Initial Expenditure Research Articles

Changes in Initial Expenditures for Benign Prostatic Hyperplasia Evaluation in the Medicare Population: A Comparison to Overall Medicare Inflation

Benign prostatic hyperplasia creates significant expenses for the Medicare program. We determined expenditure trends for benign prostatic hyperplasia evaluative testing after urologist consultation and placed these trends in the context of overall Medicare expenditures. Using a 5% national sample of Medicare beneficiaries from 2000 to 2007 we developed a cohort of 40,253 with claims for new visits to urologists for diagnoses consistent with symptomatic benign prostatic hyperplasia. We assessed trends in initial inflation and geography adjusted expenditures within 12 months of diagnosis by evaluative test categories derived from the 2003 American Urological Association guideline on the management of benign prostatic hyperplasia. Using governmental reports on Medicare expenditure trends for benign prostatic hyperplasia we compared expenditures to overall and imaging specific Medicare expenditures. Comparisons were assessed by the Z-test and regression analysis for linear trends, as appropriate. Between 2000 and 2007 inflation adjusted total Medicare expenditures per patient for the initial evaluation of patients with benign prostatic hyperplasia seen by urologists increased from $255.44 to $343.98 (p <0.0001). Benign prostatic hyperplasia related imaging increases were significantly less than overall Medicare imaging expenditure increases (55% vs 104%, p <0.001). The increase in per patient expenditures for benign prostatic hyperplasia was significantly lower than the increase in overall Medicare expenditures per enrollee (35% vs 45%, p = 0.0015). From 2000 to 2007 inflation adjusted expenditures increased for benign prostatic hyperplasia related evaluations. This growth was slower than the overall growth in Medicare expenditures. The increase in BPH related imaging expenditures was restrained compared to that of the Medicare program as a whole.

The fiscal outcome of artificial conception in Brazil--creating citizens in developing countries

Infertility is an important health issue, but only a small fraction of the affected population receives treatment in Brazil, because it is not covered by the government or private health insurance plans. We developed a generational accounting-based mathematical model to assess the direct economic result of creating a citizen through IVF in different economic scenarios, and the potential economic benefit generated by the individual and his/her future offspring. A mathematical model analyzes the revenues and expenses of an IVF-conceived individual over his lifetime. We calculated the net present value (NPV) of an IVF-conceived citizen, and this value corresponds to the fiscal contribution to the government by an individual, from birth through his predicted life expectancy. The calculation used discount rates of 4.0 and 7.0% to depreciate the money value by time. A 4.0% discount rate represents the most favorable economic scenario in Brazil, and it results in an NPV of US$ 61 428. A 7.0% discount rate represents a less favorable economic reality, and it results in a debit of U$ 563, but this debt may be compensated by his/her future offspring. The fiscal contribution generated by each IVF-conceived citizen can justify an initial government investment in infertility treatment. Poor economic times in Brazil can sometimes result in a fiscal debt from each new IVF-conceived child, but this initial expenditure may be compensated by the fiscal contribution in the next generation.

Mobile Infrastructure Sharing - An Indian Scenario

The paper focuses on the emerging trend on the Infrastructure Sharing Business of the Telecom Industry in the India Domain. Initially, all the telecom towers were maintained by the operators themselves, but now the trend is changing and the independent companies are coming up with the sole business of lending infrastructure and support to the telecom operators. This trend has changed the pattern of Initial Capital expenditure as well as the Operating expenditure of the operators. The paper also describes the auction policy of the Government of India for the 3G and BWA spectrum. The operators operating at the various circles along with various frequency bands are also taken care of. The actions of the regulatory bodies like the Telecom Regulatory Authority of India(TRAI) and the Department of Telecommunication has been controlling the regulatory issues and the way in which Indian Telecom will move in the future is much dependent on these apex bodies. Moreover, the synchronization of Indian regulatory issues with that of the International one is a must for the future. The study tries to find out the need of tower sharing in India along with the effort to find the future tower demands. The distinct functionalities of the Independent and the Operator owned tower companies will be vital for India's Telecom growth and their requirements are looked into. Finally, focus has also been given towards the various advantages and disadvantages of the infrastructure sharing pattern evolving in India and the future course of action in that domain.

Are State Expenditures to Promote Tourism Effective?

Our focus is the effect of public spending to promote tourism on tourism growth and broader economic growth among U.S. states. We estimate a series of regression models using a panel of state-level data for the years 1985 through 2003 to identify the effect of public tourism promotion spending (TPS) on state tourism growth, gross state product growth, and state employment growth, when such spending is financed through own-source revenues. Results indicate that the effect of higher TPS on tourism or employment growth depends on the existing level of tourism expenditures in the state. More specifically, results indicate that additional TPS increases tourism and employment growth for states that have low levels of initial tourism expenditures. However, that effect diminishes as initial levels of tourism expenditures increase. For states with very high initial levels of tourism expenditures, employment can decline following increased TPS funded through own-source revenues.

Competitive advantage from mandatory investments

Mandatory information system (IS) investments occur when government regulations require firms to alter their IS. These investments are additional expenditures added onto the initial expenditures of...

Competitive advantage from mandatory investments: An empirical study of Australian firms

Mandatory information system (IS) investments occur when government regulations require firms to alter their IS. These investments are additional expenditures added onto the initial expenditures of non-mandatory IS investments. Managers are concerned about associated costs and in an attempt to reduce the expenditures, most firms refrain from formal planning methods when mandatory investments are imposed upon them. Drawing on Henderson’s and Sifonis’ (1988) IS Planning and Investment Model as our theoretical lens, this paper argues that firms should re-consider this practice. It is hypothesised that formal planning methods are beneficial because they enable firms to combine mandatory and non-mandatory investments in such a way that competitive advantage can be achieved. We use a secondary dataset provided by the Australian government to test the hypotheses. Results show that only two out of three investigated formal planning methods are positively associated with competitive advantage. We conclude that in the special case of mandatory investments, formal methods are only beneficial if they incorporate information from the entire firm, rather than information from particular departments only.

Program Design and Long-Run Costs of a National Catastrophic Drug Insurance Plan

There are strong arguments that national catastrophic drug insurance should be established in Canada with assistance from the federal government. The author of this paper projects the long-run program costs for two proposals for such a program: that of the Kirby Committee and that of the Romanow Commission. He concludes that both the annual program costs to the federal government and the share of the federal government on total prescription drug expenditures in Canada would increase dramatically under either program. Although the Kirby-style program requires less initial expenditure by the federal government than does the Romanow-style program, because of their different designs, over time the Kirby-style program would become more expensive. Moreover, the Kirby-style program would be more sensitive to the growth rate of prescription drug expenditure. The choices relating to the program threshold and federal cost-sharing rate have far-reaching influences on the long-run costs to the federal government.

Primary Prevention of Sudden Cardiac Death: Can We Afford the Cost of Cardioverter‐Defibrillators? Data from the Search‐MI Registry‐Italian Sub‐study

Large randomized trials show that in appropriately selected patients with left ventricular dysfunction, implantable cardioverter-defibrillators (ICDs) can improve overall survival at 2-5 years. Since direct implementation of the criteria used in the MADIT II and SCD-HeFT will lead to a marked rise in ICD implants, there is a growing fear that increased use of ICDs may cause a dramatic burden to health care systems. The ICD has traditionally been seen as an expensive form of treatment, which is difficult to accept at the first look. This is mainly due to the nonlinear character of the ICD investment, characterized by high initial expenditure, followed by a deferred pay-off in terms of clinical benefits. Cost-effectiveness analysis may help provide a different perspective on the problem of ICD cost, as may estimation of the daily cost of ICD treatment, assuming a time horizon of 5-7 years--a particularly interesting subject for further registry studies. Based on real expenditure data from 2002 to 2005, as recorded in the Search-MI Registry-Italian Sub-study of patients implanted on MADIT II indications, we estimated the daily costs associated with the device and leads. Over a 5-7 year time horizon, the average daily cost was estimated to be euro 4.60-euro 6.70. Translation of these figures into U.S. market conditions suggests a daily cost of around $7.90-$11.40. These findings appear useful to help evaluate the affordability of ICD in comparison with other therapeutic options in a context of limited available economic resources.

Economic analysis of a shopping center in seismic zone

Life cycle cost (LCC) is an important factor in economic analysis in order to cover all expected costs and benefits for an economic life. If a decision has to be made for investment purposes then damage cost incurred due to an earthquake should also be taken into account. Therefore, the total LCC of a structure in a seismic zone should be evaluated in terms of, not only its initial cost, expenditure and income but also earthquake damage cost. This paper provides an LCC analysis for economic evaluation of a shopping center located in a seismic zone. The effects of monthly income, recovery periods, initial cost, discount rate and occurrence time of an earthquake on total LCC are observed throughout the analysis period.

What's the real cost of higher efficiency?

The problems that California had with electrical energy have only emphasized the need to look at the true cost of high-efficiency energy devices used by cement plants since electrical energy is among the top expenses in producing cement. This article focuses on low-voltage induction motors and lighting systems. Low-voltage induction motors generally account for about 30% of the electrical energy consumed by a cement plant. Lighting systems generally account for about 3-5% of the electrical energy consumed by a cement plant, but it is a fixed load that does not directly contribute to production. Life-cycle cost analysis is used to determine the true costs of this equipment. True equipment cost is defined as the total of the initial capital expenditures plus the operating costs, which include energy and maintenance. Even though the foremost requirement for a piece of equipment is its performance in the production chain, the justification for selecting one piece over another should be based upon the initial capital cost plus operating expenses. A review is given of two selected areas of electrical equipment to test their cost of ownership.

Optimal Strategies for Highway Pavement Management in Developing Countries

Highway pavement design in developing countries is usually based on standards borrowed from industrialized countries. However, it may not be economically feasible to use these high design standards in developing countries, because of significant differences in socioeconomic conditions. Using the World Bank’s highway design and maintenance standards model (HDM‐III), this paper investigates optimal pavement design and its relationship with the developmental stage of a country. Optimal pavement design can be defined as that which minimizes total transport costs to society, which comprise the sum of agency costs and road user costs. Basic data for the analysis were derived from Chinese conditions, and appropriate adjustments were made to model five classes of hypothetical countries in different developmental stages. It is shown that the optimal trade‐off between initial expenditure on construction and subsequent maintenance depends on the developmental stage of an economy. The same high design standards that are suitable for industrialized countries may not be economically justified in developing countries. Developing countries should start with modest pavements and then spend more on maintenance afterwards, which is an overdue, neglected priority today.

A system of equations model of UK tourism demand in neighbouring countries

This paper uses a system of equations model to examine tourism demand during periods of destination country transition and integration into the wider international community. The Almost Ideal Demand System model is applied to the UK demand for tourism in the neighbouring destinations, France, Spain and Portugal. Spain and Portugal are interesting cases as, during the period under consideration, they experienced a process of transition from economies with characteristics typical of developing countries, only entering the World Bank's industrialized countries classification in the 1980s. The paper examines the evolution of tourism demand during these countries' transition from ‘developing’ to ‘developed’ status. Consideration of France as a neighbouring destination also allows the behaviour of tourism demand to be compared between relatively rich and poor countries. The results show the extent to which the cross-country behaviour of demand becomes more or less similar over time with respect to changes in expenditure and effective prices. The expenditure elasticities are greater for Spain than France during the initial period, indicating that tourism can assist countries to ‘catch-up’ with their richer neighbours. However, this outcome is not always the case and may not persist, as Portugal had a low initial expenditure elasticity and Spain's relatively high expenditure elasticity decreased over time. Destinations' sensitivity to changes in their own and competitors' prices can also change over time, as indicated by the increases in the own- and cross-price elasticities for Spain, compared with the decreases for France and Portugal. The cross-price elasticity estimates indicate substitutability between the immediate neighbours, Portugal and Spain, and France and Spain.

Combined effect of reduced dose of gypsum and salt tolerant varieties of rice (Oryza sativa) and wheat (Triticum aestivum) on rice-wheat cropping system in sodic soils

A field experiment was conducted at Lucknow in Uttar Pradesh during 2001-2002 to 2003-04 on a fine loamy, mixed, hyperthermic, sodic soil having high pH, low electrical conductivity, high exchangeable sodium percentage and very low water permeability to find out the combined effect of reduced dose of gypsum and salt tolerant variet- ies of rice ( Oryza sativa L.) and wheat ( Tr iticum aestivum L. emend. Fiori &amp; Paol.) on productivity of rice - wheat cropping system in sodic soil. This study revealed that application of gypsum @ 25% gypsum requirement (G.R.) and growing of salt tolerant varieties of rice CSR 13 and wheat KRL 19 significantly increased the yield attributes and yields of these crops in the system over control treatment as well as 15% G.R. So much so it was at par with 50% G.R. with non- salt tolerant varieties. The magnitude of combined effect of reduced dose of gypsum and salt tolerant varieties was reflected as 17 and 8.2% increase in grain yield over their counterpart varieties. Interaction between gypsum levels and salt-tolerant varieties on grain yields indicated that gypsum @ 25% G.R. with sodicity tolerant varieties in rice-wheat cropping system could save about 43% of the total initial expenditure for the recla- mation of sodic soils over the recommended dose of gypsum (50% G.R.) with non-sodicity tolerant traditional high yielding varieties. Thus, for low-cost effective technology, treating the sodic soils with reduced dose of gypsum (25% G.R.) and growing salt tolerant varieties of rice 'CSR 13' and wheat 'KRL 19' proved highly economical and sustainable technology for resource scarce situations.

Effect of swine waste concentration on energy production and profitability of aerobic thermophilic processing

Improvements to aerobic thermophilic processing have led to the ability to recover significant amounts of energy as hot water (∼55°C). This energy can easily be made useful in swine production facilities as a source of heating for farrowing or nursery buildings, aquaculture tanks or greenhouses for most of the year. Work is underway to investigate alternative uses for the energy in the hot months. Potentially, the energy may be used to dry the residual solids from the process (∼40% of the original amount of solids) and these solids may be used for application as: (1) field fertilizer in the non-growing season, (2) a high value organic food fertilizer, and (3) dry solids for co-firing in electric power stations. Heat produced may also be used to generate induced draught in chimneys to aid in building ventilation, reducing electric power consumption, and also to power state-of-the-art refrigeration/chilling systems for cooling production buildings. This work makes use of a design and economic model for a given configuration of aerobic thermophilic treatment suitable for swine production facilities to evaluate the effects on economics and energy production of various swine waste concentrations. While actual waste from the animal may be in the 130 g l −1 dry solids range, waste for treatment is often diluted based on hog watering rates and building cleanout and flush systems. Some concentrations are as low as 15 g l −1 . Lower waste concentrations require larger initial expenditures related to increased reactor volumes and tend to strongly affect the profitability of the process. Straightforward engineering design considerations permit profitable use of this technology even in these low concentration ranges.

Future trends in high-resolution lithography

A perennial question is “what is the future of high-resolution lithography, a key technology that drives the semiconductor industry”? The dominant technology over the last 30 years has been optical lithography, which by lowering wavelengths to 193 nm (ArF) and 157 nm (F 2) and by using optical “tricks” such as phase shift masks, off-axis illumination and phase filters, should be capable of 100 nm CMOS technology. So where does this leave the competition? The 100-nm lithography used to be the domain of electron beam lithography but only in research laboratories. Significant efforts are being made to increase throughput by electron projection (scattering with angular limitation projection electron beam lithography or SCALPEL). X-ray lithography remains a demonstrated R&D tool waiting to be commercially exploited but the initial expenditure to do so is very high. Ion beam lithography and extreme ultraviolet (EUV) ( λ<12 nm) have also received attention in recent years. This paper will concentrate on some of the key issues and speculate on how and when an alternative to optical lithography will be embraced by industry.

Innovation and risk management in a small subsea-tieback: Arkwright Field, Central North Sea, UK

Arkwright is a 50 × 10 6 BBL oil field located within a single Forties Sandstone Member turbidite ‘channel’ system. Arkwright was discovered in 1990 and developed in 1996. Earlier start-up was precluded by reservoir risk and lack of export pipeline capacity. Reservoir definition improved after acquiring a 3D survey and applying imaging and attribute studies. This, combined with subsurface analogue, core, and carbon, oxygen and strontium isotopic studies, improved understanding of reservoir architecture and connectivity. Geostatistical techniques were used to quantify the STOIIP. The main risks identified were the absence of aquifer support, and possible vertical and lateral baffling. As these could not be tested by appraisal drilling it was decided to commence development. Low-cost, two-well development options were considered and rejected because of the subsurface risk. Without guaranteed aquifer support, the productivity from early sub-bubble point flow would be lost waiting for injection support to be added. Risk-weighting highlighted the advantage of initial expenditure to safeguard the project, and so a third initial production well was planned, in a location suitable for conversion to injection. Predicted rates were increased and the impact of lateral baffling minimized by drilling deviated producers on opposite sides of the structure, and not reusing the discovery well. Costs were reduced by using a drilling centre outside the field. The perforation strategy ensures drainage above and below potentially sealing abandonment shales, and facilitates future zonal isolation. Communication within the reservoir was tested at start-up with an interference test.

Impacts of rail privatization in Britain

Current policies in Britain involve means by which the state avoids a large initial expenditure, or gains a large income in a short period, offset against future negative cash flows. In the case of rail privatization, sale of the rolling‐stock leasing companies (ROSCOs) in the 1995/96 financial year, followed by Railtrack in the 1996/97 financial year, has produced over £3000 million (£3000m) as income to the state, but this is offset by large payments (vis‐à‐vis those under the previous rail ownership structure) to Train Operating Companies (TOCs) to meet the charges imposed by ROSCOs and Railtrack. A brief parallel is drawn with the case of DBFO (Design, Build, Finance, Operate) road schemes, in which the private sector provides initial capital, but subsequently receives revenue through shadow tolls from taxation. In both cases, the long‐run outcome is dependent upon the bids made for TOCs and DBFO projects. Discounted cash flows are used to compare present values for the current rail policy vis‐à‐vis a continuation of the previous system. In the case of rail privatization, the net outcome for the state depends upon the realism of bids made by the current franchisees.

Platelet-Rich Plasmapheresis: A Meta-Analysis of Clinical Outcomes and Costs

Platelet-rich plasmapheresis (PRP) just prior to cardiopulmonary bypass (CPB) surgery is used to improve post CPB hemostasis and to minimize the risks associated with exposure to allogeneic blood and its components. Meta-analysis examines evidence of PRP's impact on clinical outcomes by integrating the results across published research studies. Data on clinical outcomes was collected from 20 published studies. These outcomes, DRG payment rates, and current national average costs were used to examine the impact of PRP on costs. This study provides evidence that the use of PRP results in improved clinical outcomes when compared to the identical control groups not receiving PRP. These improved clinical outcomes result in subsequent lower costs per patient in the PRP groups. All clinical outcomes analyzed were improved: blood product usage, length of stay, intensive care stay, time to extubation, incidence of cardiovascular accident, and incidence of reoperation. The most striking differences occur in use of all blood products, particularly packed red blood cells. This study provides an example of how initial expenditure on technology used during CPB results in overall cost savings. Estimated cost savings range from $2,505.00 to $4,209.00. More importantly, patients benefit from improved clinical outcomes.

Monobore Completions and Novel Wireline Perforating of High-Angle Wells in the Nelson Field

The Nelson field gas-lift completions were designed to optimize production, enhance safety and reliability, and minimize well-maintenance costs. The completions are of a near-monobore design and include an annular safety system, which is regarded as a major safety benefit during gas lift. The single-trip completions were batch installed in eight high-angle (up to 70{degree}) predrilled wells. This paper presents details of the completion design and the approach taken to planning and installing the completions. The paper also describes the use of a novel technique for perforating the platform wells with wireline guns.

An economic evaluation of surgery for temporal lobe epilepsy

We wished to determine whether surgery in adults with difficult to control temporal lobe epilepsy (TLE) is more effective and less costly than medical therapy. We evaluated the costs and consequences of surgical versus medical treatment of TLE, using decision-analysis modeling and an intention-to-treat approach. Data on outcome probabilities and resource utilization were obtained from critical appraisal of the literature, local experience, a panel of experts, and community patient survey. Surgically treating 100 patients for 35 years results in 57 seizure-free patients and a cost of $8,117,911. Medically treating 100 patients results in 12 seizure-free patients and a cost of $10,741,425. Surgery required a larger initial expenditure than medical treatment ($2,775,640 vs. $856,970), but cost-time curves intersect at 8.5 years and surgery remained cheaper thereafter. Results were unchanged by extensive sensitivity analyses. The major determinant of surgical dominance is its greater effectiveness (seizure-free rate) as compared with medical treatment. Surgery remained less costly, with concurrent effectiveness rates >41 and <30%, respectively, for surgical and medical treatment. Available evidence indicates that TLE surgery is more effective and cheaper than medical treatment, a win-win situation. However, adequately designed, controlled trials are necessary to determine more accurately and comprehensively the effectiveness of each therapeutic alternative.