Cost-performance Analysis Research Articles

Otoacoustic Emissions in Rural Nicaragua: Cost Analysis and Implications for Newborn Hearing Screening.

Objective (1) Determine the incidence and risk factors for congenital hearing loss. (2) Perform cost analysis of screening programs. Study Design Proportionally distributed cross-sectional survey. Setting Jinotega, Nicaragua. Subjects and Methods Otoacoustic emissions (OAEs) were used to screen 640 infants <6 months of age from neonatal intensive care unit, institutional, and home birth settings. Data on 15 risk factors were analyzed. Cost of 4 implementation strategies was studied: universal screening, screening at the regional health center (RHC), targeted screening, and screening at the RHC plus targeted screening. Cost-effectiveness analysis over 10 years was based on disability-adjusted life year estimates, with the World Health Organization standard of cost-effectiveness ratio (CER) / gross domestic product (GDP) <3, with GDP set at $4884.15. Results Thirty-eight infants failed the initial OAE (5.94%). In terms of births, 325 (50.8%) were in the RHC, 69 (10.8%) in the neonatal intensive care unit, and 29 (4.5%) at home. Family history and birth defect were significant in univariate analysis; birth defect was significant in multivariate analysis. Cost-effectiveness analysis demonstrated that OAE screening is cost-effective without treatment (CER/GDP = 0.06-2.00) and with treatment (CER/GDP = 0.58-2.52). Conclusions Our rate of OAE failures was comparable to those of developed countries and lower than hearing loss rates noted among Nicaraguan schoolchildren, suggesting acquired or progressive etiology in the latter. Birth defects and familial hearing loss correlated with OAE failure. OAE screening of infants is feasible and cost-effective in rural Nicaragua, although highly influenced by estimated hearing loss severity in identified infants and the high travel costs incurred in a targeted screening strategy.

Cost performance analysis of small scale automotive maintenance firms in Calabar metropolis

AbstractThe paper presents the evaluation of cost-time performance analysis of small scale automotive maintenance firms in Calabar metropolis. The objective of the study is to ascertain the impacts of cost-time variation on the productivity performance of SMS auto maintenance firms. Primary data from seventy different auto-maintenance projects executed by Automobile, Heavy duty, Generator and Panel beater auto firms between February to October 2016 were sampled using direct observation. Analyses of data was performed using Microsoft Excel 2013 and Eviews 9.7 software. Descriptive results revealed poor cost estimation, maintenance duration, labour cost increase, maintenance type, industry size and poor scheduling which ranged between 69.31 ≥ 64.31 ≥ 63.75 ≥ 61.67 ≥ 60.97 ≥ 59.31 respectively as major factors causing cost-time overrun in SMS auto maintenance firms. Average cost and time overrun were specified at 82.8 and 62.8%, thus resulting in a cumulative cost-time performance factor of 6.4, 41.3 and 93....

Era of a Single Population-Based Payment to a Cancer Center: Delivering the Value of Interventional Oncology in Accountable Care Organizations.

To curtail increasing health care costs, the government has ushered in the era of the Accountable care organization (ACO). The purposes of this review are to evaluate the effects the ACO will have on the practice of interventional oncology and its role in cancer care and to explore methods to assimilate. Proposed action points include integration into the modern-day cancer center, adoption of an outpatient clinic, mandatory performance measures, and workflow and cost analysis. If adaptations are made, interventional oncology can continue its role in cancer treatment, will provide more effective care, and reach more patients in the new ACO.

Femoral arterial closure using ProGlide® is more efficacious and cost-effective when ambulating early following cardiac catheterization

ObjectiveThis was a prospective, single-center study evaluating the efficacy and cost-effectiveness of early ambulation (within 30min) following femoral artery closure with the ProGlide® suture-mediated vascular closure device (PD) in patients undergoing diagnostic cardiac catheterization compared with manual compression. BackgroundIt is unclear whether early ambulation with ProGlide is safe or is associated with patient satisfaction and cost savings as compared with manual compression (MC). Methods and resultsInclusion criteria were met in 170 patients (85 PD and 85 MC patients). Patients ambulated 20ft. within 30min (PD) or after the requisite 4h recumbent time (MC) if feasible. Primary endpoint was time-to-ambulation (TTA) following device closure. We also directly compared the safety of closure, times-to-hemostasis (TTH), -ambulation (TTA) and -discharge (TTD) with MC and, using a fully allocated cost model, performed cost analysis for both strategies. Multivariate analysis was used to determine predictors of patient satisfaction. The primary endpoint of safe, early ambulation was achieved following closure (mean of 27.1±14.9min; 95% confidence interval [CI] 25.2–30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD; the latter contributed indirectly to significant cost savings in the PD group (1250.3±146.4 vs. 2248.1±910.2 dollars, respectively; P<0.001) and incremental cost savings by strategy also favored closure over MC ($84,807). ConclusionsProGlide is safe and effective for femoral artery closure in patients who ambulate within 30min after cardiac catheterization; translating into improved patient satisfaction and substantial cost savings.

Editorial: Intravenous Proton Pump Inhibitors for Bleeding Peptic Ulcer: What is the Most Cost-Effective Approach?

During their lifetime, about 10% of the population will develop a peptic ulcer. Despite major advancements in the approach to peptic ulcer bleeding over the last 10-20 years including newer endoscopic hemostatic techniques and the advent of proton pump inhibitors (PPIs), upper gastrointestinal bleeding due to peptic ulcers results in substantial morbidity, mortality, and cost. Both oral and intravenous PPIs have proven to be effective in preventing recurrent bleeding from peptic ulcers. However, the dosing and administration of PPIs have been a source of ongoing debate, specifically in relation to cost. In this issue of the Journal, Lu et al. perform cost analysis demonstrating that costs from bleeding peptic ulcers are influenced more by efficient triage and discharge of patients than the nuances of variations in administration of intravenous PPI's.

POEM is a cost-effective procedure: cost-utility analysis of endoscopic and surgical treatment options in the management of achalasia.

Achalasia is a rare motility disorder of the esophagus. Treatment is palliative with the goal of symptom remission and slowing the progression of the disease. Treatment options include per oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LM) and endoscopic treatments such as pneumatic dilation (PD) and botulinum toxin type A injections (BI). We evaluate the economics and cost-effectiveness of treating achalasia. We performed cost analysis for POEM, LM, PD and BI at our institution from 2011 to 2015. Cost of LM was set to 1, and other procedures are presented as percentage change. Cost-effectiveness was calculated based on cost, number of interventions required for optimal results for dilations and injections and efficacy reported in the current literature. Incremental cost-effectiveness ratio was calculated by a cost-utility analysis using quality-adjusted life year gained, defined as a symptom-free year in a patient with achalasia. Average number of interventions required was 2.3 dilations or two injections for efficacies of 80 and 61%, respectively. POEM cost 1.058 times the cost of LM, and PD and BI cost 0.559 and 0.448 times the cost of LM. Annual cost per cure over a period of 4years for POEM, and LM were consistently equivalent, trending the same as PD although this has a lower initial cost. The cost per cure of BI remains stable over 3years and then doubles. The cost-effectiveness of POEM and LM is equivalent. Myotomy, either surgical or endoscopic, is more cost-effective than BI due to high failure rates of the economical intervention. When treatment is being considered BI should be utilized in patients with less than 2-year life expectancy. Pneumatic dilations are cost-effective and are an acceptable approach to treatment of achalasia, although myotomy has a lower relapse rate and is cost-effective compared to PD after 2years.

Developmental neurotoxicity test guidelines: problems and perspectives.

Epidemiologic evidence has demonstrated associations between early life exposure to industrial chemicals and the occurrence of disease states, including cognitive and behavioral abnormalities, in children. The developing brain in the fetal and infantile periods is extremely vulnerable to chemicals because the blood-brain barrier is not completely formed during these periods. The Organisation for Economic Co-operation and Development (OECD) developmental neurotoxicity (DNT) test guideline, TG426, updated in 2007, comprises in vivo behavioral observational tests and other tests intended to assess DNT induced by exposure to industrial chemicals. These chemicals may enter the market without having been subjected to DNT testing, as DNT test data is not mandated by law at the time of chemical registration. In addition, proprietary rights have led to problems concerning the non-disclosure of industrial chemical toxicity test data, including DNT test data. To overcome the disadvantages of high-cost and low time efficiency of in vivo DNT tests, in vitro or in silico tests are the proposed alternatives, but it is unlikely that the results of such tests would reflect changes in higher brain functions. Accordingly, the current DNT test guidelines need to be revised to avoid overlooking or neglecting the occurrence of DNT induced by exposure to low doses of chemicals. This review also proposes the introduction of novel in vivo DNT testing methods in light of a cost-performance analysis.

복합항법센서를 갖는 수중운동체의 정밀 유도제어 정확도 분석

To obtain the system requirement specification in the beginning of the precision guidance and control system development, the effectiveness and reliability analysis for the system are necessary. The main purpose of this research is to obtain the system requirement specification by carrying out the effectiveness analysis using the modeling and simulation(M&S) scheme. M&S model is constructed using 6-DOF dynamic model, environment model, guidanc -navigation & control model. Assume that the navigation sensor is consist of inertial navigation sensor(INS) and doppler velocity log(DVL), and the speed and direction of current is environment parameter. The effectiveness analysis is carried out using circular error probability(CEP) and variance analyze scheme. Also, the effectiveness analysis is utilized for cost-performance analysis considering the cost of commercial INS and DVL sensor. This paper shows the high-level INS and the low-level DVL configure a high price-performance integrated navigation system.

Cost Analysis of Selected Patient Categories Within A Dermatology Department Using an ABC Approach.

Background:Present trends in hospital management are facilitating the utilization of more accurate costing methods, which potentially results in superior cost-related information and improved managerial decision-making. However, the Activity-Based Costing method (ABC), which was designed for cost allocation purposes in the 1980s, is not widely used by healthcare organizations. This study analyzes costs related to selected categories of patients, those suffering from psoriasis, varicose ulcers, eczema and other conditions, within a dermatology department at a Czech regional hospital.Methods:The study was conducted in a hospital department where both inpatient and outpatient care are offered. Firstly, the diseases treated at the department were identified. Further costs were determined for each activity using ABC. The study utilized data from managerial and financial accounting, as well as data obtained through interviews with departmental staff. Using a defined cost-allocation procedure makes it possible to determine the cost of an individual patient with a given disease more accurately than via traditional costing procedures.Results:The cost analysis focused on the differences between the costs related to individual patients within the selected diagnoses, variations between inpatient and outpatient treatments and the costs of activities performed by the dermatology department. Furthermore, comparing the costs identified through this approach and the revenue stemming from the health insurance system is an option.Conclusions:Activity-Based Costing is more accurate and relevant than the traditional costing method. The outputs of ABC provide an abundance of additional information for managers. The benefits of this research lie in its practically-tested outputs, resulting from calculating the costs of hospitalization, which could prove invaluable to persons involved in hospital management and decision-making. The study also defines the managerial implications of the performed cost analysis for the hospital management. Based on the analysis results, it is possible to standardize activities and performance appraisal (Benchmarking), and provide all necessary information for hospital budgeting practices, especially Activity-Based Budgeting (ABB).

Study of surface roughness and flank wear in hard turning of AISI 4140 steel with coated ceramic inserts

This experimental investigation deals with dry hard turning of AISI 4140 steel using PVD-TiN coated Al2O3+TiCN mixed ceramic inserts. The combined effect of cutting parameters (cutting speed, feed and depth of cut) on performance characteristics such as surface roughness and flank wear is explored by Full factorial design (FFD) and analysis of variance (ANOVA). The results show that feed is the principal cutting parameter influencing surface roughness, followed by cutting speed. However, flank wear is affected by the cutting speed and interaction of feed-depth of cut, although depth of cut has not been found statistically significant, but flank wear is an increasing function of depth of cut. Observations are made on the machined surface, and worn tool by Scanning electron microscope (SEM) to establish the process. Abrasion was the major wear mechanism found during hard turning within the studied range. The effect of tool wear on surface roughness was also studied. The experimental data were analyzed to predict the optimal range of surface roughness and flank wear. Based on Response surface methodology (RSM), mathematical models were developed for surface roughness (Ra) and flank wear (VB) with 95% confidence level. Finally, under optimum cutting conditions (obtained by response optimization technique), tool life was evaluated to perform cost analysis for justifying the economic viability of coated ceramic inserts in hard turning. The estimated machining cost per part for TiN coated ceramic was found to be lower (Rs. 12.31) because of higher tool life (51 min), which results in the reduction of downtime and increase in savings.

Sensitivity analysis of energy inputs and cost assessment for almond production in Iran

The objectives of this study were to investigate the relationships between energy inputs and yield, and to perform cost analysis for almond production. Data were collected by administering questionnaire in face‐to‐face interviews from procedures. The results showed that total energy input was 59,542.61 MJ ha−1 and the output was 25,190.13 MJ ha−1. The most important energy consuming inputs were electricity and chemical fertilizers with 55.98% and 17.72% of total energy input, respectively. The energy use efficiency and energy cost ratio values were estimated to be 0.42 and 0.19, respectively. The econometric model was developed using Cobb‐Douglas production function and the results revealed that human labor, machinery, chemical fertilizer, and farmyard manure energy inputs contributed significantly to yield. The results of sensitivity analysis of energy inputs showed the high impact of chemical fertilizers, and farmyard manure inputs on the yield. Economic analysis showed that the total production cost, total gross value, and net return of almond production were 5344.48 $ ha−1, 27,241.29 $ ha−1, and 21,896.81 $ ha−1, respectively. Also, productivity and the benefit to cost ratio were obtained to be 0.16 kg $−1 and 5.10, respectively. © 2015 American Institute of Chemical Engineers Environ Prog, 35: 582–588, 2016

Perishable inventory system with service interruptions, retrial demands and negative customers

In this paper, we consider a continuous review perishable inventory system wherein demands arrive according to the Poisson process, each demanding exactly one unit of inventory item and the life time of each item is assumed to be exponential. The operating policy is (s, S) policy, i.e., whenever the inventory level drops to s, an order for Q(=S − s) items is placed. The ordered items are received after a random time which is distributed as exponential. The service may be interrupted according to the Poisson process in which case it restarts after an exponentially distributed time. The demands that occur during the server breakdown period or stock-out period may turn out to be ordinary or a negative demand and then they enter into the orbit of infinite size. These orbiting demands send out a signal to compete for their demand which is distributed as exponential. The matrix analytic method is used for the steady state distribution of the model. Various performance measures and cost analysis are shown with numerical results.

Comparing Project Performance of Design-Build and Design-Bid-Build Methods for Large-sized Public Apartment Housing Projects in Korea

The project delivery method has a great impact on project performance and construction quality. The numerous studies on the project performance of the two project delivery methods, design-bid-build (DBB) and design-build (DB), have found differing results depending on the project locations, the project types, and the project sizes. Since no previous studies have been conducted with regard to large-sized apartment housing projects, this paper presents the comparative analysis results for the project performance of the DB and DBB methods, focusing on the large-sized public apartment housing projects built in Korea. The project performances considered include cost, cost growth, construction duration, construction duration growth, and quality performance. The cost and schedule performance analysis results show that the cost growth of the DB method is about 5% lower than that of the DBB method and the construction duration is shortened by twelve days per floor. The quality performance analysis results demonstrate that the satisfaction with the DB method is higher in terms of the construction quality and efficiency of the DB method. This paper contributes to the growing body of research into the efficiency of project delivery methods, expanding the body of knowledge for large-sized public apartment housing projects.

Treatment of urban river contaminated sediment with ex situ advanced oxidation processes: technical feasibility, environmental discharges and cost-performance analysis

The technical feasibility, environmental discharges and cost-performance of urban river contaminated sediment treatment with ex situ advanced oxidation processes were evaluated for the purpose of achieving an ideal treatment goal (for marine disposal) and a cost-performance treatment goal (for beneficially reusing as a filling material). Sediment samples were collected from a river located in southern China. To achieve the ideal treatment goal, sequential treatments (Fenton's reaction + activated persulphate oxidation) were carried out. One-step Fenton's reaction was applied to achieve the cost-performance treatment goal. The resulting effluent was treated and discharged, and sludge generated in wastewater treatment was characterized. The resources input throughout the treatment processes were recorded for cost estimation. After the treatment designed for achieving the ideal treatment goal, most pollutants fulfilled the treatment goal except Pb, Cd, Hg and Ag, probably because these four metals were present mainly in stable fractions of the sediment. The cost-performance treatment goal was achieved in view of low pollutant contents in the toxicity characteristic leaching procedure leachate of treated sediment. The cost for achieving the cost-performance treatment goal is much less than that for achieving the ideal treatment goal. The major cost difference is attributed to chemical cost. Stringent sediment treatment goals based on existing standards would lead to massive chemical use, complex treatment and hence huge cost. A simpler treatment with fewer chemicals is adequate for sediment beneficially reused as a filling material, and is economically more advantageous than handling sediment for marine disposal.

Cost analysis of two-dimensional warranty for products with periodic preventive maintenance

This study uses a bivariate approach, which simultaneously considers the time and usage of a repairable product, and takes into account periodic preventive maintenance to develop a two-dimensional warranty policy for the repairable product. The proposed model is based on the bivariate Weibull process to analyze the breakdown process of a repairable product simultaneously in terms of time and usage. A repairable product may be differently utilized by various customers. We consider two types of customers: (1) customers whose product warranty is terminated because the warranty time limit has reached first; (2) customers whose product warranty is terminated because the warranty usage limit has reached first, to perform cost analyses for determining an appropriate warranty policy. However, since it is often the case that the repairable product may be equally likely purchased by the two types of customers who are equivalently important to the product manufacturer; the optimal warranty policy would thus be the equilibrium solution of the cost analyses which pay the same attention to both types of customers in order to maximize the total profit of the manufacturer.

Cost Analysis of Rotaviral Treatment in Libyan Public Hospitals

Limited data exist on economics burden of rotavirus gastroenteritis in Libya. Aim of this study is to perform cost analysis of rotavirus diseasein Libya. Cost analysis of rotavirus disease in Libya. A prospective cross sectional study was conducted among rotavirus children aged below five years from August 2012to April 2013 at three public hospitals in Libya. The cost of rotavirus treatment from the hospital and patients perspective for hospatalized and ambulatory case. A total of 311 patients were enrolled in this study of these 239 cases were inpatients while 72 cases were outpatient.The average treatment cost of a hospitalized rotavirus episode was US$66.7.76 and out of this US$480.36(72%) was by the hospital,while US$187.40 (28%) by the patient. The average cost of treatment for ambulatory rotavirus case was US$166.34, of which US$120.02(72%) was from hospital cost and US$46.32(28%) from patient's cost. These costs for inpatient and outpatient were during the whole treatment period. Hospital and patient's cost of rotavirus treatment showed the disease posed a considerable economic burden on Libyan government and facilities. Applying preventive measures would be more appropriate such as introducing rotavirus immunization to reduce the disease.

Blind Source Separation by Entropy Rate Minimization

By assuming latent sources are statistically independent, independent component analysis separates underlying sources from a given linear mixture. Since in many applications, latent sources are both non-Gaussian and have sample dependence, it is desirable to exploit both properties jointly. In this paper, we use mutual information rate to construct a general framework for analysis and derivation of algorithms that take both properties into account. We discuss two types of source models for entropy rate estimation-a Markovian and an invertible filter model-and give the general independent component analysis cost function, update rule, and performance analysis based on these. We also introduce four algorithms based on these two models, and show that their performance can approach the Cramer-Rao lower bound. In addition, we demonstrate that the algorithms with flexible models exhibit very desirable performance for “natural” data.

Retrial inventory system with negative customers and service interruptions

In this paper, we consider a single server queueing system wherein demands arrive according to Poisson process, each demanding exactly one unit of inventory item. The operating policy is (s, S) policy in which an order is placed for a quantity up to S whenever the inventory level falls to s. The ordered items are received after a random time which is exponentially distributed. The service may be interrupted according to Poisson process in which case it restarts after an exponentially distributed time. The demands that occur during the server breakdown period or stock-out period may turn out to be ordinary or negative and they enter into the orbit of infinite size. These demands retry after a random time, which is again exponentially distributed. Matrix geometric solution is obtained for the steady state distribution of the model. Various performance measures and cost analysis are shown with numerical results.

Life cycle thinking in small and medium enterprises: the results of research on the implementation of life cycle tools in Polish SMEs—Part 3: LCC-related aspects

This article is the third of a series of articles presenting the results of research on the implementation of life cycle management tools in small- and medium-sized companies in Poland. The purpose of the three-part series of articles is to present the results of research on the implementation of life cycle tools in Polish small and medium enterprises (SMEs). This work is part of a project financed by the Polish Agency for Enterprise Development (PAED) which began in February 2011. It was carried out by the Wielkopolska Quality Institute—a business environment institution associated with the Polish Centre for LCA (PCLCA). The main practical objective of the project was to support SMEs in their business development, e.g. by expanding their horizons beyond the sphere of their operation and identifying new areas for the improvement and promotion of the products and services on offer. The specific objective of the analysis involving the assessment of life-cycle costs of products and services was an attempt to answer the question to determine whether the assessment carried out in accordance with the life-cycle cost (LCC) methodology is a good tool for cost management in this type of business. Part 3 describes the results of studies on the assessment of the implementation of LCC in SMEs conducted in 50 companies involved in the project. In order to assess the effectiveness of the project and the effectiveness of the implementation of LCA and LCC, a survey was conducted of small- and medium-sized businesses where the implementation works had been fully completed. In total, 50 organisations agreed to participate in the LCC survey (while 46 in the LCA—part 2 paper), which was 71 % of all the companies where the LCA and LCC studies had been carried out within the project. The survey was conducted using individual in-depth interviews. Questions to the representatives of the companies referred both to aspects of their operating in the market (characteristics of a company, its market share, management systems, environmental policy, suppliers, clients) and the implementation of their environmental service (assessment of its effectiveness, motivation, difficulties in its implementation), as well as opinions on the potential applications of LCA in their current operations. The experience and observations of LCC experts resulting from their cooperation with the analysed organisations are largely supported by the results of the survey. The overall impression gained from the project is that the small- and medium-sized enterprises considered have a problem with accepting and understanding the life-cycle perspective, and show limited interest in taking liability for environmental and cost aspects beyond the mandatory legal standards and boundaries of their business operations. Nevertheless, the LCC analyses aroused much bigger interest among the companies than the environmental due to the fact that the cost aspects in companies undergoing normal development are seen as an important source of information about the structure of the costs generated with respect to the products or services provided. It is important to note that a very important factor encouraging businesses to join the studies was the fact that they were cost-free. Moreover, the planned introduction of a new product onto the market was the argument that often influenced the decision to implement the LCC. The survey has shown that companies rarely perform cost analyses including all stages of the life cycle of a product or service. Although the awareness of the importance of conducting economic researches for the entire life cycle of a product or service is great, it turned out to be problematic to unambiguously define the practical use of such an analysis, at least at the present stage of development of the companies surveyed. The results obtained in the survey indicate that in the case of simple products, with a short life cycle, complex cost analyses may seem less useful. For more complex products or services, with long periods of use, high reliability required, and high operating costs, the analyses presented are useful tools that increase the economic efficiency of the projects implemented. It appears that from the point of view of polish SMEs, the usefulness of an LCA is seen mainly from the angle of opportunities for cost reduction (preferably in business) and increased sales (marketing). A good solution would be to conduct relatively simple, but integrated LCA/LCC analyses in SMEs so that the companies would clearly see the economic effects of the proposed environmental improvements.

Improving Library Management by Using Cost Analysis Tools: A Case Study for Cataloguing Processes

TTDABC is a relatively new costing management technique, initially developed for manufacturing processes, which is gaining attention in libraries. This is because TDABC is a fast and simple method that only requires two parameters, an estimation of time required to perform an activity and the unit cost per time of supplying capacity. A few case studies have been documented with regard to TDABC in libraries; all of them being oriented to analyse specific library activities such as inter-library loan, acquisition and circulation processes. The primary focus of this paper is to describe TDABC implementation in one of the most important library processes, namely cataloguing. In particular, original and copy cataloguing are analysed through a case study to demonstrate the applicability and usefulness of TDABC to perform cost analysis of cataloguing processes.