Terms Of Additional Costs Research Articles

Cost Sharing Paid by Social Askes Participants at Pelamonia Hospital Makassar and Faisal Islamic Hospital Makassar

The cost of hospital services in Indonesia in general is a complex problem with many obstacles and we can see that the publication of cost information is often unclear. In Government Hospitals, in particular, budget allocations are still inadequate, this is due, among other things, to the costs that must be borne by the Hospital, especially equipment costs, operational and maintenance costs, which seem to tend to increase following advances in increasingly sophisticated health technology. The aim of the research is to obtain an overview of the cost sharing that will be incurred by Askes Social participants at Pelamonia Hospital and Islamic Faisal Hospital Makassar, reviewed in terms of additional costs incurred/types of patient inpatient treatment in terms of class/rank and linked to Regional Regulations. The type of research used is survey research with a descriptive approach, with the aim of obtaining information about cost sharing costs for health services in the inpatient unit of Pelamonia Hospital Makassar and Islamic Faisal Hospital Makassar. The results of this study and previous research show that patients participating in Askes tend to use nursing classes that are better than those specified. The conclusion is that the Cost Sharing for Social Health Insurance patients based on group/rank in the inpatient unit at Faisal Islamic Hospital is IDR 795,000,- while at Pelamonia Hospital Makassar it is IDR 1,125,000.

Cost-Effectiveness of Intravenous Iron Formulations in Patients with Iron Deficiency Anaemia and Inflammatory Bowel Disease, in a Swedish Regional Setting Using Real-World Tender Prices

Aims. A widespread complication of inflammatory bowel disease (IBD) is iron deficiency anaemia (IDA), which affects quality of life (QoL) and is associated with frequent hospitalizations. The intravenous iron therapies, ferric carboxymaltose (FCM), ferric derisomaltose (FD), and iron sucrose (IS), have previously been shown to replenish haemoglobin (Hb) levels more effectively than oral iron. However, they differ in both costs and efficacy (response to treatment), leading to differences in acquisition by health-care payers. We investigated the cost-effectiveness of FCM versus FD and IS, in terms of additional cost per additional responder, for the treatment of IBD-associated IDA in multiple Swedish regional settings, using current tender prices. Methods and Materials. A microsimulation model estimated the additional cost per patient achieving a response, based on Hb normalization or an increase of ≥2 g/dL in Hb levels. Efficacy estimates were taken from a previously published network meta-analysis. Treatment costs (2021 SEK) included current tender prices in Swedish health-care regions. Resource use depended partly on dosing, which was based on patient characteristics simulated in the model. Results. The analysis showed that FCM was associated with the highest number of responders (81%) compared to FD (74%) and IS (75%), while costing less per responder than its comparators, in included regions. Conclusions. These results suggest that regional health-care budget holders should consider more than drug prices when choosing which IV formulations to acquire and that they should use all available tools when deciding how to fulfil the needs of their patients.

POSC48 Cost-Effectiveness Analysis of Ferric Carboxymaltose Versus Iron Sucrose for the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease in Spain

Iron deficiency anemia (IDA) subsequent to inflammatory bowel disease (IBD) can result in reduced quality of life and increased healthcare costs. IV iron represents the first-line treatment option for many patients. In Spain, ferric carboxymaltose (FCM) and iron sucrose (IS) are the currently available IV iron formulations. This study assessed the cost-effectiveness of FCM compared with IS, in terms of additional cost per additional responder in patients with IDA subsequent to IBD in the Spanish setting.

Cost-effectiveness analysis of ferric carboxymaltose versus iron sucrose for the treatment of iron deficiency anemia in patients with inflammatory bowel disease in Spain.

Background:Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) and can result in reduced quality of life and increased healthcare costs. IDA is treated with iron supplementation, commonly with intravenous iron formulations, such as ferric carboxymaltose (FCM), and iron sucrose (IS).Methods:This study assessed the cost-effectiveness of FCM compared with IS, in terms of additional cost per additional responder in patients with IDA subsequent to IBD in the Spanish setting. An economic model was developed to assess the additional cost per additional responder, defined as normalization or an increase of ⩾2 g/dl in hemoglobin levels, for FCM versus IS from a Spanish healthcare payer perspective. Efficacy inputs were taken from a randomized controlled trial comparing the two interventions (FERGIcor). Costs of treatment were calculated in 2021 Euros (EUR) using a microcosting approach and included the costs of intravenous iron, healthcare professional time, and consumables. Cost-effectiveness was assessed over one cycle of treatment, with a series of sensitivity analyses performed to test the robustness of the results.Results:FCM was more effective than IS, with 84% of patients achieving a response compared with 76%. When expressed as number needed to treat, 13 patients would need to switch treatment from IS to FCM in order to achieve one additional responder. Costs of treatment were EUR 323 with FCM compared with EUR 470 with IS, a cost saving of EUR 147 with FCM. Cost savings with FCM were driven by the reduced number of infusions required, resulting in a reduced requirement for healthcare professional time and use of consumables compared with the IS arm.Conclusion:The present analysis suggests that FCM is less costly and more effective than IS for the treatment of IDA subsequent to IBD in Spain and therefore was considered dominant.

Economic evaluation of an Australian nurse home visiting programme: a randomised trial at 3 years

ObjectivesTo investigate the additional programme cost and cost-effectiveness of ‘right@home’ Nurse Home Visiting (NHV) programme in relation to improving maternal and child outcomes at child age 3 years compared with...

Evaluation of the Cost-Effectiveness of Iron Formulations for the Treatment of Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease in the UK.

IntroductionIn patients with inflammatory bowel disease (IBD), iron deficiency anaemia (IDA) can impair quality of life and increase healthcare costs. Treatment options for IDA-associated IBD include oral iron and intravenous iron formulations (such as ferric carboxymaltose [FCM], ferric derisomaltose [FD, previously known as iron isomaltoside 1000], and iron sucrose [IS]). The present analysis compared the cost-effectiveness of FCM versus FD, IS, and oral iron sulfate in terms of additional cost per additional responder in the UK setting.MethodsCost-effectiveness was calculated for FCM versus FD, IS, and oral iron individually in terms of the additional cost per additional responder, defined as haemoglobin normalisation or an increase of ≥2 g/dL in haemoglobin levels, in a model developed in Microsoft Excel. Relative efficacy inputs were taken from a previously published network meta-analysis, since there is currently no single head-to-head trial evidence comparing all therapy options. Costs were calculated in 2020 pounds sterling (GBP) capturing the costs of iron preparations, healthcare professional time, and consumables.ResultsThe analysis suggested that FCM may be the most effective intervention, with 81% of patients achieving a response. Response rates with FD, IS, and oral iron were 74%, 75%, and 69%, respectively. Total costs with FCM, FD, IS, and oral iron were GBP 296, GBP 312, GBP 503, and GBP 56, respectively. FCM was found to be more effective and less costly than both FD and IS, and therefore was considered dominant. Compared with oral iron, FCM was associated with an incremental cost-effectiveness ratio of GBP 2045 per additional responder.ConclusionsFCM is likely to be the least costly and most effective IV iron therapy in the UK setting. Compared with oral iron, healthcare payers must decide whether the superior treatment efficacy of FCM is worth the additional cost.

Cost-effectiveness analysis of chronic mechanical back pain treatment modalities.

Objectives This study aims to evaluate and compare the cost-effectiveness of inpatient physical therapy, outpatient physical therapy applications, and back school education in low back pain (LBP) treatment. Patients and methods Between March 2011 and September 2011, a total of 105 patients (43 males, 62 females; mean age 44.8±12.7 years; range, 27 to 58 years) who were treated for chronic LBP were included in this prospective study. Of the patients, 34 received inpatient physical therapy consisting of electrotherapy, superficial-deep heat application, and basic back exercise program, 35 received the same treatment in the outpatient setting, and 36 received back school education. Each patient was evaluated five times during the study using pain intensity Visual Analog Scale (VAS), spinal mobility measurements (inclinometer), general evaluation (VAS), functional disability measurement (Roland-Morris Disability Questionnaire [RMDQ]), and quality of life (Short Form-36 [SF-36]). All expenses and costs for treatment of LBP were estimated. Results At the end of six months of follow-up, all study groups had a statistically significant improvement in all variables. Improvements in spinal mobility, RMDQ, and SF-36 scores were significantly higher in the inpatient physical therapy group (p<0.001). Direct and total costs were the highest in the inpatient treatment group and were the lowest in the back school education group (p<0.001). No statistically significant differences were observed in terms of additional cost of one-unit improvement in these variables among the study groups. Conclusion Our study results suggest that all three treatment modalities are effective in chronic LBP. In patients with LBP-related impairment in functional status and quality of life, inpatient physical therapy and rehabilitation should be preferred.

Iron Formulations for the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease: A Cost-Effectiveness Analysis in Switzerland.

IntroductionIron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) and can result in reduced quality of life and increased healthcare costs. IDA is treated with iron supplementation, either with oral iron therapy (OI) or intravenous iron formulations, including ferric carboxymaltose (FCM), iron isomaltoside 1000 (IIM), and iron sucrose (IS). This analysis compared the cost-effectiveness of FCM versus IIM, IS, and OI in terms of additional cost per additional responder in Switzerland.MethodsA health economic model was developed to assess the additional cost per additional responder, defined as normalization or an increase of at least 2 g/dL in hemoglobin levels, for FCM versus IIM, IS, and OI. To date, no single head-to-head trial comparing all therapies is available, and therefore relative efficacy data were taken from a published network meta-analysis. Costs of treatment were calculated in 2020 Swiss francs (CHF) using a microcosting approach, and included the costs of iron, healthcare professional time, and consumables. Costs are also presented in euros (EUR) based on an exchange rate of CHF 1 = EUR 0.94.ResultsResponse rates with FCM, IIM, IS, and OI were 81%, 74%, 75%, and 69%, respectively, with FCM projected to be the most effective treatment. FCM was associated with cost savings of CHF 24 (EUR 23) versus IIM and of CHF 147 (EUR 138) versus IS, and increased costs by CHF 345 (EUR 324) versus OI. Therefore FCM was considered dominant versus both IIM and IS, improving clinical outcomes with cost savings. FCM was associated with an incremental cost-effectiveness ratio of CHF 2970 (EUR 2792) per additional responder versus OI.ConclusionsFCM was projected to be the most cost-effective intravenous iron therapy in Switzerland, increasing the number of responders and leading to cost savings for healthcare payers.

Effectiveness and cost-effectiveness of treatment with additional enrollment to a homeopathic integrated care contract in Germany

BackgroundA number of German statutory health insurance companies are offering integrated care contracts for homeopathy (ICCHs) that cover the reimbursement of homeopathic treatment. The effectiveness and cost-effectiveness of these contracts are highly debated.MethodsTo evaluate the effectiveness and cost-effectiveness of treatment after an additional enrollment in an ICCH, a comparative, prospective, observational study was conducted in which participants in the ICCH (HOM group) were compared with matched (on diagnosis, sex and age) insured individuals (CON group) who received usual care alone.Those insured with either migraine or headache, allergic rhinitis, asthma, atopic dermatitis and depression were included. Primary effectiveness outcomes were the baseline adjusted scores of diagnosis-specific questionnaires (e.g. RQLQ, AQLQ, DLQI, BDI-II) after 6 months. Primary cost-effectiveness endpoints were the baseline adjusted total costs from an insurer perspective in relation to the achieved quality-adjusted life years (QALYs). Costs were derived from health claims data and QALYs were calculated based on SF-12 data.ResultsData from 2524 participants (1543 HOM group) were analyzed. The primary effectiveness outcomes after six months were statistically significant in favor of the HOM group for migraine or headache (Δ = difference between groups, days with headache: − 0.9, p = 0.042), asthma (Δ-AQLQ(S): + 0.4, p = 0.014), atopic dermatitis (Δ-DLQI: − 5.6, p ≤ 0.001) and depression (Δ-BDI-II: − 5.6, p ≤ 0.001). BDI-II differences reached the minimal clinically important difference. For all diagnoses, the adjusted mean total costs over 12 months were higher in the HOM group from an insurer perspective, with migraine or headache, atopic dermatitis and depression suggesting cost-effectiveness in terms of additional costs per QALY gained.ConclusionAfter an additional enrollment in the ICCH, the treatment of participants with depression showed minimally clinically relevant improvements. From an insurer perspective, treatment with an ICCH enrollment resulted in higher costs over all diagnoses but seemed to be cost-effective for migraine or headache, atopic dermatitis and depression according to international used threshold values. Based on the study design and further limitations, our findings should be considered cautiously and no conclusions regarding the effectiveness of specific treatment components can be made. Further research is needed to overcome limitations of this study and to confirm our findings.Trial registrationclinicaltrials.gov, NCT01854580. Registered 15 March 2013 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01854580

Optimum Laser Polishing Decision-Making for On-Demand Additive Manufacturing of Spare Parts: An Exploratory Study

Additive manufacturing is increasingly being used for satisfying spare parts needs of capital products using a nearby 3D printer. Such a technology allows inventory managers to start manufacturing after the demand realization which eliminates significant portion of spare parts inventory being held due to random nature of component breakdowns. Quality difference between printed and original parts, which is one of the biggest problems of using 3D printers, can be decreased by the use of laser polishing which alleviates surface roughness and increases reliability of parts in exchange of an additional cost term. Using different parameters, reliability of parts can be altered depending on needs of capital products and systems’ status. In this study, the problem where surface roughness and reliability of printed parts are jointly optimized with inventory levels of original spare parts is considered. In the problem setting, a machine part consisting of a constant number of identical products which are subject to random breakdowns over a finite planning horizon is considered. Using mathematical analysis and exhaustive numerical experiments, the relationship between optimum control policy and cost parameters was shown, which might be critical for cost-effective management of the system.

Procurement Practices and its Problems in Telecom Sector: The Case of Northeast Region – Ethiopia.

Procurement is a means by which an organization acquires goods, works &amp; services based on law. In Ethiopia, the monopoly of telecom services rendered by Ethio telecommunication as a Government owned enterprises. More than two third of Ethio telecom northeast region’s annual budget is spent to procurement. The negligence of the procurement unit has a direct impact on the performance of all departments in terms of additional costs. This paper is to identify the Perception of employees and Problems (Performance) of Procurement practices in the Ethio telecom. The research takes a form of explanatory research and primary data were used to collect data through questionnaires from a sample of 133 employees of the organization, interviews from procurement department head, focus group discussion from purchasing committee and the secondary data were collected from the organization’s procurement department documents. The data collected was analyzed using descriptive statistics. The major finding indicates that, the performance of the procurement department is low in terms of procurement of the right quality, time &amp; source due to long work flow process flow of the new revised Works Procurement Policies and Procedures (WPPP), bureaucratic nature, lack of delegation, problem of planning in supplier’s selection. Hence, the management of ethio telecom should give adequate emphasis on effective implementation of the Procurement manual, follow procurement principles, attention to user’s complaints, prearranged mechanism to manage purchase documents and strong relationships with competent suppliers are desirable to uplift the telecommunications into a profitable service.

PCV40 COST-EFFECTIVENESS ANALYSIS OF PRASUGREL, CLOPIDOGREL AND TICAGRELOR IN DUAL ANTIPLATELET THERAPY ON PATIENTS WITH ACUTE CORONARY SYNDROME IN AUSTRIA BETWEEN 2009 AND 2014

We have conducted a cost-effectiveness analysis to evaluate the cost-effectiveness of the compared therapies with P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor). The number of treated patients was 32830. 18640 (56.8%) of them were prescribed clopidogrel, 6683 (20.4%) of them prasugrel, and (7507) 22.9% of them ticagrelor. The primary end point was recurrence of ACS or death >30 day after the index event. Data was collected from an observational study – a comprehensive population study in Austria between 2009 and 2014 including data from 13 Austrian health insurance funds. The cumulative incidence of ACS/death was used as a measure for the therapeutic results. The results from the cost-effectiveness analysis show that the incremental cost-effectiveness ratio (ICER) for prasugrel compared to clopidogrel is 874.86 EUR, for ticagrelor compared to clopidogrel is 753.99 EUR. The cost-effectiveness ratio for clopidogrel itself is 2719.32 EUR. This means prasugrel/ticagrelor is cost-effective over clopidogrel in terms of additional cost to be paid for patients with cumulative incidence of ACS/death. Furthermore, our study has shown that ticagrelor has a better ICER compared to prasugrel when clopidogrel was used as an active comparator in terms of additional cost that should be paid for additional cases of ACS or death. A sensitivity analysis was also conducted to measure the effect of the uncertain data (cost of therapy and results measured in HR) on the ICER. Our sensitivity analysis has shown that the parameter that influences the changes in the ICER the most is the cost of ticagrelor, followed by the efficacy and cost of prasugrel. Overall ticagrelor is the most cost-effective agent within the dual antiplatelet therapy (DAPT).

Initial modelling and updates on cost effectiveness from the first 10 years of a spleen registry

Objective:To validate our estimates from our original model and re‐evaluate the cost‐effectiveness of Spleen Australia, the Australian post‐splenectomy registry, using our original model with updated model parameters based on advances in the literature and experience of the registry over the past decade. Methods:We revisited a decision model from 2005, comparing 1,000 hypothetical registered patients with asplenia or hyposplenism against 1,000 who were not registered, and updated the model parameters. The cost‐effectiveness of the registry was evaluated from a healthcare perspective in terms of additional cost per case of overwhelming post‐splenectomy infection (OPSI) avoided and as additional cost per life year gained. Results:Over a cohort lifetime the registry was associated with an additional cost of $125,724 per case of OPSI avoided or $19,286 per life year gained. Conclusions:Despite our initial over‐estimation of immunisation and chemoprophylaxis uptake and increases in unit costs, our re‐evaluation confirmed use of the registry to be cost‐effective. Implications for public health:Improved outcomes for patients with asplenia or hyposplenism can be achieved by a cost‐effective registry. Additional research into effectiveness of interventions, OPSI prevalence associated with varying intervention use, and compliance rates over time after registration would provide improved accuracy of cost‐effectiveness estimates.

An Exploration of Students’ Experiences of a Distance Service-Learning Course in Four African Countries

This article explores the experiences of students who participated in a distance service-learning programme. The students from Lesotho, Kenya, Malawi and Zimbabwe had completed a service-learning project in their communities. Using telephone interviews, this study attempted to ascertain the benefits and challenges of doing service-learning via distance learning, and in addition to establish whether the experience had been meaningful to the students from an Afrocentric perspective. Interviews of 11 students revealed that the challenges they had experienced were those commonly experienced by African students enrolled in distance learning. Service-learning added challenges in terms of additional costs, and the difficulties of establishing relationships of trust in communities. The students also reported having a sense of responsibility and empathy towards others which made their service-learning endeavours meaningful to them. Issues of social justice and learning from the communities in which they were placed did not feature in the interviews. This highlights the importance of foregrounding these matters in the materials developed for these courses.

SC30.04 Impact of Working Time Directives on Thoracic Surgical Training: The North-American Experience

The following is in part the STS, TSDA and AATS combined response to ACGME (collated and written up by Dr. Ara Vaporciyan) regarding the effect of Duty hour regulations on resident education in Thoracic Surgery in North America. This has impacted the profession in terms of additional cost from their much higher salaries, which are anywhere from 50% to 100% higher, but also a subtle but steady transfer of bedside teaching previously focused on the trainee to bedside teaching focused on the mid-level provider. Our profession still fills the bulk of its training position from general surgery graduates. Duty hour restrictions have contracted the ability of those programs to provide elective rotations in thoracic and cardiac. Limited exposure translates into limited interest and diminished applications. This is where we have felt the greatest impact. We, like all surgical professions, have developed an increasing variety of procedures necessitating expansion of our case log requirements. This puts pressure on trainees to participate in every available case. Appropriate cases are harder to find due to increasing case complexity and outcome reporting. Therefore, the inability to scrub on just one or two of these cases can be significant. While some large surgery programs have implemented float pools to ensure that all cases provide someone a learning experience most CT training programs are small and cannot implement that solution Even more difficult to overcome is when a trainee misses a rare postoperative event. As a high acuity specialty our patients will frequently develop rapid changes in their condition which, if not recognized, can quickly become catastrophic. Most occur in the immediate postoperative period at night. The use of mid-level providers and other services to cover call in an effort to preserve a trainee’s ability to do cases the next day prevents them from taking part in the bedside assessment and management of these rare events. One solution is to lengthen training to allow more opportunities but there is concurrent pressure to reduce what is already one of the longest training paradigms (up to 9 years for congenital surgeons without considering any time for research). Alternatively simulation has been used but these are expensive and are not easily implemented at all programs. While there is no clear study demonstrating documented impact on patient safety there are many surveys of resident and faculty perceptions of patient safety. The majority of these, especially in surgery, have shown that the perception is that safety is compromised. The increased number of handoffs, especially of high acuity cases, is frequently the target of that perception. The subtle aspects of the intraoperative findings cannot always be accurately communicated in a handoff. While patient safety data is not conclusive there is data on worse outcomes in spinal and meningioma surgery post implementation of duty hour regulations. These data may serve to corroborate the perceived concerns. Education, duty hour regulation, working time directives

Judicial Review of International Adjudicatory Decisions: A Cross-Regime Comparison of Annulment and Appellate Mechanisms

The call for an appellate mechanism in international investment arbitration is located within a broader debate concerning judicial review of international adjudicatory decisions. Existing avenues of setting aside, refusal of enforcement and annulment offer little solace because grounds for intervention generally do not extend to the merits. This article compares three international review mechanisms: the ad hoc annulment procedure of the International Centre for the Settlement of Investment Disputes, the Appellate Body of the World Trade Organization and the Optional Appellate Rules of the American Arbitration Association. Against this cross-regime background, the potential of a (multilateral) appellate tribunal in investment disputes, as advocated by the European Commission in its proposal for an Investment Court System, is evaluated. Notwithstanding potential disadvantages in terms of additional cost and length of proceedings, an appellate mechanism could nonetheless enhance the coherence, consistency, and, ultimately, (the public perception of) the legitimacy of international awards.

Modelling the cost-effectiveness of public awareness campaigns for the early detection of non-small-cell lung cancer.

Background:Survival rates in lung cancer in England are significantly lower than in many similar countries. A range of Be Clear on Cancer (BCOC) campaigns have been conducted targeting lung cancer and found to improve the proportion of diagnoses at the early stage of disease. This paper considers the cost-effectiveness of such campaigns, evaluating the effect of both the regional and national BCOC campaigns on the stage distribution of non-small-cell lung cancer (NSCLC) at diagnosis.Methods:A natural history model of NSCLC was developed using incidence data, data elicited from clinical experts and model calibration techniques. This structure is used to consider the lifetime cost and quality-adjusted survival implications of the early awareness campaigns. Incremental cost-effectiveness ratios (ICERs) in terms of additional costs per quality-adjusted life-years (QALYs) gained are presented. Two scenario analyses were conducted to investigate the role of changes in the ‘worried-well' population and the route of diagnosis that might occur as a result of the campaigns.Results:The base-case theoretical model found the regional and national early awareness campaigns to be associated with QALY gains of 289 and 178 QALYs and ICERs of £13 660 and £18 173 per QALY gained, respectively. The scenarios found that increases in the ‘worried-well' population may impact the cost-effectiveness conclusions.Conclusions:Subject to the available evidence, the analysis suggests that early awareness campaigns in lung cancer have the potential to be cost-effective. However, significant additional research is required to address many of the limitations of this study. In addition, the estimated natural history model presents previously unavailable estimates of the prevalence and rate of disease progression in the undiagnosed population.

Evaluating the effectiveness of task overlapping as a risk response strategy in engineering projects

In the last two decades, the failure of multiple engineering projects has highlighted the importance of adopting risk management practices. While risk identification and risk assessment have been widely studied in the literature, only few authors have proposed formal tools for helping project managers to evaluate the effectiveness of their risk response plan. While some risk response measures might be easily validated, overlapping, a commonly used mitigation measure in engineering projects is difficult to evaluate because of the complex interactions between activities and resources. This paper proposes an evaluation model to measure the effectiveness of overlapping strategy as a risk response in terms of additional cost and total maximum time reduction. Results based on a large set of generated projects highlight the importance of three factors in the effectiveness of an overlapping strategy: the number of opportunities of overlapping, the maximum overlapping amount allowed, and the level of resource constraints.

Punctuality-based departure time scheduling under stochastic bottleneck capacity: formulation and equilibrium

This paper proposes a departure time scheduling model for a single bottleneck that is subjected to degradable capacity. Instead of considering travel cost due to uncertainty (either in form of schedule delay or travel time variance) as an additional cost term to be traded with congestion delay and other out-of-pocket costs, it is supposed that travellers deal with uncertainty by adjusting their departure times in order to achieve a certain desirable level of punctuality in accordance to their behavioural preference and trip characteristic. This paper develops the formulation in solving for the scheduling equilibrium, with a detailed exposition on how the expected travel time and schedule delays can be computed. Moreover, this paper discusses the existence of equilibrium of the proposed scheduling equilibrium. In the deterministic bottleneck model and subsequent works that extend to the case of stochastic bottleneck, it is often assumed that the start time of congestion (first appearance of queue) is fixed; in this paper, it is demonstrated that the congestion start time is in fact dependent on the random bottleneck capacity. Lastly, some interesting properties regarding the equilibrium departure profile are discussed and compared with the deterministic bottleneck results.

Cost-Effectiveness of Routine Screening for Cardiac Toxicity in Patients Treated with Imatinib in Brazil

We performed a cost-effectiveness study of different strategies of screening for cardiotoxicity in patients receiving imatinib, the first strategy based on yearly echocardiograms in all patients and the second strategy based on yearly B-type natriuretic peptide level measurement, reserving echocardiograms for patients with an abnormal test result. Results are presented in terms of additional cost per diagnosis as compared with not performing any screening. From the Brazilian private sector’s perspective, strategies 1 and 2 resulted in additional costs of US $30,951.53 and US $19,925.64 per diagnosis of cardiotoxicity, respectively. From the perspective of the Brazilian public health system, the same strategies generated additional costs of US $7,668.00 and US $20,232.87 per diagnosis, respectively. In our study, systematic screening for cardiotoxicity in patients using imatinib has a high cost per diagnosis. If screening is to be adopted, a strategy based on B-type natriuretic peptide level measurement, reserving echocardiography for patients with abnormal results, results in lower costs per diagnosis in the private sector. From the public health system’s perspective, costs per diagnosis will greatly depend on the reimbursement values adopted for B-type natriuretic peptide level measurement.