Comprehensive Economic Evaluation Research Articles

Alternate wetting and drying technique in paddy production in the Mekong Delta, Vietnam: economic evaluation and adoption determinants

PurposeThis study aims to investigate the adoption of alternate wetting and drying (AWD) technique and provides the economic evaluation and determinants of AWD adoption in rice production in the Mekong Delta in Vietnam.Design/methodology/approachThe study extends the drainage factor into the AWD score. The cost benefit analysis is utilized for the economic evaluation, and the Cragg model is applied to examine the determinants of AWD adoption.FindingsThe results indicate that there are significant differences in inputs such as water, seed, fertilizers and mechanization between the low and high levels of AWD adoption. The yields are significantly different at different adoption levels. The Cragg model found that irrigation infrastructure, AWD training and perceived ease of use of the technology are determinants of AWD adoption level. Collective pumping is considered as a major constraint in the AWD adoption.Research limitations/implicationsThe results provide managerial implications, with a focus on the effectiveness of inputs, the irrigation infrastructure and AWD training to promote the AWD adoption. Challenges of rice field flatness should be investigated in a further study.Originality/valueThe study contributes to existing literature by providing an empirical evidence for the large-scale adoption of AWD with a comprehensive economic evaluation, extending the drainage performance into the score to accurately reflect the water conservation and promoting the use of a more flexible modeling approach with the Cragg model.

Comprehensive Economic Benefit Evaluation Method of Coastal Enterprises Based on AHP

Wang, J. and Deng, X., 2020. Comprehensive economic benefit evaluation method of coastal enterprises based on AHP. In: Yang, Y.; Mi, C.; Zhao, L., and Lam, S. (eds.), Global Topics and New Trends in Coastal Research: Port, Coastal and Ocean Engineering. Journal of Coastal Research, Special Issue No. 103, pp. 24–28. Coconut Creek (Florida), ISSN 0749-0208.In the process of comprehensive economic benefit evaluation, coastal enterprises need to consider the factors of economy, technology and reliability. These factors affect each other and are difficult to distinguish accurately. In this context, the AHP and fuzzy comprehensive evaluation method are combined to evaluate the comprehensive economic benefits of coastal enterprises. First of all, the weight of each evaluation factor is determined by using the analytic hierarchy process (AHP) legally and quantitatively; then, the fuzzy comprehensive evaluation model based on AHP is constructed to evaluate the evaluation scheme containing uncertain factors; finally, the application of AHP in state-owned and private enterprises proves that the evaluation method is scientific and feasible.

Integrated palliative homecare in advanced dementia: reduced healthcare utilisation and costs

ObjectivesTo determine the economic benefit of an integrated home-based palliative care programme for advanced dementia (Programme Dignity), evaluation is required. This study aimed to estimate Programme Dignity’s average monthly cost...

Impact of Switch Options on the Economics of Pneumococcal Conjugate Vaccine (PCV) Introduction in Indonesia.

As one of Gavi, the Vaccine Alliance (previously the Global Alliance for Vaccines and Immunization), graduating countries, Indonesia is still eligible to access Gavi price for PCV13, PCV10 A and B. This study aims to estimate the economic impact of switch from the existing product/presentation of PCV (single-dose of PCV13) to the new product/presentation of PCV (multi-dose of PCV13, PCV10 A and B) since PCV is one of the most expensive vaccines in the Expanded Program on Immunization (EPI) schedule. Assuming that Gavi-Advance Market Commitment (AMC) price for all PCVs can be accessed in 2021, the use of multi-dose PCV13, PCV10 A and PCV10 B with Gavi-AMC price in 2021–2024 were considered as respective scenarios. The result showed that the scenario assuming the use of single-dose of PCV13 with contract price in 2019–2020 that would be switched into multi-dose of PCV10 B with Gavi-AMC price in 2021–2024 resulted in the highest potential saving, compared with other scenarios. Our analysis suggests an economic advantage to switch from single-dose into a multi-dose presentation. Vaccination coverage, vaccine price, vaccine wastage and additional Gavi-AMC vaccine costs were considered to be the most influential parameter affecting the savings in all scenarios. Applying the effectiveness of PCV13 and PCV10 A on reducing the risk for invasive pneumococcal disease (IPD), potential averted incidence of IPD in children under one year of age during 2019–2024 would be 246,164 and 105,587 in both scenarios. Despite the result confirmed that PCV13 may provide an additional benefit, a more comprehensive economic evaluation study is required to investigate further the comparison of cost-effectiveness values among all PCVs in Indonesia.

Assessment of the Financial and Investment Components of Industrial Potential

<p>Theoretical background: The need for national industrial revival requires the assessment process of the financial and investment components of industrial potential, since such process allows for the development of a further strategy of industrial development of the country, taking into account the available opportunities as well as implementing effective government controls aimed at increasing the competitiveness of the national economy.</p><p>Purpose of the article: The development of a methodological foundation for a complex economic assessment of financial and investment components of industrial potential.</p><p>Research methods: A comparative analysis was used to study methodological approaches to the economic assessment of potential, laying the groundwork for conceptual foundations of a comprehensive economic evaluation of the financial and investment components. The types of analysis used were: a system analysis – to set the system of assessment indices and indicators of financial and investment components of industrial potential; an integral assessment analysis – to determine the integral levels of the potential development for certain types of industrial activity based on standardisation of indicators reflecting the development of financial and investment components; a statistical analysis – to identify changes in the development level of the financial and investment components of potential for certain types of industrial activity; and an abstract-logical analysis to draw conclusions and formulate theoretical generalisation of the obtained results.</p><p>Main findings: Our research collected the experiences of former scientists and developed methodological bases in order to study industrial potential as a complex economic category, the development of which is conditioned by the development level of its financial and investment components. The authors’ approach to a comprehensive economic assessment of the financial and investment components of industrial potential is based on the identification of both input and output indicators. Such allocations allowed the determining of the reproductive potential of the financial and investment components as a potential opportunity to attract relevant resources, as well as implemented potential, which characterises the effectiveness of their use (the opportunity used). Next, the input indicators were further split into general indicators – which are characterised by quantitative parameters of the scope of the resources, and reflect the involvement scale – and partial indicators, which reflect the qualitative resources characteristics. The proposed integrated indicators of the development levels of financial and investment components have a complex hierarchical structure. For example, the first level generates a set of indicators that provide for a qualitative and quantitative assessment of the development state, the second level determines the integral indices in terms of individual types of indicators, while the third level is based on the potential type (reproductive and implemented). A modified Harrington’s scale was proposed to draw a conclusion on the development level achieved for the financial and investment components of industrial potential. Research was conducted using the methodology proposed, on the development levels of financial and investment components of potential for various types of industrial activity. The results showed the existence of a high level of both reproductive and implemented potential in the production of computers, electronics and optical devices, and basic pharmaceutical products, which demonstrates the technological progress in the structural industrial potential transformation. The proposed methodological approach will allow for the definition of a “critical area” in the financial and investment components development necessary for the adoption of appropriate management decisions with regard to adjusting industrial potential development strategies.</p>

How much is a public park worth? An ex ante methodology for impact and cost-benefit analysis on the example of Millenáris Széllkapu in Budapest

Establishing a public park raises a number of methodological issues. The model worked out by HÉTFA Research Institute is suitable for cost-benefit analysis and ex ante viability test of a public park integrated into urban landscape. The paper presents the model by the example of a planned public park at one of the busiest centers of Budapest, the junction of Margit Boulevard and Millennium Park. Such a comprehensive economic evaluation for public parks has not been made in Hungary. First the mechanism of effects was set up, and by using the hedonic price method the project’s costs and benefits were presented with national and international statistical indicators and benchmarks. The investment, that has been started in 2016 with in the initial planning and demolition pays for itself by 2019. The results are tested with sensitivity analysis, which has inter alia shown that if we count by the general approach of the project management - costs are expected to increase by 10% and benefits are to reduce by 10% - investment returns for the city and their inhabitants for 2030. Furthermore, without the effect of property appreciation - the investment turns positive by 2061 thanks only to indirect social, economic, environmental benefits. According to our analysis, the park's development, which relaxes a built-in highly populated urban fabric, has become an economically profitable investment as a result of significant beneficial external effects.

The LCOE-Indicator-Based Comprehensive Economic Comparison between AC and DC Power Distribution Networks with High Penetration of Renewable Energy

DC distribution networks are operationally economical from the perspective of renewable energy penetration due to the reduction of power loss from the simplified power conversion structure. However, the initial investment cost of a DC network is high because DC technology is in the early stage of development. So, selecting AC or DC technology becomes an important issue in the planning stage of a distribution network, where a comprehensive quantitative economic comparison between AC and DC distribution networks is necessary. To compare the economy between AC and DC distribution networks with high penetration of a renewable energy scenario, this paper introduces a comprehensive economic evaluation method. In this study, first, typical system models for AC and DC distribution networks were proposed as the foundation of the research. Then, a levelized cost of energy (LCOE)-indicator-based comprehensive economic evaluation model was established, where the operation cost was classified into power loss cost, reliability loss cost, and operational cost. A time sequential simulation model was applied to calculate the power loss. The simulation results showed that a DC distribution network has higher initial investment, operation, and maintenance costs than an AC distribution network, but the loss cost is far lower than an AC distribution network. A sensitivity analysis showed that the equipment cost and proportion of renewable energy are two of the most important factors that affect the economics of DC distribution networks at present.

PMD19 ECONOMIC EVALUATION OF CATARACT PHACOEMULSIFICATION IN THE RUSSIAN FEDERATION

To determine costs, associated with use of different phacoemulsification platforms in treatment of cataract in the Russian Federation. We performed cost analysis from public healthcare system perspective for six available in the Russian Federation phacoemulsification platforms based on public data of government procurement average prices for the period of 2016-2018 years. We considered only direct costs for platforms and its consumables, those include cassettes, sleeves, needles and BSS solutions. We made assumption of usage only original consumables for each platform. Time horizon of the analysis was up to five years. Exchange rate was €1 = 72 Rub. We involved into analysis following phacoemulsification platforms: Centurion and Infiniti by Alcon Inc., Stellaris and Stellaris PC (StPC) by Bausch&Lomb, Whitestar Signature (WhSg) by AMO and Visalis 500 (Vis500) by Zeiss. The prices of the platforms (and ultrasound grip) were €73311, €34386, €43426, €75074 and €61478 for Centurion, Infiniti, Stellaris, StPC and Vis500, respectively. The price for WhSg platform was not available. The average costs for consumables for the treatment of one patient with cataract were €127, €117, €123, €123, €310 and €222 for Centurion, Infiniti, Stellaris, StPC, WhSg and Vis500, respectively. Nevertheless, depend on choosen consumables options there was meaningful change in costs. The total annual costs of platforms and consumables for 2240 patients were €357946, €296994, €318355, €350003 and €558789 for Centurion, Infiniti, Stellaris, StPC and Vis500, respectively. The share of platforms in total costs vary from 10 to 20%. When five year time horizon was selected, the share of platform costs dropped down to less than 5%. We have determined costs for phacoemulsification of cataract through six platforms in the Russian Federation. Data on training and maintenance costs for each platform is required for more comprehensive economic evaluation of platform usage.

Comprehensive comparative economic evaluation of woody biomass energy from silvicultural fuel treatments

Fuel treatments are used in overstocked, fire-prone forests to alter wildfire behavior and reduce fire risk. Some of the benefits they provide are not captured in markets, and therefore represent unaccounted environmental externalities that can lead to inefficient decision making. This study uses a replicable method to integrate market and nonmarket economic values into a comprehensive economic evaluation of fuel treatment and bioenergy production using a case study of ponderosa pine and mixed-conifer forests in Colorado's wildland-urban interface. Treatment costs and people's willingness to pay for better forest health, lower likelihood of wildfire, improved air quality, and expanded renewable energy production are incorporated into techno-economic analysis of biopower production. Results show that fuel treatments are likely to be undervalued when evaluated strictly on a financial basis. Under the standard practice of disposing of treatment residues through pile-burning, net present value (NPV) of fuel treatment on 138,034 ha over 20 years is -$275 million, without consideration of nonmarket benefits. If nonmarket benefits associated with forest health, wildfire likelihood and air quality are included, NPV improves to -$116 million. Without the consideration of nonmarket benefits, when treatment resides are used for biopower production, NPV is -$178 million, with net cost savings compared to pile burning attributable to reduced biomass disposal costs and electricity revenue. Accounting for additional air quality benefits and nonmarket value associated with renewable energy, the bioenergy scenario improves NPV to -$25 million, with 27.7% of outcomes having positive NPV. The impact of additional nonmarket values and potential revenues from timber harvest are discussed, and are likely to make mean NPV positive for this scenario.

Valuing the impact of residential photovoltaics and batteries on network electricity losses: An Australian case study

The transition to decentralised energy networks incorporating high levels distributed generation is the greatest network challenge since their formation. The eager adoption of photovoltaics by households is accelerating this change; the addition of residential batteries provide the next step in the process. The costs of the transition must be considered in a comprehensive evaluation of how value in the network is affected. A little considered aspect to date is the financial impact of network loss reduction resulting from generation being located at the point of load. Using an Australian case study, this paper seeks to value the reduction of network losses, the degree to which all consumers benefit, and verify the impact of PV and batteries on the LV network through power-flow modelling and comprehensive economic evaluation. This paper finds that losses can be reduced by up to 78% with the addition of batteries to manage evening peak and provide load support.

Comprehensive Economic Evaluation of Automatic Optimization in Cardiac Resynchronization Defibrillators (CRT-Ds): Cost-Effectiveness Analysis - A Canadian Perspective

Introduction Innovative algorithms allowing automated optimization of cardiac resynchronization therapy defibrillators (CRT-Ds), have been introduced in Canada. These automatically adjust the A-V interval and appropriately withhold right ventricular (RV) pacing during times it may not be needed. These “adaptive” algorithms may increase response to therapy, as network meta-analyses have demonstrated, reduce hospitalizations, and drastically reduce the need of periodic ultrasound-driven device optimization. We wanted to investigate the cost-effectiveness of these algorithms from a Canadian provincial Healthcare system. Methods Markov Modelling informed by the AdaptivCRT Clinical Trial and propensity score matching with earlier CRT-D trials. Costs of device implantations were achieved from Ontario Case Costing Initiative. Other costs were obtained through Canadian literature reviews. 3% discounting of costs and outcomes was applied. Results The predicted patient survival was 10.97 years with adaptive algorithms and 10.50 years with traditional CRT, a 4.5% increase over lifetime. Deterministic results suggested adaptive algorithms produce 0.31 quality-adjusted life years (QALYs) more than traditional CRT (7.41 vs. 7.10). The cost saving per life-year gained with adaptive algorithms was CAD 2,118.47. The cost saving per QALY was CAD 3,133.83. Conclusions The use of adaptive algorithms was projected to improve average patient survival, quality of life, while avoiding costs. Avoidance of AF-related admissions and cardiac ultrasounds will make the benefits more pronounced.

Urban green infrastructure: perspectives on life-cycle thinking for holistic assessments

This article discusses the application of life-cycle thinking (LCT) methods for holistic urban green infrastructure (UGI) assessments to inform and enhance urban sustainability decision-making. It draws upon scientific and grey literature to present the key concepts and emerging LCT methodology developments within the urban green infrastructure evaluation context. Key methodological challenges are identified and discussed: the issues of (i) defining “green infrastructure” and (ii)“urban” boundaries, achieving (iii) the full representation of the broad range of UGI benefits and impacts (iv) over its whole life cycle, as well as (v) accounting for the wide variety of UGI types, their combinations and (vi) inherently dynamic nature, (vii) high performance dependency on climatic and other local conditions, and also, the challenges related to (viii) the monetisation of costs and benefits for comprehensive economic evaluation as well as (ix) the issues of city-scale assessments. Further methodology development and data needs for the adaptation of LCT methods for urban green infrastructure assessments are outlined. Four guiding principles are proposed: alignment with global urban sustainability goals, integration of ecosystem services accounting, harmonisation with existing LCA and LCC standards, and co-creation. The article concludes that urban green infrastructure is a novel field of application of LCT methods and differs considerably from traditional uses due to a range of methodological challenges specific to the inherent characteristics of urban green infrastructure. These need to be addressed in order to close the knowledge gaps and better understand the holistic value and performance of urban green infrastructure to enable evidence-based decision-making.

Energy, exergy and economic analyses of a novel hybrid ocean thermal energy conversion system for clean power production

In this study, comprehensive thermodynamic performance and economic evaluation of the ocean thermal energy conversion (OTEC) and wind turbine combined hybrid plant is investigated. The proposed system consists of the two main sub-cycles, which are isobutene working fluid ocean thermal energy conversion system and wind turbine. The proposed study is projected to meet the daily total electrical power demands for a petrol station on the edge of the Mediterranean Sea in Turkey (Antalya). Energetic, exergetic performances and total irreversibility as well as economic assessment of the whole plant and its components are investigated according to various factors for example dead state temperature, turbine isentropic efficiency and inlet pressure of turbine. The results obtained by calculating the effects of these parameters on the ocean thermal energy conversion - wind plant performance (energy and exergy efficiency) are presented in graphs. According to the results, the total energy and exergy efficiencies of the ocean thermal energy conversion plant are 4.49% and 14.84%, respectively. Also, the overall energy and exergy efficiency of the hybrid system are 12.27% and 23.34%, respectively. In addition, the total exergy destruction rate of the modelled plant is 2168.405 kW, and the heat exchanger has maximum exergy destruction ratio with 44.77%. Finally, the total cost of the proposed hybrid study is found as 3.03 $/hr.

Thermal and economic assessment of a solar chimney cooled semi-transparent photovoltaic (STPV) power plant in different climates

A new cooling approach for a semi-transparent photovoltaic system using a solar chimney (STPV-SC) is proposed and economically evaluated. The STPV panels are utilized as the collector roof of a solar chimney for enhancing the panels cooling. For analyzing the system, a mathematical model based on the heat transfers between three main components of system: STPV, inside air and ground is developed and the results are validated by the experimental data reported in the literature. Furthermore, a comprehensive economic evaluation is carried out for the proposed system and payback period, as well as unit cost of produced power, are reported as the main economic parameters. The influence of main decision variables including packing factor, chimney height and collector radius is investigated on the power generation and economic performance. Moreover, the economic assessment of proposed system is carried out for five selected cities in Iran. Based on the results, packing factor always optimizes the economic performance, whereas the lowest payback period is obtained for packing factors between 0.3 and 0.5. Also, it is found that the highest and lowest economic enhancements by using the proposed system belong to Shiraz and Tabriz cities with about 11% and 5%, respectively.

A BIM-Based Study on the Comprehensive Benefit Analysis for Prefabricated Building Projects in China

Prefabricated construction has been widely accepted as an alternative to conventional cast-in-situ construction, given its improved performance. Great efforts have also been made to develop prefabricated construction technologies in China. However, there is a lack of an appropriate pattern for evaluating its comprehensive economic merits, and reasonable mathematical models for providing a comparative analysis of conventional cast-in-situ and prefabricated building projects have yet to be developed. Therefore, the research in this paper aims to comprehensively evaluate the economic benefits of implementing prefabricated construction techniques in order to surpass the economic barrier and promote the development of prefabricated buildings in China. The comprehensive economic evaluation is formulated in terms of resource-use efficiencies, project progress, and incentive policies. An apartment building in Shanghai is selected as a case study. Construction progress is simulated on the BIM platform when the same case study is rationally transformed from the prefabricated to the conventional cast-in-situ construction technique. The results reveal that the comprehensive economic merit can reach ¥739.6/m2 when selecting the prefabricated construction process. The economic benefit brought by shortening the construction period can be regarded as the most significant contributor. Yet, the current incentive policies only contribute 7.1% of the comprehensive economic evaluation. Overall, this research contributes an assessment framework for decision-making in the technique management of building construction. The BIM-based simulation approach can greatly help investors to identify the relevant economic factors and adopt the latest incentive policies.

A Technical, Economic and Environmental Evaluation Study of Utilising Fixed, Single and Dual-Axis Solar Photovoltaic Systems in Boubyan and Failaka Islands in Kuwait

Implementing renewable energy technologies, such as solar energy, is an important step towards meeting the increasing demand for electricity in Kuwait. This would be a very helpful way of minimising the negative environmental impacts of conventional power plants. This study reports on the results of a comprehensive technical, environmental and economic evaluation of the use of a grid-connected solar photovoltaic system to generate electricity at Boubyan and Failaka islands in Kuwait. The study also evaluated the effects of using single and dual-axis tracking systems. The results showed that the obtained performance parameters are excellent and fall within the standard reference ranges of the solar photovoltaic systems. The use of tracking systems is highly beneficial and energy production increased by approximately 26% and 31% respectively as a result of implementing single and dual-axis tracking systems. The computed levelized cost of electricity (LCOE) results were $0.076 /kWh, $0.064 /kWh and $0.066 /kWh respectively for fixed, single and dual-axis tracking systems. These obtained values are less than the LCOE of the conventional Kuwaiti power plants, therefore making the proposed systems economically feasible. In addition, the results revealed that single-axis tracking systems are the best option. Life cycle assessment (LCA) analysis shows that the annual energy payback time (EPBT) results obtained in this paper were 1.84, 1.46 and 1.41 years respectively. The average total CO2 emission rate was 49.58 CO2, eq/kWh, 39.25 CO2, eq/kWh and 37.84 CO2, eq/kWh for single and dual-axis tracking systems respectively.

Abstract WP389: A Critical Analysis of Stent Retriever and Suction Catheter Thrombectomy Device Cost-Effectiveness Studies

Background: Although comprehensive economic evaluation reporting standards exist for medical devices (MDs), the quality of reporting in cost analysis studies remains unknown for neurosurgical devices. The emergence of novel mechanical thrombectomy devices, such as stent-retrievers and suction catheters may reduce the economic burden of acute ischemic stroke by improving patient outcomes in the long term. The objective of this study was to assess the methodological quality of reporting in economic evaluations of stent-retrievers and suction catheters. Methods: A systematic review of the literature was performed to identify all available economic evaluations on stent-retrievers and suction catheters published up to June 2018. Articles were excluded if they did not specifically perform cost analyses. The methodological quality of reporting was assessed using the Comprehensive Health Economic Evaluation Reporting Standards (CHEERS) statement with specific criterion employed for MDs. Results: The search yielded 93 publications, of which 10 studies met inclusion criteria for cost analyses. Eight of ten (80%) studies were self-reported as cost-effectiveness studies. Only three studies (30%) reported incremental cost-effectiveness ratios and only one study (10%) reported net monetary benefit values. Two of the ten (20%) studies were completed with a lifetime horizon and the remaining were five years or less. No study had a substantial review of device-associated learning curves, incremental innovations in technology, dynamic prices, or institutional impacts of device pricing, all of which influence cost analyses. Conclusion: While stent-retrievers and suction catheters have been described to be cost-effective in the literature, the quality of published economic evaluations is highly varied. Since economic assessments can provide essential guidance for clinical decision-making, ensuring high-quality reporting by integrating the CHEERS checklist is critical. Further, as these results indicate, there is a need to create uniform reporting standards for thrombectomy device cost analyses in order to ensure generalizability and comparability amongst studies.

Комплексная экономическая оценка месторождений Ненецкого автономного округа

Комплексная экономическая оценка месторождений Ненецкого автономного округа

Economic evaluation of border closure for a generic severe pandemic threat using New Zealand Treasury methods

Objective:To perform a comprehensive economic evaluation of border closure for an island nation in the face of severe pandemic scenarios. Methods:The costing tool developed by the New Zealand (NZ) Treasury (CBAx) was used for the analyses. Pandemic scenarios were as per previous work;1 epidemiological data were from past New Zealand influenza pandemics. Results:The net present value of successful border closure was NZ$7.86 billion for Scenario A (half the mortality rate of the 1918 influenza pandemic) and $144 billion for preventing a more severe pandemic (10 times the mortality of scenario A). Cost–utility analyses found border closure was relatively cost‐effective, at $14,400 per QALY gained in Scenario A, and cost‐saving for Scenario B (taking the societal perspective). Conclusions:This work quantifies the economic benefits and costs from border closure for New Zealand under specific assumptions in a generic but severe pandemic threat (e.g. influenza, synthetic bioweapon). Preparing for such a pandemic response seems wise for an island nation, although successful border closure may only be feasible if planned well ahead. Implications for public health:Policy makers responsible for generic pandemic planning should explore how border closure could be implemented, including practical and legal frameworks.

A Framework to Guide Economic Analysis of Advance Care Planning.

Advance care planning (ACP) is fundamental to guiding medical care at the end of life. Understanding the economic impact of ACP is critical to implementation, but most economic evaluations of ACP focus on only a few actors, such as hospitals. To develop a framework for understanding and quantifying the economic effects of ACP, particularly its distributional consequences, for use in economic evaluations. Literature review of economic analyses of ACP and related costs to estimate magnitude and direction of costs and benefits for each actor and how data on these costs and benefits could be obtained or estimated. ACP can lead to more efficient allocation of resources by reducing low-value care and reallocating resources to high-value care, and can increase welfare by aligning care to patient preferences. This economic framework considers the costs and benefits of ACP that accrue to or are borne by six actors: the patient, the patient's family and caregivers, healthcare providers, acute care settings, subacute and home care settings, and payers. Program implementation costs and nonhealthcare costs, such as time costs borne by patients and caregivers, are included. Findings suggest that out-of-pocket costs for patients and families will likely change if subacute or home care is substituted for acute care, and subacute care utilization is likely to increase while primary healthcare providers and acute care settings may experience heterogeneous effects. A comprehensive economic evaluation of ACP should consider how costs and benefits accrue to different actors.