Maximum Allowable Cost Research Articles

Analysis of the cost-effectiveness of early diagnosis and pharmacotherapy of pulmonary arterial hypertension

Over the past decades, health policy makers have focused on early diagnosis to introduce targeted and innovative treatments. Early diagnosis of pulmonary arterial hypertension (PAH) is associated with improved long-term survival, so screening high-risk groups is a reasonable strategy to improve outcomes in PAH treatment.
 Today, screening is an important part of preventive medicine, with the goal of detecting disease at an early and pre-symptomatic stage.
 All healthcare systems have limited resources and face opportunity costs; this means that any investment in a screening tool will come at the expense of other healthcare services, to the detriment of those patients who would otherwise be treated.
 By recognizing opportunity costs, health systems can require that health interventions be both clinically and cost-effective to be considered for implementation.
 The objective of the paper –to conduct a cost-effectiveness analysis of early diagnosis and pharmacotherapy of pulmonary arterial hypertension.
 Our analysis of the cost-effectiveness of early diagnosis and pharmacotherapy of pulmonary arterial hypertension is based on a cost‒utility model that estimates patient survival, which is significantly improved by reducing the delay in diagnosis of PAH and indicates the prevention of premature death of undiagnosed patients. The analysis of input data was conducted using systematic review, documentary, informational and graphical research methods.
 The results of the study showed that the choice of the target population and the level of diagnostic coverage of this risk group is critical for the cost-effectiveness of the implementation of PAH diagnostic screening. A decrease in these indicators leads to a decrease in the maximum allowable cost of diagnostic screening, and thus to a decrease in its profitability in real medical practice. The introduction of new treatments and the corresponding increase in the utility of PAP detection have the most positive effect on the profitability of the PAP diagnostic screening program.
 This cost-effectiveness analysis is the first attempt to evaluate the economic value of reducing the delay in PAH diagnosis compared to its benefits to the health care system and society as a whole.

Effectiveness of phase change material in improving the summer thermal performance of an office building under future climate conditions: An investigation study for the Moroccan Mediterranean climate zone

The rise in global temperature due to the climate change phenomenon would increase the severity of summer season in the future. The integration of phase change materials (PCM) into the building envelope has been considered as one of the most promising measures to improve the thermal performance of buildings. This paper aims at investigating the effectiveness of the PCM in improving summer thermal performance of buildings under the climate conditions of the next three decades. The moderate scenario RCP4.5 of the Intergovernmental Panel on Climate Change was used to simulate future climate conditions. The present study was conducted for two building case studies: free-running and air-conditioned office buildings located in the north of Morocco (Mediterranean climate with hot summer). The findings have disclosed that an appropriate selection of the PCM melting temperature could enhance the thermal performance by 9.87 % for the free-running building and by 20.5 % for the air-conditioned building case over the whole building lifespan (30 years). A decade-by-decade analysis showed that the effectiveness of the optimum selected PCM would slightly decline over time. The research involved an economic analysis of the air-conditioned building case study. The latter led to calculating the maximum allowable cost of the PCM installation to achieve a payback period within the lifespan of the building. The findings of the present work can be used as guidelines to design office buildings integrated with PCM in the Mediterranean region.

Moisture-participating MOF thermal battery for heat reallocation between indoor environment and building-integrated photovoltaics

The present deployment of photovoltaic (PV) panels on the rooftop has been far below its potential. Stakeholders often see the PV as a strong design constraint, isolated from the built environment and not adapted to their requirements. Here, we propose a new design that combines the PV panels with a metal-organic framework based sorptive thermal battery, which serves as a multi-functional building element and is more actively involved in the indoor environment regulation. The open-loop thermal battery can stock moisture from air with 10 5 times its volume so that the built environment with high humidity at night is dried to a comfortable and healthy level. The moisture is removed at daytime with unpleasant solar heat, thereby cools the PV panels simultaneously, improving electricity generation by 5%. The benefits of this design can be translated into economic added value to facilitate investment decisions of building-integrated PV projects. We demonstrate a new design of MOF-based thermal battery to reallocate heat between PV panels and the built environment in bi-direction. Using excess moisture for discharging and waste solar thermal for charging realizes the dehumidification and PV cooling alternately. The interactive working mode can significantly benefit the maximum allowable cost of such an energy storage and transfer system to facilitate the investment decision of stakeholders along the value chain. • Novel MOF heat battery for building integrated PV. • Heat reallocation performances of less hydrophilic MOFs are more robust. • Energy benefits of the bi-directional working mode are two-fold on aspects of cooling and dehumidification. • Economic value of interactive system design to the built environment is more prominent.

A Two-Stage DSS to Evaluate Optimal Locations for Bioenergy Facilities

Research Highlights: A set of 128 potential bioenergy facility locations is established and evaluated based on the transport cost to select optimal locations. Background and Objectives: The identification of optimal facility locations to process recovered forest biomass is an important decision in designing a bioenergy supply chain at the strategic planning level. The result of this analysis can affect supply chain costs and the overall efficiency of the network, due to the low density and dispersed nature of forest biomass and the high costs associated with its logistics operations. In this study, we develop a two-stage decision support system to identify the optimal site locations for forest biomass conversion based on biomass availability, transport distance and cost. Materials and Methods: In the first stage, a GIS-based analysis is designed to identify strategic locations of potential bioenergy sites. The second stage evaluates the most cost-effective locations individually using a transportation cost model, based on the results from stage one. The sensitivity of inputs, such as maximum allowable transport cost, the distance of transport and their relations to the profit balance, and changes in fuel price are tested. The method is applied to a real case study in the state of Queensland, Australia. Results and Conclusions: The GIS analysis resulted in 128 strategic candidate locations being suggested for bioenergy conversion sites. The logistics analysis estimated the optimal cost and transportation distance of each one of the locations and ranked them according to the overall performance between capacities of 5 and 100 MW.

Reaction systems for solar hydrogen production via water splitting with particulate semiconductor photocatalysts

Photocatalytic water splitting using particulate semiconductor materials has been studied as a simple means of hydrogen production. However, there are still many obstacles to the development of complete, practical and renewable solar hydrogen production processes. This review discusses particulate photocatalyst systems intended for large-scale solar hydrogen production via water splitting, focusing on their current status and potential impact. The cost and efficiency targets for solar-to-fuel conversion on a practical scale are also reviewed, based on the maximum allowable cost of solar hydrogen production systems, which has been estimated to be US$102 m–2, at most. Particulate photocatalyst material design principles are discussed, using efficient oxide photocatalysts as examples. Approaches to constructing photocatalytic reactors extensible to large areas are also introduced. Finally, challenges related to the development of efficient and inexpensive photocatalyst systems and potentially useful analytical methods are outlined. Photocatalytic water splitting with particulate semiconductors represents a promising strategy for the generation of hydrogen as a solar fuel. This review covers recent advances in the development of reaction systems and photocatalysts towards the scale-up of this technology, emphasizing at the same time the challenges to overcome.

The Effect of Project Manager’s Leadership Style on Performance of Water Projects in Kenya

The objective of this study was to determine the relationship between project manager’s leadership style and performance of water projects in Kenya. Operationalization of leadership style was based on transformation and transaction leadership style while project performance was based on project time and cost performance. The study analyzed secondary and primary data for 102 water projects that were completed between 2011 and 2014. Hierarchical regression analysis was undertaken on the variables. The results show that a significant relationship exist between project manager’s leadership style and project time performance. In addition, the findings show that adoption of transformational leadership style leads to higher level of project performance. However, no significant relationship was established between project manager’s leadership style and project cost performance. This may be due to the use of fixed price contracts that specify the conditions for escalation and the maximum allowable cost escalations which could have made cost changes insignificant. The study has provided empirical evidence on the relationship between project manager’s leadership style and project performance within a developing country context. To enhance project time performance, project manager’s leadership style is critical and managers should strive to intellectually stimulate project team members.

Third-party reimbursement for generic prescription drugs: The prevalence of below-cost reimbursement in an environment of maximum allowable cost–based reimbursement

ObjectivesTo examine average prescription gross margin (GM) for prescriptions and to evaluate the prevalence of below-cost reimbursement for generic prescriptions across different third-party payers and therapeutic categories. DesignA retrospective descriptive study using 2015 dispensing data from a single independently owned pharmacy in Iowa. To calculate GM, the pharmacy's actual acquisition cost was subtracted from the third-party reimbursement rate for each generic prescription. The frequency of negative GMs was calculated for the top 6 plans and the top 10 therapeutic categories by prescription volume. SettingA single, independently owned community pharmacy in Iowa. ParticipantsPrescription dispensing records for the pharmacy's largest private and public payers by prescription volume. InterventionGross margins were calculated on a payer and United States Pharmacopeia (USP) medication category level. Main outcome measuresGM for generic prescriptions reimbursed under cost for specific payers and USP medication categories. ResultsThe 2015 prescription volume for the study pharmacy was 70,866 prescriptions, of which 88% were generic. For all prescriptions, the mean GM was $6.63 per prescription, and the median GM was $3.49 per prescription. Generic medications had a mean GM of $4.66 (median, $2.86), and brand name medications had a mean GM of $21.83 (median, $16.15). The percentage of generic prescriptions paid below acquisition cost was 15.1% overall and ranged from 4.1% for Iowa Medicaid to 25.9% for one of the private payers. The most common USP medication category by prescription volume was cardiovascular agents, representing 25.2% of generic prescriptions. For the 10.9% of these prescriptions reimbursed below cost, the mean GM was –$6.80. The 2 USP medication categories with the largest negative mean GM for generic prescriptions were analgesics and anticonvulsants, with mean GMs of –$10.10 and –$11.30, respectively. ConclusionThe current maximum allowable cost–based reimbursement system often results in inadequate payment for generic prescription drugs. The amount of underpayment varies substantially by payer and therapeutic class.

Burden of non-adherence to latent tuberculosis infection drug therapy and the potential cost-effectiveness of adherence interventions in Canada: a simulation study

ObjectivePharmaceutical treatment of latent tuberculosis infection (LTBI) reduces the risk of progression to active tuberculosis (TB); however, poor adherence tempers the protective effect. We aimed to estimate the health burden...

Thermodynamic sensitivity analysis of a novel trigeneration thermodynamic cycle with two-phase expanders and two-phase compressors

A novel Combined Cooling, Heating and Power (CCHP) cycle, operating with two-phase devices for the compression and expansion processes and a single-component wet working fluid, is proposed.A detailed sensitivity analysis of the novel CCHP cycle has been investigated in order to evaluate, in terms of energy performance indicators, its potentiality to serve typical trigenerative tertiary and industrial end-users with different fixed operating temperatures. In general, the novel CCHP cycle is characterized by higher energy performance indicators than a separated energy production system.The comparison between the novel CCHP cycle and several commercialized CCHP systems has been performed in the case studies related to tertiary and industrial end-users. The novel CCHP cycle shows a trigenerative capability in wide ranges of the end-users demands without surplus or deficit of the electric or thermal powers.Furthermore, the maximum allowable capital cost of the whole novel CCHP plant (BEPCC), that will assure the profitability of the investment, is calculated in the tertiary and industrial end-users case studies. For the tertiary end-user, the capital costs of the commercialized CCHP are between the minimum and maximum BEPCC values. On the contrary, for the industrial end-user, they are lower than the minimum and maximum BEPCC values.

Determining the value of medical technologies to treat ultra-rare disorders: a consensus statement

BackgroundIn most jurisdictions, policies have been adopted to encourage the development of treatments for rare or orphan diseases. While successful as assessed against their primary objective, these policies have prompted concerns among payers about the economic burden that might be caused by an annual cost per patient in some cases exceeding 100,000 Euro. At the same time, many drugs for rare disorders do not meet conventional standards for cost-effectiveness or ‘value for money’. Owing to the fixed (volume-independent) cost of research and development, this issue is becoming increasingly serious with decreasing prevalence of a given disorder.MethodsIn order to critically appraise the problems posed by the systematic valuation of interventions for ultra-rare disorders (URDs), an international group of clinical and health economic experts was convened in conjunction with the Annual European ISPOR Congress in Berlin, Germany, in November 2012. Following this meeting and during subsequent deliberations, the group achieved a consensus on the specific challenges and potential ways forward.ResultsThe group concluded that the complexities of research and development for new treatments for URDs may require conditional approval and reimbursement policies, such as managed entry schemes and coverage with evidence development agreements, but should not use as justification surrogate end point improvement only. As a prerequisite for value assessment, the demonstration of a minimum significant clinical benefit should be expected within a reasonable time frame. As to the health economic evaluation of interventions for URDs, the currently prevailing logic of cost-effectiveness (using benchmarks for the maximum allowable incremental cost per quality-adjusted life year gained) was considered deficient as it does not capture well-established social preferences regarding health care resource allocation.ConclusionModified approaches or alternative paradigms to establish the ‘value for money’ conferred by interventions for URDs should be developed with high priority.

Impact of Maximum Allowable Cost on CO2 Storage Capacity in Saline Formations.

Injecting CO2 into deep saline formations represents an important component of many greenhouse-gas-reduction strategies for the future. A number of authors have posed concern over the thousands of injection wells likely to be needed. However, a more important criterion than the number of wells is whether the total cost of storing the CO2 is market-bearable. Previous studies have sought to determine the number of injection wells required to achieve a specified storage target. Here an alternative methodology is presented whereby we specify a maximum allowable cost (MAC) per ton of CO2 stored, a priori, and determine the corresponding potential operational storage capacity. The methodology takes advantage of an analytical solution for pressure build-up during CO2 injection into a cylindrical saline formation, accounting for two-phase flow, brine evaporation, and salt precipitation around the injection well. The methodology is applied to 375 saline formations from the U.K. Continental Shelf. Parameter uncertainty is propagated using Monte Carlo simulation with 10 000 realizations for each formation. The results show that MAC affects both the magnitude and spatial distribution of potential operational storage capacity on a national scale. Different storage prospects can appear more or less attractive depending on the MAC scenario considered. It is also shown that, under high well-injection rate scenarios with relatively low cost, there is adequate operational storage capacity for the equivalent of 40 years of U.K. CO2 emissions.

Pharmacists’ value: Time to be heard

Abstract In January, the Iowa Pharmacy Association (IPA) held its annual Legislative Day, during which Iowa pharmacists met with their legislators to discuss the legislative priorities established by IPA's Legislative Committee and Board of Trustees. This was a particularly interesting session because in the previous year, both the Iowa House and Senate unanimously passed House File 2297 (HF 2297), which provided greater transparency of PBMs' practices to the Iowa Insurance Division (IID) and implemented changes related to maximum allowable cost pricing.

The Evaluation of Economic Methods to Assess the Social Value of Medical Interventions for Ultra-Rare Disorders (URDS).

Objectives: To develop a set of criteria to critically appraise the strengths and weaknesses of health economic methods for the systematic valuation of interventions for ultra-rare disorders (URDs). Methods: An international group of clinical and health economic experts met in conjunction with the Annual European ISPOR Congresses in Berlin/Germany and Dublin/Ireland, November 2012 and 2013, to deliberate and agree on a set of criteria to assess the potential of the various methods, which have been used or proposed to estimate the social value of medical interventions for URDs. Results: The group identified a broad set of potential criteria, which may be grouped according to the following dimensions: theoretical foundations (normative premises, i.e., links to moral and economic theories, including - but not limited to - nonutilitarian consequentialist and deontological reasoning, definition and treatment of core concepts of economic thinking such as opportunity costs and efficiency), empirical underpinnings (social preferences related to attributes of the health condition or of the person afflicted with it), and pragmatic aspects (feasibility of implementation and potential for bias and misuse). For each of the dimensions, a set of criteria has been agreed upon, which in turn will need further scrutiny and justification. Conclusions: Previously, a need had been identified for modifications or alternatives to the conventional logic of cost effectiveness applying benchmarks for the maximum allowable cost per qualityadjusted life year (QALY). We propose a framework for the systematic assessment how well different evaluation approaches reflect prevalent social norms and value judgments. As a next step, the framework shall be applied on multi-criteria decision analysis methods and social cost value analysis, either using the person trade-off (PTO) or the relative social willingness-to-pay (RS-WTP) instrument.

A novel hybrid genetic algorithm to solve the make-to-order sequence-dependent flow-shop scheduling problem

Flow-shop scheduling problem (FSP) deals with the scheduling of a set of n jobs that visit a set of m machines in the same order. As the FSP is NP-hard, there is no efficient algorithm to reach the optimal solution of the problem. To minimize the holding, delay and setup costs of large permutation flow-shop scheduling problems with sequence-dependent setup times on each machine, this paper develops a novel hybrid genetic algorithm (HGA) with three genetic operators. Proposed HGA applies a modified approach to generate a pool of initial solutions, and also uses an improved heuristic called the iterated swap procedure to improve the initial solutions. We consider the make-to-order production approach that some sequences between jobs are assumed as tabu based on maximum allowable setup cost. In addition, the results are compared to some recently developed heuristics and computational experimental results show that the proposed HGA performs very competitively with respect to accuracy and efficiency of solution.

Polynomial time solutions for scheduling problems on a proportionate flowshop with two competing agents

In scheduling problems with two competing agents, each one of the agents has his own set of jobs and his own objective function, but both share the same processor. The goal is to minimize the value of the objective function of one agent, subject to an upper bound on the value of the objective function of the second agent. In this paper we study two-agent scheduling problems on a proportionate flowshop. Three objective functions of the first agent are considered: minimum maximum cost of all the jobs, minimum total completion time, and minimum number of tardy jobs. For the second agent, an upper bound on the maximum allowable cost is assumed. We introduce efficient polynomial time solution algorithms for all cases.

A stochastic programming approach for integrated nurse staffing and assignment

The shortage of nurses has attracted considerable attention due to its direct impact on the quality of patient care. High workloads and undesirable schedules are two major reasons for nurses to report job dissatisfaction. The focus of this article is to find non-dominated solutions to an integrated nurse staffing and assignment problem that minimizes excess workload on nurses and staffing cost. A stochastic integer programming model with an objective to minimize excess workload subject to a hard budget constraint is presented. Three solution approaches are applied, which are Benders’ decomposition, Lagrangian relaxation with Benders’ decomposition, and a heuristic based on nested Benders’ decomposition. The maximum allowable staffing cost in the budget constraint is varied in the Benders’ decomposition and nested Benders’ decomposition approaches, and the budget constraint is relaxed and the staffing cost is penalized in the Lagrangian relaxation with Benders’ decomposition approach. Non-dominated bicriteria solutions are collected from the algorithms. The effectiveness of the model and algorithms is demonstrated in a computational study based on data from two medical-surgical units at a Northeast Texas hospital. A floating nurses policy is also evaluated. Finally, areas of future research are discussed.

Multiple Drug Cost Containment Policies In Michigan’s Medicaid Program Saved Money Overall, Although Some Increased Costs

Michigan's Medicaid program implemented four cost containment policies--preferred drug lists, joint and multistate purchasing arrangements, and maximum allowable cost--during 2002-04. The goal was to control growth of drug spending for beneficiaries who were enrolled in both Medicaid and Medicare and taking antihypertensive or antihyperlipidemic prescription drugs. We analyzed the impact of each policy while holding the effect of all other policies constant. Preferred drug lists increased both preferred and generic drugs' market share and reduced daily cost--the cost per day for each prescription provided to a beneficiary. In contrast, the maximum allowable cost policy increased daily cost and was the only policy that did not generate cost savings. The joint and multistate arrangements did not affect daily cost. Despite these policy trade-offs, the cumulative effect was a 10 percent decrease in daily cost and a total cost savings of $46,195 per year. Our findings suggest that policy makers need to evaluate the impact of multiple policies aimed at restraining drug spending, and further evaluate the policy trade-offs, to ensure that scarce public dollars achieve the greatest return for money spent.

Five-year examination of utilization and drug cost outcomes associated with benefit design changes including reference pricing for proton pump inhibitors in a state employee health plan.

The Arkansas State Employee Benefits Division (EBD) is a self-insured program comprising public school and other state employees, their spouses, and dependents. Previous research published in JMCP (2006) showed drug cost savings of $2.20 per member per month (PMPM; 37.6%) or annualized savings of $3.4 million associated with a benefit design change and coverage of the proton pump inhibitor (PPI) omeprazole over-the-counter (OTC) beginning in March 2004. On May 1, 2005, brand esomeprazole was excluded from coverage, with current users grandfathered for 4 months until September 2005. Reference pricing for PPIs, including esomeprazole but excluding generic omeprazole, was implemented on September 1, 2005, and the beneficiary cost share for all PPIs except generic omeprazole was determined from comparison of the PPI actual price to the $0.90 omeprazole OTC reference price per unit. To examine PPI utilization and drug costs before and after (a) excluding esomeprazole from coverage (with grandfathering current users) and (b) implementing a therapeutic maximum allowable cost (TMAC), or reference-pricing benefit design, for the PPI class in a large state employee health plan with fairly stable enrollment of approximately 127,500 members in 2005 through 2008 and approximately 128,000 members in 2009 Q1. The pharmacy claims database for the EBD was used to examine utilization and cost data for PPIs in a longitudinal analysis for the 61-month period from March 1, 2004, through March 31, 2009. Pharmacy claims data were compared for the period 14 months prior to esomeprazole exclusion (preperiod), 4 months during the esomeprazole exclusion (postperiod 1), and the ensuing 43 months of PPI reference pricing (postperiod 2). PPI cost and utilization data for the intervention group of approximately 127,500 beneficiaries were compared with a group of 122 self-insured employers with a total of nearly 1 million beneficiaries whose pharmacy benefits did not include reference pricing for PPIs. Despite 79% of existing esomeprazole users being grandfathered during the 4-month esomeprazole-exclusion period (postperiod 1), the share of omeprazole OTC claims increased from 35.2% to 42.5% (+ 7.3 percentage points) of all PPI claims, and esomeprazole claims decreased from 16.7% to 12.0% (-4.7 percentage points), with little change in the use of other PPIs. The average allowed charge (price) per day of PPI drug therapy decreased in postperiod 1 by 8.9% from $2.81 to $2.56, while utilization increased by 2.2% from 1.83 days PMPM to 1.87 days PMPM; the net plan cost PMPM decreased by $0.40 PMPM from $3.78 to $3.38 (-10.6%), representing a reduction in spending of $35,664 per month while the average member copayment per claim was essentially unchanged. In the 43 months of reference pricing in postperiod 2, PPI utilization was essentially unchanged at 1.82 days PMPM compared with the preperiod (1.83 days PMPM) and 2.7% lower than the esomeprazole-exclusion period (1.87 days PMPM); however, price (charge per day) decreased by 38.4% during refer- RESEARCH ence pricing to $1.73 from $2.81 in the preperiod and by 32.4% compared with $2.56 in the esomeprazole-exclusion period, despite an increase in the average pharmacy dispensing fee to $5.21 per PPI claim. Net plan cost decreased by $1.87 PMPM (49.5%) to $1.91 PMPM during reference pricing compared with the preperiod ($3.78 PMPM) and by $1.47 PMPM (43.5%) compared with the esomeprazole-exclusion period 1 ($3.38 PMPM). Beneficiary costs (copayment per claim) for PPIs decreased to $1.24 PMPM ($23.27 per claim) compared with the preperiod ($1.37 PMPM, $24.95 per claim) and compared with the esomeprazole-exclusion period ($1.40 PMPM, $25.06 per claim). The reductions in net plan costs represented lower plan spending for the 43 months of reference pricing (postperiod 2) of approximately $9.4 million or an average of approximately $219,500 per month compared with the preperiod or $7.9 million (approximately $183,900 per month) compared with the esomeprazole-exclusion period. Compared with a group of self-insured health plans without pharmacy benefit reference pricing of PPIs, the cost savings over the 43-month period from September 1, 2005, through March 31, 2009, were approximately $7.2 million or $1.31 PMPM. For this state employee health plan, the policy change that excluded esomeprazole from coverage but grandfathered current users was associated with a relatively small reduction in PMPM spending on PPIs compared with the subsequent policy change that applied reference pricing to the PPI class based on the price (drug cost plus dispensing fee) for omeprazole OTC. Over 43 months of reference pricing, net plan costs fell dramatically by 49.5% PMPM compared with the preperiod or decreased by 43.5% compared with the esomeprazole-exclusion period. While utilization was essentially unchanged compared with the 18 months before reference pricing, the average pharmacy dispensing fee per PPI claim increased, and beneficiary costs PMPM decreased.

Integration of wave power in Haida Gwaii

Remote communities, such as Haida Gwaii, Canada, often have high energy costs due to their dependence on diesel fuel for generation. Haida Gwaii's lengthy coastline, exposed to the northeast Pacific Ocean, provides opportunities for capturing wave energy to potentially reduce energy costs. A mixed integer optimization model of the Haida Gwaii network is used to develop an operational strategy indicative of realistic operator behaviour. Two offshore locations are analyzed where the annual mean theoretical wave power is 42 kW/m and 16 kW/m, respectively. Results from both models show that the wave energy resource in Haida Gwaii has the potential to reduce the operational cost of energy and carbon dioxide emissions. A maximum allowable capital cost, above which the overall cost of energy would increase, is determined for various levels of installed wave capacity. Offshore transmission cost estimates are included, as well as the effects of the offshore transmission distance.

The relationship between type of drug therapy and blood glucose self-monitoring test strips claimed by beneficiaries of the Seniors' Pharmacare Program in Nova Scotia, Canada.

BackgroundThe healthcare expenditure on self-monitoring of blood glucose (SMBG) test strips under the Nova Scotia Seniors' Pharmacare Program (NSSPP) has increased significantly in recent years. The objective of this study was to identify the frequency and cost of claims for blood glucose monitoring test strips by NSSPP beneficiaries in the fiscal year 2005/06 and to explore the variation in the use of test strips by type of treatment, age and sex.MethodsRetrospective analysis was conducted using pharmacy administrative claims data for NSSPP beneficiaries. Study subjects were aged ≥ 65 years on October 1, 2004, received SMBG test strips in the 110 days prior to April 1, 2005, and were alive throughout the twelve month study period. Subjects were categorized into four groups: insulin only, oral antihyperglycemic agents (OAA) only, both OAA and insulin; and no reimbursed diabetes medications. Statistical analysis was performed to identify differences in expenditure by medication group and in frequency of SMBG test strips claimed by medication group, age, and sex.ResultsOf 13,564 included beneficiaries, 13.2% were categorized as insulin only, 53.5% OAA only, 7.2% both OAA and insulin, and 26.0% no reimbursed diabetes medications. Over half (58.7%) were femle. The insulin only category had the highest mean (± SD) number of SMBG test strips claimed per day (2.0 ± 1.5) with a mean annual total cost of $615 ± $441/beneficiary. Beneficiaries aged 80 years and above claimed fewer test strips than beneficiaries below 80 years.ConclusionThis population based study shows that in Nova Scotia the SMBG test strips claimed by the majority of seniors were within Canadian guidelines. However, a small proportion of beneficiaries claimed for SMBG test strips infrequently or too frequently, which suggests areas for improvement. The provincial drug plan covers the majority of the costs of test strip utilization, suggesting that the majority of test strips claimed did not exceed the maximum allowable cost (MAC) established in the program's MAC policy. Drug insurance programs need to work with healthcare providers to determine if patients are using test strips optimally; and to determine their impact on patient outcomes. In addition, they need to determine the cost-effectiveness of their SMBG test strip reimbursement policies.