Cost-effective Price Research Articles

White Bikes of De Hoge Veluwe National Park, Netherlands

Federal land managers in the United States, especially in the National Park Service, are becoming more interested in providing opportunities for visitors to experience a unit in the national park system without a private vehicle. Alternative modes of transportation can help park units address numerous challenges, including preserving the resources for present and future generations and enhancing the quality of the visitor experience. One mode of travel that is receiving considerable attention is the bicycle, especially various forms of bikesharing. De Hoge Veluwe National Park, in the Netherlands, has had a bikeshare system since 1975. Federal land managers may be particularly interested in this system because ( a) the bikes are provided without charge, ( b) there are provisions for children, ( c) the bikes are not used to advertise private businesses, and ( d) bicycling is good for the environment and users’ health. This paper briefly reviews the evolution of bikesharing, summarizes studies related to bicycles and pedestrians in the context of federal lands, presents information about De Hoge Veluwe National Park and describes its white bikeshare program, and concludes with considerations, such as unit size and location, for implementing a similar system in the United States. Units that are developing bikeshare systems should consider features that are attractive to potential users, such as a cost-effective pricing system and bicycles for a wide variety of users.

Implementing a new urinary catheter insertion and removal pack.

This article describes the implementation of a community urinary catheter insertion and removal pack that provides equipment to maintain safe and effective practice at a cost-effective price within Newcastle upon Tyne Hospitals NHS Foundation Trust. This development was achieved through service integration as a result of two large trusts amalgamating, offering the opportunity for practice development resulting in the development of a joint catheter product formulary, the implementation of a patient catheter record booklet and the design of a community urinary catheterisation pack. The impact of service integration has provided scope for proactive working between acute and community continence services, resulting in innovative approaches generating better quality outcomes for patients who require urinary catheterisation.

Design study of an ultra-compact superconducting cyclotron for isotope production

A 12.5MeV, 25μA, proton compact superconducting cyclotron for medical isotope production has been designed and is currently in fabrication. The machine is initially aimed at producing 13N ammonia for Positron Emission Tomography (PET) cardiology applications. With an ultra-compact size and cost-effective price point, this system will offer clinicians unprecedented access to the preferred radiopharmaceutical isotope for cardiac PET imaging. A systems approach that carefully balanced the subsystem requirements coupled to precise beam dynamics calculations was followed. The system is designed to irradiate a liquid target internal to the cyclotron and to minimize the need for radiation shielding. The main parameters of the cyclotron, its design, and principal steps of the development work are presented here.

Comparative effectiveness research and the rise of orphan indications

Purpose – The purpose of this paper is to show the link between the comparative effectiveness research (CER) and the interest in developing drugs for rare disease by the pharmaceutical industry. Total healthcare spending is on the rise without having a corresponding better health outcome. As such, with the growing role of government in healthcare, measuring and demonstrating value is beginning to expand beyond the private sector to metrics applied in the public sector. A modern approach to comparative effective research began its rapid rise in the USA when the American Recovery and Reinvestment Act of 2009 allocated $1.1 billion for CER. This paper analyzes the implication and impact on the pharmaceutical industry. Design/methodology/approach – The paper reviews the basic definitions of CER and its areas of strength and weakness. It used real examples of drugs to show the impact of the Reinvestment Act of 2009 on the rise of orphan drugs. Findings – The study shows that the act encouraged the development of orphan drugs, mainly because of the low budget impact due to a smaller patient base. Provisions of the Affordable Care Act provide incentives for such rare disease indications, as no one can be denied coverage with pre-existing conditions. Research limitations/implications – The study is limited by the number of available rare drugs and the ongoing process of implementation of the Affordable Care Act. Practical implications – The study shows the cost-effective method of treating medical conditions. Social implications – Development of orphan drugs opens up access to care for many patients at a cost-effective price. Originality/value – This paper shows the link between the CER and the interest in developing drugs for rare disease by the pharmaceutical industry. It also brings out the possible implication of the Affordable Care Act on the pharmaceutical industry with respect to its strategies for drug development and drug portfolio.

Transferability of results of cost utility analyses for biologicals in inflammatory conditions for Central and Eastern European countries.

Several Central and Eastern European (CEE) countries require cost-utility analyses (CUAs) to support reimbursement formulary listing. However, CUAs informed by local evidence are often unavailable, and the cost-effectiveness of the several currently reimbursed biologicals is unclear. To estimate the cost-effectiveness as multiples of per capita GDP/quality adjusted life years (QALY) of four biologicals (infliximab, etanercept, adalimumab, golimumab) currently reimbursed in six CEE countries in six inflammatory rheumatoid and bowel disease conditions. Systematic literature review of published cost-utility analyses in the selected conditions, using the United Kingdom (UK) as reference country and with study selection criteria set to optimize the transfer of results to the CEEs. Prices in each CEE country were pro-rated against UK prices using purchasing power parity (PPP)-adjusted per capita GDP, and local GDP per capita/QALY ratios estimated. Central and Eastern European countries list prices were 144-333% higher than pro rata prices. Out of 85 CUAs identified by previous systematic literature reviews, 15 were selected as a convenience sample for estimating the cost-effectiveness of biologicals in the CEE countries in terms of per capita GDP/QALY. Per capita GDP/QALY values varied from 0.42 to 6.4 across countries and conditions (Bulgaria: 0.97-6.38; Czech Republic: 0.42-2.76; Hungary: 0.54-3.54; Poland: 0.59-3.90; Romania: 0.77-5.07; Slovakia: 0.55-3.61). While results must be interpreted with caution, calculating pro rata (cost-effective) prices and per capita GDP/QALY ratios based on CUAs can aid reimbursement decision-making in the absence of analyses using local data.

PRM234 - An Analysis of How Not to Use Cost-Effectiveness Analysis for Price-Setting

Objectives: Cost-effectiveness Analysis (CEA) and the calculation of the Incremental Cost-Effectiveness Ratio (ICER) together with its comparison with a threshold such as Gross Domestic Product (GDP)/capita, have long been used to assess the value for money of a new intervention compared with a comparator that this new intervention precisely seeks to displace. In this paper we show the paradoxical increase in cost-effective price using data from middle, low and very low income settings. Methods: Using the introduction of rotavirus vaccination compared with no-vaccination as the example. We create a theoretical framework for calculating the ICER by gradually decreasing the investment for treatment of rotavirus related disease (the 'no-vaccination comparator') representing different countries with different GDP levels and decreasing levels of existing health care investment. We compare these results with an analysis of cost-effectiveness using real data from 9 countries representing a range of different GDP levels. Results: The theoretical framework works well in situations where the GDP/capita exceeds $10,000 - as expected the cost-effective price decreases with a decrease in the GDP/capita. Below this the scant investment in health care infrastructure, thereby reducing potential cost-offsets, coupled with the significant increase in the potential effect gain, results in a much wider margin between a cost-neutral and costeffective price that could effectively be set using this approach. Conclusions: Although Cost-Effectiveness Analysis is widely used to assess the value for money of a new intervention for a particular price, we would argue that where investment in health care is low and disease burden is high, the use of CEA leads to paradoxes in price-setting.

Failure Analysis, Condition Assessment Technologies, and Performance Prediction of Prestressed-Concrete Cylinder Pipe: State-of-the-Art Literature Review

AbstractPrestressed concrete cylinder pipe (PCCP) is a large-diameter and high-strength pipe used in water or wastewater transmission mains. It has been widely used in North America because of its good performance, large capacity, and cost-effective price. However, some PCCPs fail after a certain time of service because of deterioration. PCCP failures can be very significant considering the pipe size and high internal pressure. To mitigate the serious results of PCCP failures, many condition assessment technologies have been developed to inspect the pipe condition, and many models have been developed to predict the performance of the pipe. These technologies and performance prediction methods have been used as reference for decision-making in PCCP pipeline management. However, because of their limitations, there is still a strong need to improve them for better application in the future. This paper, by using three databases, presents a state-of-the-art literature review of the most commonly used condition...

Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study

Objective To determine the relative costs and health effects of interventions to combat cardiovascular disease, diabetes, and tobacco related disease in order to guide the allocation of resources in developing...

PHP151 Evidence on the Impact of Managed Entries on Payers, Patients, Manufacturers, and Health Care Workers

Managed entries (MEs) are innovative pricing and reimbursement agreements aiming to share the risk related to the introduction of new, high-cost drugs between the payer and the manufacturer. This study aims to review evidence on the impact of MEs on payer, patients, manufacturer, and health care workers and to analyse emerging trends in managed entries at international level. A systematic literature review (grey and peer-reviewed) was performed complemented by search of health technology assessment agency's websites and selective interviews with decision makers in key European countries. Evidence exists of improved cost-effectiveness and lower drug price following the implementation of coverage with evidence development in Sweden. Data from France shows that price-volume agreements led to rebates totalling around 3% of the total drugs bill. Evidence from Italy shows that authorization with a risk-sharing agreement was associated with more rapid patient access in comparison to authorization without such an agreement. It is unclear whether managed entries constitute a reward for manufacturers, however, various benefits have been reported such as reimbursement for drugs which received an initial negative recommendation (e.g. bortezomib and trabectedin, UK) and competitive advantage in the form of better formulary position (sitagliptin & sitagliptin + metformin, USA); not to mention the possibility of granting discounts while leaving list prices untouched. Considerable administrative burden is placed on health care staff due to the diversity of existing schemes, the complexities linked with retrospective reimbursement, and lack of management capacity at current staffing levels. Although evidence on the impact of MEs is patchy, the systematic literature review showed that there are already lessons to be learnt. Preliminary findings seem to suggest that MEs have indeed the potential of meeting payer, patient, and manufacturer expectations, yet important threats such as implementation difficulties, administrative burden and lack of management capacity need to be addressed.

Viscous Contact Lens System for Vitrectomy

The authors describe a recently developed system for use in vitreoretinal surgery. The system is compatible with a variety of lens choices, including wide-field, equatorial, and high-magnification direct viewing lenses, allowing for visualization of the far peripheral retina and detailed imaging of the macula. Used with autoclavable lenses, the system achieves high-resolution image quality at a cost-effective price.

New desalinated drinking water regulations are met by an innovative post-treatment process for improved public health

The recent supply of large volumes of seawater desalinated water in Israel prompted both the development of new water quality standards and the development of a novel post treatment process, designed to comply with the new standards at a cost effective price. The new process is designed to supply water with alkalinity, Ca2 + and calcium carbonate precipitation potential values as required in the new criteria, along with the addition of a threshold Mg2 + concentration recently recommended by the WHO. The current paper describes the process in general, and focuses in particular on attaining these criteria while maintaining a low total hardness concentration (120 mg/L as CaCO3). The process is based on dissolving calcite using H2SO4 and replacing the excess calcium ions generated in this process by Mg2 + ions (using a specific cation exchange resin—Amberlite) and by Na+ (using a second cation exchange resin—chabazite, from the zeolite group). Once exhausted the resins are re-loaded with Mg2 + and Na+ by the brine generated in the RO process, thus no unwanted brines are generated. A case study is presented for which operational costs were approximated at 0.034 $US/m3 product water.

A new post-treatment process for attaining Ca 2+, Mg 2+, SO 42− and alkalinity criteria in desalinated water

A novel post-treatment approach for desalinated water, aimed at supplying a balanced concentration of alkalinity, Ca 2+, Mg 2+ and SO 4 2−, is introduced. The process is based on replacing excess Ca 2+ ions generated in the common H 2SO 4-based calcite dissolution post-treatment process with Mg 2+ ions originating from seawater. In the first step, Mg 2+ ions are separated from seawater by means of a specific ion exchange resin that has high affinity toward divalent cations (Mg 2+ and Ca 2+) and an extremely low affinity toward monovalent cations (namely Na + and K +). In the second step, the Mg 2+-loaded resin is contacted with the effluent of the calcite dissolution reactor and Mg 2+ and Ca 2+ are exchanged. Consequently, the excess Ca 2+ concentration in the water decreases while the Mg 2+ concentration increases. The process is stopped at a predetermined Ca 2+ to Mg 2+ ratio. All water streams used in the process are internal and form a part of the desalination plant sequence, regardless of the additional ion exchange component. The proposed process allows for the supply of cheap Mg 2+ ions, while at the same time enables the application of the cheap H 2SO 4-based calcite dissolution process, thus resulting in higher quality water at a cost-effective price. A case study is presented in which additional cost of supplying a Mg 2+ concentration of 12 mg/L using the process is estimated at $0.004/m 3 product water.

Communications — the emancipation of the small business

Many new services have been introduced to help people communicate. In the business arena, large enterprises have been well served by new services. However, small-and medium-sized businesses (SMBs) have suffered as customisable services at cost-effective prices have not been available. Only recently has new technology been able to assist this market segment. The specific requirements of the SMB sector are examined in this paper and propositions to address these requirements are discussed. A shared platform architecture to deliver the services to the SMB market-place is considered in detail.

Economic Framework for Melbourne Traffic Planning

elbourne has the size, population density and car ownership levels of many North American cities but the levels of public transport infrastructure seen in European cities. Although possessing aboveaverage public transport infrastructure it still faces problems of dealing with high car use and socially-costly traffic congestion that amount to losses of billions of dollars annually. The costs include wasted travel time, increased stress and fatigue, excessive fuel and maintenance costs, lower worker productivity, increased transport capital requirements, reduced business competitiveness and deterioration of an otherwise aesthetically pleasing environment. Although these costs can be reduced with demand-side policies, roads are the only public utility in Victoria not targeted for efficient pricing. In this paper, economics-based policies are proposed for ameliorating Melbourne’s traffic congestion. A suite of demand-side strategies is suggested including a cordon pricing scheme for the central city, parking policies which address boundary problems on the cordon perimeter and pricing of major arterials and ring-roads. These policies should be accompanied by ‘traffic calming’ measures on smaller urban roads. Auxiliary public transport pricing reforms are advocated promoting competition. Current policies of concentrating urban expansion on city boundaries are criticised. The proposed policy mix is a stop-gap bringing congestion closer to efficient levels thereby facilitating transfer to comprehensive electronic pricing. Comprehensive ‘first-best’ pricing of Melbourne’s roads by satellite monitoring is impractical due to high start-up costs relative to congestion. However, inexpensive demand-side policies can reduce congestion costs. This paper exposits such policies. Section 2 overviews Melbourne’s transport system. Section 3 analyses congestion policies emphasising demand-side tactics and costeffective cordon pricing of the city centre. Supply-side strategies, information policies, indirect demand-side strategies and other policies are discussed. Section 4 outlines a plan to relieve radial and central traffic congestion by curb-side pricing, cordon pricing and ‘traffic calming’. Section 5 explains why direct demand-side strategies are generally unsuited to reduce cross-town congestion. Section 6 offers conclusions and final remarks.

The UNESCO Bioethics Declaration ‘social responsibility ’ principle and cost-effectiveness price evaluations for essential medicines

The United Nations Scientific, Education and Cultural Organisation (UNESCO) has commenced drafting a Universal Bioethics Declaration. Some in the relevant UNESCO drafting committee have previously desired to restrict its content to general principles concerning the application (but not necessarily the goals) of science and technology. As potentially a crucial agenda-setting statement of global bioethics, however, it is arguable important the Universal Bioethics Declaration transparently address major bioethical dilemmas in the field of public health, such as universal access to affordable, essential medicines. Article 13 (Social Responsibility) of the Preliminary Draft Universal Bioethics Declaration states: 'Any decision or practice shall ensure that progress in science and technology contributes, wherever possible, to the common good, including the achievement of goals such as: (i) access to quality health care and essential medicines, including for reproductive health and health of children.' Cost effectiveness pricing systems, such as that most notably used in Australia's Pharmaceutical Benefits Scheme (PBS), arguably represent one of the most scientifically effective mechanisms whereby public monies may be utilised to assist in the provision of medicines for the common good. They contain two essential elements: first, a process of scientific evaluation of objectively demonstrated therapeutic significance, and then, a fiscal lever (the government reimbursement price) attached to that evaluation. It is now well established that the US Pharmaceutical Research and Manufacturers Association (Pharma), through the assistance of the US Trade Representative (USTR), saw the Australia United States Free Trade Agreement (AUSFTA) as an opportunity to fulfill a legislative mandate to 'eliminate' the cost-effectiveness pricing system in Australia's PBS. One of the most remarkable features of the arguments raised against the PBS in this context was the fact that they made almost no reference to the normative discourse of bioethics or international human rights. Provisions such as Article 13 in UNESCO's Universal Bioethics Declaration, although they will create no immediate obligations under international law, may play an extremely valuable role in legitimising the use of bioethical and human rights concepts in access to medicines debates surrounding multilateral and bilateral international trade deals such as the AUSFTA.

Detecting motor bearing faults

Three-phase induction motors are the workhorses of industry because of their widespread use. They are used extensively for heating, cooling, refrigeration, pumping, conveyors, and similar applications. They offer users simple, rugged construction, easy maintenance, and cost-effective pricing. These factors have promoted standardization and development of a manufacturing infrastructure that has led to a vast installed base of motors; more than 90% of all motors used in industry worldwide are ac induction motors. Causes of motor failures are bearing faults, insulation faults, and rotor faults. Early detection of bearing faults allows replacement of the bearings, rather than replacement of the motor. The same type of bearing defects that plague such larger machines as 100 hp are mirrored in lower hp machines which has the same type of bearings. Even though the replacement of defective bearings is the cheapest fix among the three causes of failure, it is the most difficult one to detect. Motors that are in continuous use cannot be stopped for analysis. We have developed a circuit monitor for these motors. Incipient bearing failures are detectable by the presence of characteristic machine vibration frequencies associated with the various modes of bearing failure. We will show that circuit monitors that we developed can detect these frequencies using wavelet packet decomposition and a radial basis neural network. This device monitors an induction motor's current and defines a bearing failure.

Low-cost networking for dynamic window systems

A low-cost building communications network is needed that would allow individual window and lighting loads to be controlled from an existing enterprise LAN network. This building communications network concept, which we term Integrated Building Environmental Communications System (IBECS™), would enable both occupant-based and building-wide control of individual window, lighting, and sensor devices. IBECS can reduce the cost of systemic control because it allows a drastic cost reduction in per point networking costs. This kind of effort is needed to encourage the control industry to make the commitment to build this technology and to demonstrate to prospective customers that this breakthrough approach to more comprehensive systemic control will provide them with high-quality, convenient control while saving them money. The development and demonstration of network interfaces to DC- and AC-motorized shades and to an electrochromic window are described. The network interfaces enable one to control and monitor the condition of these fenestration appliances from a variety of sources, including a user’s personal computer. By creating a functional specification for an IBECS network interface and testing a prototype, the ability to construct such an interface was demonstrated and the cost-effective price per point better understood. The network interfaces were demonstrated to be reliable in a full-scale test of three DC-motorized Venetian blinds in an open-plan office over 2 years and in limited bench-scale tests of an electrochromic window.

Post Harvest Mangement of Split Thickness Skin Graft Donor Sites; A systematic Review

Introduction The use of the split skin graft as reconstructive technique is commonplace. This process involves the creation of a superficial wound that is the donor site.The focus of this review is the post harvest management of the Split Thickness Skin Graft (STSG) donor site. The aim of donor management is to maintain an environment that promotes optimal healing and prevents morbidity that may include, pain, infection and ultimately delayed healing. The focus of research in this area relates mainly to the type of dressings used. The recent developments in dressing technology, the continued variability in practice and persistent recommendations to use non-moist wound healing methods as an alternative demonstrate the need for a systematic review in this area of care. Objectives To conduct a systematic review to determine the best available evidence related to the post harvest management of STSG donor sites. Specific review questions addressed; interventions/dressings used in the management of the STSG donor site, interventions/dressings used in managing infected STSG donor sites, and interventions managing the healed STSG donor site. Criteria for considering studies in this review This review considered all studies that included patients of any age and that related to the objectives of the review. Outcomes included measures of healing, infection rate, and pain scores. The review primarily considered any intra-individual trials (IITs) and prospective randomised controlled trials (RCTs) relating to the management of STSG donors but also considered other studies when RCTs and IITs were not identified. Search strategy for identification of studies The search sought to find published and unpublished studies. The databases searched included; CINAHL, Medline, Pre-Medline, Cochrane Library, Current Contents, Healthstar, Embase, Expanded Academic Index, and Dissertation Abstracts International. Studies were additionally identified from reference list of all studies retrieved. Assessment and data extraction All studies were checked for methodological quality, and data extracted using a data extraction tool. Results Interventions relating to the post harvest management of STSG donor sites The objectives in managing a STSG donor site are, to achieve healing as rapidly as possible, without complication, maximising patient comfort and at a cost effective price. Treatment regimes vary considerably in terms of their ability to achieve these objectives and cost in particular can be a significant factor. The circumstances of the patient will dictate which of these objectives have priority. Moist verses non-moist wound healing products The analyses for this comparison revealed with a strong degree of confidence based on many acceptable RCT/IITs that moist wound healing products are significantly superior to non-moist products in terms of healing, infection rates and pain/comfort. Calcium alginates There were insufficient studies of sufficient quality to make any judgement between the performance of calcium alginates and other moist wound healing products or between specific products within the calcium alginate group. Well designed clinical trials should be conducted to compare calcium alginates with other moist wound healing products. Hydrocolloids Hydrocolloids were found to be superior to non-moist wound products in relation to healing, pain, and infection. The studies comparing hydrocolloids with other non-moist products in relation to healing are insufficient to indicate that they are superior to other moist wound healing products. The results for the outcomes of pain and rates of infection suggest that hydrocolloids are not superior to other moist products. The overall cost of any of the treatments used in wound management is greatly affected by frequency of dressing changes. It has been suggested that when hydrocolloids leak that reinforcement rather than changing the dressing outright is appropriate and has no greater risk of morbidity, this should be more rigorously TRUNCATED AT 600 WORD

Computer-aided tolerance synthesis with statistical method and optimization techniques

Most tolerance design optimization problems have focused on developing exact methods to reduce manufacturing cost or to increase product quality. The inherent assumption with this approach is that assembly functions are known before a tolerance design problem is analyzed. With the current development of CAD (Computer-Aided Design) software, design engineers can address the tolerance design problem without knowing assembly functions in advance. In this study, VSA-3D/Pro software, which contains a set of simulation tools, is employed to generate experimental assembly data. These computer experimental data will be converted into other forms such as total cost and Process Capability Index. Total cost consists of tolerance cost and quality loss. Then, empirical equations representing two variables can be obtained through a statistical regression method. After that, mathematical optimization and sensitivity analysis are performed within the constrained ‘desired design and process’ space. Consequently, tolerance design via computer experiments enables engineers to optimize design tolerance and manufacturing variation to achieve the highest quality at the most cost effective price during the design and planning stage. Copyright © 2001 John Wiley & Sons, Ltd.

Construction of a Semi‐Prefabricated Masonry Facade

One of the crucial problems that faces designers, construction managers, general contractors, and subcontractors is creating the most appealing facade of a building at the most cost-effective price, while satisfying an owner’s goal of exploiting the enclosed space to maximum advantage. A brick facade has long been considered a durable and aesthetic solution for the exterior walls. A stud wall with gypsum board sheathing is today’s most economical and widely used interior perimeter material. The development of innovative construction techniques that combine this exterior facade with interior perimeter materials in the most cost-effective and time-effective manner is the object of continuing trial and error. The industrialization of construction components has long been considered but, as yet, is not widely used, although its future appears bright. This paper analyzes the advantages of a semi-prefabricated facade based on specific experience.