed significantly by Glasgow Coma Scale (GCS) score at admission, development of pneumonia and infections during hospitalization, and functional outcome at hospital discharge. Aggregate national healthcare expenditures for acute treatment of incident ICH were $194.2m (range 97.1,388.4) and $239.9m for IS (range 119.9,479.7). Conclusion,,, The direct hospital costs of incident ICH and IS in Argentina are substantial and primarily driven by stroke severity, in-hospital complications and clinical outcomes. With the expected increase in the incidence of stroke over the coming decades, these results emphasize the need for effective preventive and acute medical care. [source] Cost of prophylaxis in the management of cytomegalovirus infection in solid organ transplant recipientsCLINICAL TRANSPLANTATION, Issue 4 2007Federico Oppenheimer Abstract:, Background:, Limited economic data exist on the use of valganciclovir for the prevention of cytomegalovirus (CMV) infection and disease in solid organ transplant (SOT) recipients. We compared the economics of sequential i.v. and oral ganciclovir prophylaxis vs. oral valganciclovir prophylaxis alone in high-risk (D+/R,) SOT patients. Methods:, A cost-minimization analysis was performed from the perspective of the Spanish National Health System comparing the cost of sequential ganciclovir prophylaxis (induction with i.v. ganciclovir 10 mg/kg daily for 14 d followed by oral ganciclovir 1 g t.i.d. for 3 months) vs. oral valganciclovir prophylaxis (900 mg once daily for 100 d). Resource utilization data for both regimens were obtained from the literature and from clinical records of 83 patients in nine Spanish hospitals. Results were expressed as average cost per patient treated. Results:, The average cost per patient treated with sequential ganciclovir or valganciclovir prophylaxis was ,3715.51 and ,3295.90, respectively. The higher cost of ganciclovir therapy was due to concomitant administration of anti-CMV immunoglobulin (,313.73), drug administration costs (,401.45), catheter culture tests (,13.64) and adverse events associated with catheter use (,3.30). Following a sensitivity analysis, taking into account dose and duration of drug, concomitant medications and adverse events, costs for valganciclovir and sequential therapy were similar. Conclusions:, Valganciclovir prophylaxis is as economical as sequential ganciclovir prophylaxis in high-risk D+/R, SOT patients. In addition, the once-daily dosing regimen of valganciclovir is more convenient, and avoids the complications associated with catheter use. [source] Changing GPs' prescription patterns through guidelines and feedback.PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2007Intervention study Abstract Purpose To investigate whether and how a multi-dimensional intervention including clinical guidelines on the choice of medical treatment in the primary and the secondary health care sector, and individual feedback to general practices about their own and other practices' prescription patterns in five Anatomical Therapeutic Chemical classification system (ATC)-groups was followed by changes in the practices' prescription pattern. Methods Prospective historical registry study and a questionnaire study of GPs' self-reported use of guidelines and feedback. Results In every ATC-group the number of prescribed defined daily doses (DDDs) kept growing after the intervention, while potential savings by DDD decreased. Individual practices' changes in the prescription pattern differed by ATC-group and practices with high potential savings/DDD before the intervention showed the greatest relative reduction in potential savings/DDD. The county's average cost/DDD for the five ATC-groups declined from above the Danish average before the intervention to a level below the average cost/DDD after the intervention. In the questionnaire study (response rate: 79%), 69% of respondents had read the guidelines and 78% reported that the feedback influenced their prescription of drugs. Conclusions The observed changes in drug costs and potential savings were not due to volume effects but a combination of price effects, including generic substitution and choice of less expensive analogues, demonstrating that it is possible to change GPs' prescription patterns without interfering with patients' access to treatment or with GPs' clinical freedom.' Copyright © 2007 John Wiley & Sons, Ltd. [source] Clinical and Economic Factors Associated with Ambulance Use to the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2006Jennifer Prah Ruger PhD Background: Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. Objectives: To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED. Methods: This was a retrospective, cross-sectional study of all patients seen during 2001 (N= 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use. Results: In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0,10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight,8 AM (OR, 2.0; 95% CI = 1.8 to 2.1), and age ,65 years (OR, 1.3; 95% CI = 1.2 to 1.5). Conclusions: Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means. [source] Identification and adaptive control of some stochastic distributed parameter systemsINTERNATIONAL JOURNAL OF ADAPTIVE CONTROL AND SIGNAL PROCESSING, Issue 6 2001B. Pasik-Duncan Abstract An important class of controlled linear stochastic distributed parameter systems is that with boundary or point control. A survey of some existing adaptive control problems with their solutions for the boundary or the point control of a partially known linear stochastic distributed parameter systems is presented. The distributed parameter system is described by an analytic semigroup with cylindrical white noise and a control that occurs only on the boundary or at discrete points. The unknown parameters in the model appear affinely in both the infinitesimal generator of the semigroup and the linear transformation of the control. The noise in the system is a cylindrical white Gaussian noise. Strong consistency is verified for a family of least-squares estimates of the unknown parameters. For a quadratic cost functional of the state and the control, the certainty equivalence control is self-optimizing, that is the family of average costs converges to the optimal ergodic cost. Copyright © 2001 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||