Search results for: cost effectiveness

Authors: Jayant Kumar, Aarcha Jayachandran Sasikala, Barry Adrian Shepherd

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Public Distribution System is a flagship welfare programme of the Government of India with both historical and political significance. Targeted at lower sections of society,it is one of the largest supply chain networks in the world. There has been several studies by academics and planning commission about the effectiveness of the system. Our study focuses on applying predictive analytics to aid the central body to keep track of the problem of breach of service level agreement between the two echelons of food supply chain. Each shop breach is leading to a potential additional inventory carrying cost. Thus, through this study, we aim to show that aided with such analytics, the network can be made more cost effective. The methods we illustrate in this study are applicable to other commercial supply chains as well.

Keywords: PDS, analytics, cost effectiveness, Karnataka, inventory cost, service level JEL classification: C53

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Authors: Shannon Hearney, Jeffrey Hoch

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Pancreatic cancer is a notoriously costly and deadly form of cancer. Many types of treatment centers exist for patients to seek care from, including high-volume centers which have shown promise to provide the highest quality of care. While it may be true that this type of center provides the best care it is unclear if that care is cost-effective. Studies in the US have confirmed that high-volume hospitals do provide higher quality of care but have shown inconsistencies in the cost-effectiveness of that care. Other studies, like those from Finland have shown that high-volume centers had lower mortality and lower costs than low-volume centers. This paper thus seeks to review the current scientific literature to better understand if high-volume centers are cost-effective in delivering care in both a European setting and in the US. A review of major reference databases such as Medline, Embase and PubMed will be conducted for cost-effectiveness studies on the surgical treatment of pancreatic cancer at high-volume centers. Possible MeSH terms to be included, but not limited to, are: “pancreatic cancer”, “cost analysis”, “cost-effectiveness”, “economic evaluation”, “pancreatic neoplasms”, “surgical”, and “high-volume”. Studies must also have been available in the English language. This review will encompass European scientific literature, as well as those in the US. Based on our preliminary findings, we anticipate high-volume hospitals to provide better care at greater costs. We anticipate that high-volume hospitals may be cost-effective in different contexts depending on the national structure of a healthcare system. Countries with more centralized and socialized healthcare may yield results that are more cost-effective. High-volume centers may differ in their cost-effectiveness of the surgical care of pancreatic cancer internationally especially when comparing those in the United States to others throughout Europe.

Keywords: cost-effectiveness analysis, economic evaluation, pancreatic cancer, scientific literature review

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Authors: Shannon Hearney, Jeffrey Hoch

Abstract:

While all cancers are costly to treat, pancreatic cancer is a notoriously costly and deadly form of cancer. Across the world there are a variety of treatment centers ranging from small clinics to large, high-volume hospitals as well as differing structures of payment and access. It has been noted that centers that treat a high volume of pancreatic cancer patients have higher quality of care, it is unclear if that care is cost-effective. In the US there is no clear consensus on the cost-effectiveness of high-volume centers for the surgical care of pancreatic cancer. Other European countries, like Finland and Italy have shown that high-volume centers have lower mortality rates and can have lower costs, there however, is still a gap in knowledge about these centers cost-effectiveness globally. This paper seeks to review the current literature in Europe and the US to gain a better understanding of the state of high-volume pancreatic surgical centers cost-effectiveness while considering the contextual differences in health system structure. A review of major reference databases such as Medline, Embase and PubMed will be conducted for cost-effectiveness studies on the surgical treatment of pancreatic cancer at high-volume centers. Possible MeSH terms to be included, but not limited to, are: “pancreatic cancer”, “cost analysis”, “cost-effectiveness”, “economic evaluation”, “pancreatic neoplasms”, “surgical”, “Europe” “socialized medicine”, “privatized medicine”, “for-profit”, and “high-volume”. Studies must also have been available in the English language. This review will encompass European scientific literature, as well as those in the US. Based on our preliminary findings, we anticipate high-volume hospitals to provide better care at greater costs. We anticipate that high-volume hospitals may be cost-effective in different contexts depending on the national structure of a healthcare system. Countries with more centralized and socialized healthcare may yield results that are more cost-effective. High-volume centers may differ in their cost-effectiveness of the surgical care of pancreatic cancer internationally especially when comparing those in the United States to others throughout Europe.

Keywords: cost-effectiveness analysis, economic evaluation, pancreatic cancer, scientific literature review

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Authors: B. Sudarsan Baskar, S. Pooja Pragati, S. Raj Kumar

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The cost effectiveness in aircraft maintenance is of high privilege in the recent days. The cost effectiveness can be effectively made when line maintenance activities are incorporated at airports during Turn around time (TAT). The present work outcomes the shortcomings that affect the dispatching of the aircrafts, aiming at high fleet operability and low maintenance cost. The operational and cost constraints have been discussed and a suggestive alternative mechanism is proposed. The possible allocation of all deferred maintenance tasks to a set of all deferred maintenance tasks to a set of suitable airport resources have termed as alternative and is discussed in this paper from the data’s collected from the kingfisher airlines.

Keywords: decision support system, aircraft maintenance planning, maintenance-cost, RUL(remaining useful life), logistics, supply chain management

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Authors: Lundqvist M., Alwin J., Levin L-A.

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Background: Assistance dogs are dogs trained to assist persons with functional impairment or chronic diseases. The assistance dog concept includes different types: guide dogs, hearing dogs, and service dogs. The service dog can further be divided into subgroups of physical services dogs, diabetes alert dogs, and seizure alert dogs. To examine the long-term effects of health care interventions, both in terms of resource use and health outcomes, cost-effectiveness analyses can be conducted. This analysis can provide important input to decision-makers when setting priorities. Little is known when it comes to the cost-effectiveness of assistance dogs. The study aimed to assess the cost-effectiveness of certified service or hearing dogs in comparison to regular companion dogs. Methods: The main data source for the analysis was the “service and hearing dog project”. It was a longitudinal interventional study with a pre-post design that incorporated fifty-five owners and their dogs. Data on all relevant costs affected by the use of a service dog such as; municipal services, health care costs, costs of sick leave, and costs of informal care were collected. Health-related quality of life was measured with the standardized instrument EQ-5D-3L. A decision-analytic Markov model was constructed to conduct the cost-effectiveness analysis. Outcomes were estimated over a 10-year time horizon. The incremental cost-effectiveness ratio expressed as cost per gained quality-adjusted life year was the primary outcome. The analysis employed a societal perspective. Results: The result of the cost-effectiveness analysis showed that compared to a regular companion dog, a certified dog is cost-effective with both lower total costs [-32,000 USD] and more quality-adjusted life-years [0.17]. Also, we will present subgroup results analyzing the cost-effectiveness of physicals service dogs and diabetes alert dogs. Conclusions: The study shows that a certified dog is cost-effective in comparison with a regular companion dog for individuals with functional impairments or chronic diseases. Analyses of uncertainty imply that further studies are needed.

Keywords: service dogs, hearing dogs, health economics, Markov model, quality-adjusted, life years

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Authors: Vasuki Rayapati, Bhanu Duggal

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Trans catheter aortic valve replacement (TAVR) is the recommended treatment over surgical aortic valve replacement (SAVR) for high-risk groups, patients >75 years of age with severe symptomatic Aortic stenosis (AS). In high income countries TAVR is more cost effective because of – i) Reduction in total length of stay including less number of days in ICU ii) Non-procedural costs like cost of general anaesthesia are higher for SAVR. In India, there are two kinds of hospitals – Public and Private. Most patients visit public sector hospitals than private sector hospitals. In a LMIC like India, especially in the Public health sector cost of TAVR is prohibitive. In a small study from three (public) hospitals in India, it was envisaged that cost of TAVR should decrease at least by 2/3 to be a cost effective option in Public health sector for severe AS.

Keywords: cost effectiveness, TAVR vs SAVR, LMIC, HTA

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Authors: Boukelkoul Lahcen

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The cumulative costs for O&M may represent as much as 65%-90% of the turbine's investment cost. Nowadays the cost effectiveness concept becomes a decision-making and technology evaluation metric. The cost of energy metric accounts for the effect replacement cost and unscheduled maintenance cost parameters. One key of the proposed approach is the idea of maintaining the WTs which can be captured via use of a finite state Markov chain. Such a model can be embedded within a probabilistic operation and maintenance simulation reflecting the action to be done. In this paper, an approach of estimating the cost of O&M is presented. The finite state Markov model is used for decision problems with number of determined periods (life cycle) to predict the cost according to various options of maintenance.

Keywords: cost, finite state, Markov model, operation and maintenance

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Authors: Felipa De Mello-Sampayo

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Background: The aim of this study is to undertake, from a patient perspective, an economic analysis of presurgical teledermatology, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients’ out-of-pocket expenses, i.e., costs that patients incur when traveling to and from health providers for treatment, visits’ fees, and the opportunity cost of time spent in visits. Method: Patients’ out-of-pocket expenses-effectiveness of presurgical teledermatology were analyzed in the setting of a public hospital during two years. The mean delay in surgery was used to measure effectiveness. The teledermatology network covering the area served by the Hospital Garcia da Horta (HGO), Portugal, linked the primary care centers of 24 health districts with the hospital’s dermatology department. The patients’ opportunity cost of visits, travel costs, and visits’ fee of each presurgical modality (teledermatology and conventional referral), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated from initial primary care visit until surgical intervention. Two groups of patients: those with squamous cell carcinoma and those with basal cell carcinoma were distinguished in order to compare the effectiveness according to the dermatoses. Results: From a patient perspective, the conventional system was 2.15 times more expensive than presurgical teledermatology. Teledermatology had an incremental out-of-pocket expenses-effectiveness ratio of €1.22 per patient and per day of delay avoided. This saving was greater in patients with squamous cell carcinoma than in patients with basal cell carcinoma. Conclusion: From a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses-effectiveness than the conventional referral system, especially for patients with severe dermatoses.

Keywords: economic analysis, out-of-pocket expenses, opportunity cost, teledermatology, waiting time

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Authors: Sony Baral, Bijendra Basnyat, Kalyan Gauli

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Forests are depleted throughout the world in the 1990s, and since then, various efforts have been undertaken for the restoration of the forest. A government of Nepal promoted various community based forest management in which leasehold forestry was the one introduce in 1990s, aiming to restore degraded forests land. However, few attempts have been made to systematically evaluate its cost effectiveness. Hence the study assesses the cost effectiveness of leasehold forestry intervention in the mid-hill district of Nepal following the cost and benefit analysis approach. The study followed quasi-experimental design and collected costs and benefits information from 320 leasehold forestry groups (with intervention) and 154 comparison groups (without intervention) through household survey, forest inventory and then validated with the stakeholders’ consultative workshop. The study found that both the benefits and costs from intervention outweighed without situation. The members of leasehold forestry groups were generating multiple benefits from the forests, such as firewood, grasses, fodder, and fruits, whereas those from comparison groups were mostly getting a single benefit. Likewise, extent of soil carbon is high in leasehold forests. Average expense per unit area is high in intervention sites due to high government investment for capacity building. Nevertheless, positive net present value and internal rate of return was observed for both situations. However, net present value from intervention, i.e., leasehold forestry, is almost double compared to comparison sites, revealing that community are getting higher benefits from restoration. The study concludes that leasehold forestry is a highly cost-effective intervention that contributes towards forest restoration that brings multiple benefits to rural poor.

Keywords: cost effectiveness, economic efficiency, intervention, restoration, leasehold forestry, nepal

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Authors: Paolo Lenzuni

Abstract:

Cost-effectiveness of noise abatement treatments at the workplace has not yet received adequate consideration. Furthermore, most of the published work is focused on productivity, despite the poor correlation of this quantity with noise levels. There is currently no tool to estimate the social benefit associated to a specific noise abatement treatment, and no comparison among different options is accordingly possible. In this paper, we present an algorithm which has been developed to predict the cost-effectiveness of any planned noise control treatment in a workplace. This algorithm is based the estimates of hearing threshold shifts included in ISO 1999, and on compensations that workers are entitled to once their work-related hearing impairments have been certified. The benefits of a noise abatement treatment are estimated by means of the lower compensation costs which are paid to the impaired workers. Although such benefits have no real meaning in strictly monetary terms, they allow a reliable comparison between different treatments, since actual social costs can be assumed to be proportional to compensation costs. The existing European legislation on occupational exposure to noise it mandates that the noise exposure level be reduced below the upper action limit (85 dBA). There is accordingly little or no motivation for employers to sustain the extra costs required to lower the noise exposure below the lower action limit (80 dBA). In order to make this goal more appealing for employers, the algorithm proposed in this work also includes an ad-hoc element that promotes actions which bring the noise exposure down below 80 dBA. The algorithm has a twofold potential: 1) it can be used as a quality index to promote cost-effective practices; 2) it can be added to the existing criteria used by workers’ compensation authorities to evaluate the cost-effectiveness of technical actions, and support dedicated employers.

Keywords: cost-effectiveness, noise, occupational exposure, treatment

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Authors: Chil-Chyuan Kuo, Chen-Hsuan Tsai

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This study presents a cost-effective approach for rapid fabricating modeling platforms utilized in fused deposition modeling system. A small-batch production of modeling platforms about 20 pieces can be obtained economically through silicone rubber mold using vacuum casting without applying the plastic injection molding. The air venting systems is crucial for fabricating modeling platform using vacuum casting. Modeling platforms fabricated can be used for building rapid prototyping model after sandblasting. This study offers industrial value because it has both time-effectiveness and cost-effectiveness.

Keywords: vacuum casting, fused deposition modeling, modeling platform, sandblasting, surface roughness

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Authors: Mansour Fakhri, Monire Zokaei

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Where there are many demolitions on conventional asphalt pavements, heavy costs are paid to repair and reconstruct the pavement roads annually. Recently some research has been done in order to increase the pavement life. Perpetual pavement is regarded as one of them which can improve the pavement life and minimize the maintenance activity and cost. In this research, ABAQUS which is a finite element software is implemented for analyzing and simulation of perpetual pavement. Viscoelastic model of material is used and loading wheel is considered to be dynamic. Effect of different parameters on pavement function has been considered. Because of high primary cost these pavements are not widely used. In this regard, life cost analysis was also carried out to compare perpetual pavement to conventional asphalt concrete pavement. It was concluded that although the initial cost of perpetual pavement is higher than that of conventional asphalt pavement, life cycle cost analysis during 50 years of service life showed that the performance of this pavement is better and the whole life cost of that is less.

Keywords: ABAQUS, lifecycle cost analysis, mechanistic empirical, perpetual pavement

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Authors: Jyun-Huei Huang, Ting-I Lee

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Urban heat island effect is derived from the reduction of vegetative cover by urban development. Because plants can improve air quality and microclimate, green walls have been applied as a sustainable design approach to cool building temperature. By using plants to green vertical surfaces, they decrease room temperature and, as a result, decrease the energy use for air conditioning. Based on their structures, green walls can be divided into two categories, green façades and living walls. A green façade uses the climbing ability of a plant itself, while a living wall assembles planter modules. The latter one is widely adopted in public space, as it is time-effective and less limited. Although a living wall saves energy spent on cooling, it is not necessarily cost-effective from the perspective of a lifecycle analysis. The Italian study shows that the overall benefit of a living wall is only greater than its costs after 47 years of its establishment. In Taiwan, urban greening policies encourage establishment of green walls by referring to their benefits of energy saving while neglecting their low performance on cost-effectiveness. Thus, this research aims at understanding the perception of appliers and consumers on the cost-effectiveness of their living wall products from the lifecycle viewpoint. It adopts semi-structured interviews and field observations on the maintenance of the products. By comparing the two results, it generates insights for sustainable urban greening policies. The preliminary finding shows that stakeholders do not have a holistic sense of lifecycle or cost-effectiveness. Most importantly, a living wall well maintained is often with high input due to the availability of its maintenance budget, and thus less sustainable. In conclusion, without a comprehensive sense of cost-effectiveness throughout a product’s lifecycle, it is very difficult for suppliers and consumers to maintain a living wall system while achieve sustainability.

Keywords: case study, maintenance, post-occupancy evaluation, vertical greening

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Authors: André Smith, Amr Abdel-Dayem

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The stereo matching problem, while having been present for several decades, continues to be an active area of research. The goal of this research is to find correspondences between elements found in a set of stereoscopic images. With these pairings, it is possible to infer the distance of objects within a scene, relative to the observer. Advancements in this field have led to experimentations with various techniques, from graph-cut energy minimization to artificial neural networks. At the basis of these techniques is a cost function, which is used to evaluate the likelihood of a particular match between points in each image. While at its core, the cost is based on comparing the image pixel data; there is a general lack of consistency as to what image data representation to use. This paper presents an experimental analysis to compare the effectiveness of more common image data representations. The goal is to determine the effectiveness of these data representations to reduce the cost for the correct correspondence relative to other possible matches.

Keywords: colour data, local stereo matching, stereo correspondence, disparity map

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Authors: Getachew Tilahun, Oluwole Makinde, David Malonza

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We propose and analyze a non-linear mathematical model for the transmission dynamics of pneumonia disease in a population of varying size. The deterministic compartmental model is studied using stability theory of differential equations. The effective reproduction number is obtained and also the local and global asymptotically stability conditions for the disease free and as well as for the endemic equilibria are established. The model exhibit a backward bifurcation and the sensitivity indices of the basic reproduction number to the key parameters are determined. Using Pontryagin’s maximum principle, the optimal control problem is formulated with three control strategies; namely disease prevention through education, treatment and screening. The cost effectiveness analysis of the adopted control strategies revealed that the combination of prevention and treatment is the most cost effective intervention strategies to combat the pneumonia pandemic. Numerical simulation is performed and pertinent results are displayed graphically.

Keywords: cost effectiveness analysis, optimal control, pneumonia dynamics, stability analysis, numerical simulation

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Authors: Sung Ho Oh

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The advanced traffic lights, the system of traffic information collection and provision, the CCTVs for traffic control, and the traffic information center were installed in Asuncion, capital of Paraguay. After pre-post comparison of the installation, significant changes were found. Even though the traffic volumes were increased, travel speed was higher, so that travel time from origin to destination was decreased. the saving values for travel time, gas cost, and environmental cost are about 47 million US dollars per year. Satisfaction survey results for the installation were presented with statistical significance analysis.

Keywords: advanced transport management systems, effectiveness, Paraguay, traffic lights

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Authors: Mende Mensa Sorato, Majid Davari, Abbas Kebriaeezadeh, Nizal Sarrafzadegan, Tamiru Shibru, Behzad Fatemi

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Markov model, like cardiovascular disease (CVD) policy model based simulation, is being used for evaluating the cost-effectiveness of hypertension treatment. Stroke, angina, myocardial infarction (MI), cardiac arrest, and all-cause mortality were included in this model. Hypertension is a risk factor for a number of vascular and cardiac complications and CVD outcomes. Objective: This systematic review was conducted to evaluate the comprehensiveness of this model across different regions globally. Methods: We searched articles written in the English language from PubMed/Medline, Ovid/Medline, Embase, Scopus, Web of Science, and Google scholar with a systematic search query. Results: Thirteen cohort studies involving a total of 2,165,770 (1,666,554 hypertensive adult population and 499,226 adults with treatment-resistant hypertension) were included in this scoping review. Hypertension is clearly associated with coronary heart disease (CHD) and stroke mortality, unstable angina, stable angina, MI, heart failure (HF), sudden cardiac death, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, peripheral arterial disease (PAD), and abdominal aortic aneurism (AAA). Association between HF and hypertension is variable across regions. Treatment resistant hypertension is associated with a higher relative risk of developing major cardiovascular events and all-cause mortality when compared with non-resistant hypertension. However, it is not included in the previous CVD policy model. Conclusion: The CVD policy model used can be used in most regions for the evaluation of the cost-effectiveness of hypertension treatment. However, hypertension is highly associated with HF in Latin America, the Caribbean, Eastern Europe, and Sub-Saharan Africa. Therefore, it is important to consider HF in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment in these regions. We do not suggest the inclusion of PAD and AAA in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment due to a lack of sufficient evidence. Researchers should consider the effect of treatment-resistant hypertension either by including it in the basic model or during setting the model assumptions.

Keywords: cardiovascular disease policy model, cost-effectiveness analysis, hypertension, systematic review, twelve major cardiovascular events

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Authors: Reza Lotfalian, Sudarshan Martins, Peter Radziszewski

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The effect of reliability on life-cycle cost, including initial and maintenance cost of a system is studied. The failure probability of a component is used to calculate the average maintenance cost during the operation cycle of the component. The standard deviation of the life-cycle cost is also calculated as an error measure for the average life-cycle cost. As a numerical example, the model is used to study the average life cycle cost of an electric motor.

Keywords: initial cost, life-cycle cost, maintenance cost, reliability

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Authors: A. S. Walkey, N. P. Patidar

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It is not always economical to provide reactive power using synchronous alternators. The cost of reactive power can be minimized by optimal placing of FACTS devices in power systems. In this paper a Particle Swarm Optimization- Sequential Quadratic Programming (PSO-SQP) algorithm is applied to minimize the cost of reactive power generation along with real power generation to alleviate the bus voltage violations. The effectiveness of proposed approach tested on IEEE-14 bus systems. In this paper in addition to synchronous generators, an opportunity of FACTS devices are also proposed to procure the reactive power demands in the power system.

Keywords: reactive power, reactive power cost, voltage security margins, capability curve, FACTS devices

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Authors: M. R. Al-Rashidi, K. M. El-Naggar, M. F. Al-Hajri

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The fuel cost function describes the electric power generation-cost relationship in thermal plants, hence, it sheds light on economical aspects of power industry. Different models have been proposed to describe this relationship with the quadratic function model being the most popular one. Parameters of second order fuel cost function are estimated in this paper using cuckoo search algorithm. It is a new population based meta-heuristic optimization technique that has been used in this study primarily as an accurate estimation tool. Its main features are flexibility, simplicity, and effectiveness when compared to other estimation techniques. The parameter estimation problem is formulated as an optimization one with the goal being minimizing the error associated with the estimated parameters. A case study is considered in this paper to illustrate cuckoo search promising potential as a valuable estimation and optimization technique.

Keywords: cuckoo search, parameters estimation, fuel cost function, economic dispatch

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Authors: V. E. Selaule, R. M. Schoeman H. C. Z. Pienaar

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Research has shown that solar energy is a renewable energy resource with the most potential when compared to other renewable energy resources in South Africa. There are many makes of Photovoltaic (PV) panels on the market and it is difficult to assess which to use. PV panel manufacturers use Standard Test Conditions (STC) to rate their PV panels. STC conditions are different from the actual operating environmental conditions were the PV panels are used. This paper describes a practical method to determine the most cost effective available PV panel. The method shows that PV panel manufacturer STC ratings cannot be used to select a cost effective PV panel.

Keywords: PV orientation, PV panel, PV STC, Solar energy

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Authors: James Li, Darko Joksimovic

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Urban development changes the natural hydrologic cycle, resulting in storm water impacts such as flooding, water quality degradation, receiving water erosion, and ecosystem deterioration. An integrated storm water managementapproach utilizing source and conveyance (termed green infrastructure) and end-of-pipe control measures is an effective way to manage urban storm water impacts. This paper focuses onplanning green infrastructure (GI) at the source and along the drainage system on a city level. It consists of (1)geospatial analysis of feasible GI using physical suitability; (2) modelling of cumulative GI's stormwater performance; and (3) cost-effectiveness analysis to prioritize the implementation of GI. A case study of the City of Barrie in Ontario, Canada, was used to demonstrate the GI's planning.

Keywords: cost-effectiveness of storm water controls, green infrastructure, urban storm water, city-level master planning

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Authors: Babatunde Akeem Lawal

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In any organization, the primary aim is to maximize profit, but the major challenges facing them is the increase in cost of operation because of this there is increase in cost of production that could lead to inevitable cost control and cost reduction scheme which make it difficult for most organizations to operate at the cost efficient frontier. The study aims to critically examine and evaluate the application of cost control and cost reduction in organization performance and also to review budget as an effective tool of cost control and cost reduction. A descriptive survey research was adopted. A total number of 40 respondent retrieved were used for the study. The analysis of data collected was undertaken by applying appropriate statistical tools. Regression analysis was used to test the hypothesis with the use of SPSS. Based on the findings; it was evident that cost control has a positive impact on organizational performance and also the style of management has a positive impact on organizational performance.

Keywords: organization, cost reduction, cost control, performance, budget, profit

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Authors: Tess Howard, Lily Owens, Maneesha De Silva, Russell Hodgson

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Purpose: This study aims to evaluate the cost-effectiveness of laparoscopic common bile duct exploration (CBDE) compared to endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy for the emergency management of common bile duct (CBD) stones. Methodology: A retrospective case note review was conducted on consecutive patients undergoing emergency management of CBD stones using either CBDE, or ERCP and cholecystectomy at a single centre between January 2014-October 2014. Data on admission and procedural costs, length of hospital stay, postoperative complications and further stone related interventions were analysed. Results: A total of 350 patients were analysed. Among them, 299 patients underwent CBDE at the time of cholecystectomy, while the remaining 51 underwent ERCP either pre-, intra- or post cholecystectomy. CBDE was associated with lower overall costs compared to ERCP with an average hospital stay cost of $13,093 vs $22,930 respectively. This was largely attributed to shorter hospital stays (6.5 vs 10.3 days), decreased need for intensive care unit admission and fewer postoperative interventions within the CBDE group. Notably, single procedure laparoscopic cholecystectomy with CBDE demonstrated decreased operative costs compared to laparoscopic cholecystectomy combined with ERCP pre-/intra- or post-operatively ($3,747 vs. $4,641). Conclusion: Emergent CBDE is a cost-effective alternative to ERCP for managing CBD stones when combined with cholecystectomy. The upfront investment in equipment for CBDE and increased cholecystectomy procedural time is counterbalanced by reduced hospital stay, fewer procedures and subsequent cost savings. Economic considerations, in conjunction with clinical outcomes, should inform the selection of the optimal approach for CBD stone management in emergency settings.

Keywords: choledocolithiasis, management, cost-effectiveness, endoscopic retrograde cholangiopancreatography, ERCP, CBDE, common bile duct exploration

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Authors: Nuran Bahar, Mehmet A. Akcayol

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In the aviation industry, many faults may occur frequently during the maintenance processes and assembly operations of complex structured aircrafts because of their high dependencies of components. These faults affect the quality of aircraft parts or developed modules adversely. Technical employee requires long time and high labor force while checking the correctness of each component. In addition, the person must be trained regularly because of the ever-growing and changing technology. Generally, the cost of this training is very high. Augmented Reality (AR) technology reduces the cost of training radically and improves the effectiveness of the training. In this study, the usage of AR technology in the aviation industry has been investigated and the effectiveness of AR with heads-up display glasses has been examined. An application has been developed for comparison of production process with AR and manual one.

Keywords: aerospace, assembly quality, augmented reality, heads-up display

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Authors: Mukul Anand

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Quality oriented affordable shelter for all has always been the key issue in the housing sector of our country. Homelessness is the acute form of housing need. It is a paradox that in spite of innumerable government initiated programmes for affordable housing, certain section of society is still devoid of shelter. About nineteen million (18.78 million) households grapple with housing shortage in Urban India in 2012. In Indian scenario there is major mismatch between the people for whom the houses are being built and those who need them. The prime force faced by public authorities in facilitation of quality housing for all is high cost of construction. The present paper will comprehend executable techniques for dilution of cost factor in housing the homeless. The key actors responsible for delivery of cheap housing stock such as capacity building, resource optimization, innovative low cost building material and indigenous skeleton housing system will also be incorporated in developing these techniques. Time performance, which is an important angle of above actors, will also be explored so as to increase the effectiveness of low cost housing. Along with this best practices will be taken up as case studies where both conventional techniques of housing and innovative low cost housing techniques would be cited. Transportation consists of approximately 30% of total construction budget. Thus use of alternative local solutions depending upon the region would be covered so as to highlight major components of low cost housing. Government is laid back regarding base line information on use of innovative low cost method and technique of resource optimization. Therefore, the paper would be an attempt to bring to light simpler solutions for achieving low cost housing.

Keywords: construction, cost, housing, optimization, shelter

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Authors: Martins Onyekwelu Onuorah, Jnr Dahiru Usman

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Introduction: In the realm of public health, the threat posed by Monkeypox continues to elicit concern, prompting rigorous studies to understand its dynamics and devise effective containment strategies. Particularly significant is its recurrence in variable populations, such as the observed outbreak in Nigeria in 2022. In light of this, our study undertakes a meticulous analysis, employing a data-driven approach to explore, validate, and propose optimized intervention strategies tailored to the distinct dynamics of Monkeypox within varying demographic structures. Utilizing a deterministic mathematical model, we delved into the intricate dynamics of Monkeypox, with a particular focus on a variable population context. Our qualitative analysis provided insights into the disease-free equilibrium, revealing its stability when R0 is less than one and discounting the possibility of backward bifurcation, as substantiated by the presence of a single stable endemic equilibrium. The model was rigorously validated using real-time data from the Nigerian 2022 recorded cases for Epi weeks 1 – 52. Transitioning from qualitative to quantitative, we augmented our deterministic model with optimal control, introducing three time-dependent interventions to scrutinize their efficacy and influence on the epidemic's trajectory. Numerical simulations unveiled a pronounced impact of the interventions, offering a data-supported blueprint for informed decision-making in containing the disease. A comprehensive cost-effectiveness analysis employing the Infection Averted Ratio (IAR), Average Cost-Effectiveness Ratio (ACER), and Incremental Cost-Effectiveness Ratio (ICER) facilitated a balanced evaluation of the interventions’ economic and health impacts. In essence, our study epitomizes a holistic approach to understanding and mitigating Monkeypox, intertwining rigorous mathematical modeling, empirical validation, and economic evaluation. The insights derived not only bolster our comprehension of Monkeypox's intricate dynamics but also unveil optimized, cost-effective interventions. This integration of methodologies and findings underscores a pivotal stride towards aligning public health imperatives with economic sustainability, marking a significant contribution to global efforts in combating infectious diseases.

Keywords: monkeypox, equilibrium states, stability, bifurcation, optimal control, cost-effectiveness

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Authors: Remzi Saltoglu, Nazmia Humaira, Gokhan Inalhan

Abstract:

During aircraft maintenance scheduling, operator calculates the budget of the maintenance. Usually, this calculation includes only the costs that are directly related to the maintenance process such as cost of labor, material, and equipment. In some cases, overhead cost is also included. However, in some of those, downtime cost is neglected claiming that grounding is a natural fact of maintenance; therefore, it is not considered as part of the analytical decision-making process. Based on the normalized data, we introduce downtime cost with its monetary value and add its seasonal character. We envision that the rest of the model, which works together with the downtime cost, could be checked with the real life cases, through the review of MRO cost and airline spending in the particular and scheduled maintenance events.

Keywords: aircraft maintenance, downtime, downtime cost, maintenance cost

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Authors: A. Abubakar, A. Parsa, S. Walker

Abstract:

Despite advances made in the diagnosis and management of drug-sensitive tuberculosis (TB) over the past decades, treatment of multidrug-resistant tuberculosis (MDR-TB) remains challenging and complex particularly in high burden countries including Nigeria. Treatment of MDR-TB is cost-prohibitive with success rate generally lower compared to drug-sensitive TB and if care is not taken it may become the dominant form of TB in future with many treatment uncertainties and substantial morbidity and mortality. Addressing these challenges requires collaborative efforts thorough sustained researches to evaluate the current treatment guidelines, particularly in high burden countries and prevent progression of resistance. To our best knowledge, there has been no research exploring the acceptability, effectiveness, and cost-effectiveness of community-based-MDR-TB treatment model in Nigeria, which is among the high burden countries. The previous similar qualitative study looks at the home-based management of MDR-TB in rural Uganda. This research aimed to explore patient’s views and acceptability of community-based-MDR-TB treatment model and to evaluate and compare the effectiveness and cost-effectiveness of community-based versus hospital-based MDR-TB treatment model of care from the Nigerian perspective. Knowledge of patient’s views and acceptability of community-based-MDR-TB treatment approach would help in designing future treatment recommendations and in health policymaking. Accordingly, knowledge of effectiveness and cost-effectiveness are part of the evidence needed to inform a decision about whether and how to scale up MDR-TB treatment, particularly in a poor resource setting with limited knowledge of TB. Mixed methods using qualitative and quantitative approach were employed. Qualitative data were obtained using in-depth semi-structured interviews with 21 MDR-TB patients in Nigeria to explore their views and acceptability of community-based MDR-TB treatment model. Qualitative data collection followed an iterative process which allowed adaptation of topic guides until data saturation. In-depth interviews were analyzed using thematic analysis. Quantitative data on treatment outcomes were obtained from medical records of MDR-TB patients to determine the effectiveness and direct and indirect costs were obtained from the patients using validated questionnaire and health system costs from the donor agencies to determine the cost-effectiveness difference between community and hospital-based model from the Nigerian perspective. Findings: Some themes have emerged from the patient’s perspectives indicating preference and high acceptability of community-based-MDR-TB treatment model by the patients and mixed feelings about the risk of MDR-TB transmission within the community due to poor infection control. The result of the modeling from the quantitative data is still on course. Community-based MDR-TB care was seen as the acceptable and most preferred model of care by the majority of the participants because of its convenience which in turn enhanced recovery, enables social interaction and offer more psychosocial benefits as well as averted productivity loss. However, there is a need to strengthen this model of care thorough enhanced strategies that ensure guidelines compliance and infection control in order to prevent the progression of resistance and curtail community transmission.

Keywords: acceptability, cost-effectiveness, multidrug-resistant TB treatment, community and hospital approach

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Authors: Ayoade Adeyemi, Leo Nherera, Paul Trueman, Antje Emmermann

Abstract:

Background and objectives: Radiofrequency (RF) generated plasma chondroplasty is considered a promising treatment alternative to mechanical debridement (MD) with a shaver. The aim of the study was to perform a cost-effectiveness analysis comparing costs and outcomes following COBLATION chondroplasty versus mechanical debridement in patients with knee pain associated with a medial meniscus tear and idiopathic ICRS grade III focal lesion of the medial femoral condyle from a payer perspective. Methods: A decision-analytic model was developed comparing economic and clinical outcomes between the two treatment options in German patients following knee chondroplasty. Revision rates based on the frequency of repeat arthroscopy, osteotomy and conversion to total knee replacement, reimbursement costs and outcomes data over a 4-year time horizon were extracted from published literature. One-way sensitivity analyses were conducted to assess uncertainties around model parameters. Threshold analysis determined the revision rate at which model results change. All costs were reported in 2016 euros, future costs were discounted at a 3% annual rate. Results: Over a 4 year period, COBLATION chondroplasty resulted in an overall net saving cost of €461 due to a lower revision rate of 14% compared to 48% with MD. Threshold analysis showed that both options were associated with comparable costs if COBLATION revision rate was assumed to increase up to 23%. The initial procedure costs for COBLATION were higher compared to MD and outcome scores were significantly improved at 1 and 4 years post-operation versus MD. Conclusion: The analysis shows that COBLATION chondroplasty is a cost-effective option compared to mechanical debridement in the treatment of patients with a medial meniscus tear and idiopathic ICRS grade III defect of the medial femoral condyle.

Keywords: COBLATION, cost-effectiveness, knee chondroplasty, mechanical debridement

Procedia PDF Downloads 392