Significant Cost Variation Research Articles

PMH33: OLANZAPINE VERSUS RISPERIDONE IN THE TREATMENT OF SCHIZOPHRENIA: A COMPARISON OF COSTS AMONG TEXAS MEDICAID PATIENTS

plus non-schizophrenia) healthcare costs among Texas Medicaid recipients who had been diagnosed with a schizophrenic disorder and had been initiated on olanzapine or risperidone. Methods: Cost data for services and prescription use were retrieved for 2885 patients with schizophrenia who were initiated on olanzapine or risperidone between 1 January 1997 and 31 August 1998. Each patient was followed for 1 year before and 1 year after initiation of therapy. Multivariate analysis was used to control for a wide range of factors (drug choice, patient demographics, pre-utilisation costs, region, health conditions, and treatment patterns) that may influence schizophrenia-related costs and total healthcare costs. Estimation was conducted via a two-stage instrumental variables model. Results: The mean unadjusted total schizophrenia-related cost per patient per year during the observation period was $US4892, and the total unadjusted healthcare cost per patient was $US7101. Results revealed significant regional variation in schizophrenia-related and total healthcare costs. Significantly higher total healthcare costs were found for patients with other (nonpsychiatric) diagnoses, such as HIV and diabetes mellitus. Although, on average, patients taking olanzapine stayed on therapy longer than those taking risperidone (248.2 days vs 211.1 days; p < 0.0001), multivariate analysis revealed no significant difference in schizophrenia-related costs between patients who received olanzapine and risperidone ($US123 lower with olanzapine; p = 0.6439). However, patients who received olanzapine compared with risperidone had significantly lower total medical costs ($US693 lower with olanzapine; p = 0.0311). Conclusion: This naturalistic study used data from a Texas Medicaid population to examine the schizophrenia-related costs and total healthcare costs for patients who received olanzapine versus risperidone. Multivariate analysis revealed no significant differences in schizophrenia-related costs for patients receiving olan

Measuring Cost Variability in Provision of Transit Service

The cost of producing public-transit service is not uniform but varies by trip type (e.g., local or express), trip length, time of travel, and direction of travel, among other factors. However, the models employed by public-transit operators to estimate costs typically do not account for this variation. The exclusion of cost variability in most transit-cost-allocation models has long been noted in the literature, particularly with respect to time-of-day variations in costs. This analysis addresses many of the limitations of cost-allocation models typically used in practice by developing a set of models that account for marginal variations in vehicle-passenger capacity, capital costs, and time-of-day costs. FY 1994 capital and operating data are used for the Los Angeles Metropolitan Transportation Authority (MTA). This analysis is unique in that it combines a number of previously and separately proposed improvements to cost-allocation models. In comparison with the model currently used by the Los Angeles MTA, it was found that the models developed for this analysis estimate ( a) higher peak costs and off-peak costs, ( b) significant cost variation by mode, and ( c) lower costs for incremental additions in service. The focus is on the limitations of the rudimentary cost-allocation models employed by most transit operators and not on the Los Angeles MTA per se. This analysis found that an array of factors addressed separately in the literature can be incorporated simultaneously and practically into a usable cost-allocation model to provide transit systems with far better information about the highly variable costs of producing service.

The energy cost of horizontal walking and running in adolescents.

This study developed and cross-validated generalized equations for predicting VO2 (mL x kg(-1) x min(-1)) and caloric expenditure (kcal x kg(-1) x min(-1)) during horizontal walking and running in adolescents. Subjects were 47 male and 35 female adolescent volunteers, ages 12-18. Each subject underwent a submaximal treadmill exercise test to determine VO2 at randomly selected walking and jogging speeds (67-215 m x min(-1)). Caloric expenditure was estimated from VO2 and RER. Multiple regression was used to develop prediction equations for estimating VO2 and caloric expenditure from a derivation sample of 77 random observations, both walking and running. The group relationship between running speed and energy cost in the derivation sample was linear, whereas the relationship between walking speed and energy cost was quadratic. Gender, age, and height each failed to account for significant additional variation in energy cost after speed and mode were considered. Skinfolds accounted for a small yet significant amount of additional variation in energy cost. The derived equations were cross-validated on a sample of 76 separate random observations. The cross-validation statistics are: for VO2, R = 0.95, error = 3.58 mL x kg(-1) x min(-1), and for caloric expenditure, R = 0.94, error = 0.019 kcal x kg(-1) x min(-1). Most selected adult equations consistently underestimated both VO2 and caloric expenditure in the cross-validation sample. These results suggest that in adolescents, within the range of speeds tested, the relationship between speed of movement and energy cost for running is linear, but for walking is curvilinear. Also, adult models for estimating VO2 or caloric expenditure do not account for the higher relative energy cost of walking and running in adolescents.

Establishing Cucumber Production in Lesser Developed Countries: An Absolute Cost Advantage of Mexico versus Hispaniola Producers

During winter months, a substantial volume of various horticultural products are imported to the United States from the Caribbean and Central and South America. United States cucumber (Cucumis sativus L.) processors who market fresh-pack and refrigerated products require raw product daily to meet consumer demands. Mexico serves as a single-source supplier to all United States processors during this period, and thus Mexican production represents certain price risks. United States processors would consider other growing regions to reduce these risks if financially attractive alternatives could be identified. Therefore, a project was initiated to acquire information on production and export costs in Hispaniola (Dominican Republic and Haiti), and to compare those to Mexican and United States production and transport costs. Experimentation lead to the identification of the critical influences of market prices, costs and conditions for the financial feasibility of establishing a processing cucumber industry on Hispaniola. Comparative evaluation indicated that significant variation in total cost was caused by fluctuations in transport, tariffs, and labor cost components. The causes of variation in transportation costs were distance, method (sea, air, truck), competitive demand (volume), and shipping frequency, consistency, and capacity.

Identifying opportunities to improve the management of care: a population-based diagnostic methodology.

The growth of managed care and specifically capitation will dramatically change the basis of competition for health care providers. In order for medical groups to succeed in this new environment they must be able to accept the accountability for both managing the care of populations and managing the delivery of individual encounters of care. Being held accountable for the management of populations will require at-risk medical groups to focus on developing three entirely new strategic capabilities: the assessment of health risk, the management of access, and the management of care. This article describes the analytic approach of Deloitte & Touche Consulting Group's population-based diagnostic methodology, which will enable an at-risk organization to identify opportunities for improving the management of care for specific populations and diseases. The hypotheses driving the need for these organizations to establish population-based care management capabilities stem from the plethora of empirical evidence indicating significant variation in costs, utilization, and outcomes in the practice of medicine. Applying a systematic, planned approach to caring for patients who have common, predictable health care needs will result in better outcomes and lower costs for all.

An examination of ISO 9000 registration practices of American, German and Japanese firms operating in the USA

Examines three important issues related to the ISO 9000 registration experiences of American, German and Japanese firms operating in the United States. The three issues are reasons for seeking registration, cost and effort to register and operational requirements for achieving registration. The case study method was used for this project. Indicates competitive pressures as the most common reason for seeking registration. Shows significant variation in costs and levels of effort needed to achieve registration, though none of the firms invested more than 1 per cent of their total available work hours. Suggests no commonality in operational strategy when pursuing registration.

Choice of distribution functions for hydrologic design

The problem of selecting a bivariate probability density function (pdf) for the simultaneous water stages at both ends of a confluence reach is considered. This pdf is used to compute the expected flood losses in the design of a levee with minimum expected yearly cost. A case study in Hungary illustrates the methodology throughout the paper. Two model selection procedures are compared: ranking the candidate pdf's by the likelihood of the X2 statistic and ranking them by their sample likelihoods. A composite model consisting of a linear combination of candidate pdfs weighted proportionally to their sample likelihoods is also considered. It is found that the two selection procedures lead to different choices, which in the example represent a significant cost variation. Although the ranking of the distributions reduces the uncertainty by imposing an ordering within the candidate set, a unique pdf does not fully account for the model uncertainty. In this sense the composite model seems a more reasonable choice, especially if the decisions are based on expected values.