Total Implementation Cost Research Articles

An urban air quality modeling system to support decision-making: design and implementation

This paper describes the design and application of a modeling system capable of rapidly supporting decision-makers regarding urban air quality strategies, in particular, providing emission and concentration maps, as well as external costs (mortality and morbidity) due to air pollution, and total implementation costs of improvement measures. Results from a chemical transport model are used to train artificial neural networks and link emission of pollutant precursors and urban air quality. A ranking of different emission scenarios is done based on multi-criteria decision analysis (MCDA), which includes economic and social aspects. The Integrated Urban Air Pollution Assessment Model (IUAPAM) was applied to the Porto city (Portugal) and results show that it is possible to reduce the number of premature deaths per year attributable to particulate matter (PM10), from 1300 to 1240 (5%), with an investment of 0.64 M€/year, based on fireplace replacements.

Planning of Fast-Charging Stations for a Battery Electric Bus System under Energy Consumption Uncertainty

Battery-powered electric buses are gaining popularity as an energy-efficient and emission-free alternative for bus fleets. However, battery electric buses continue to struggle with concerns related to their limited driving range and time-consuming recharging processes. Fast-charging technology, which utilizes dwelling time at bus stops or terminals to recharge buses in operation employing high power, can raise battery electric buses to the same level of capability as their diesel counterparts in terms of driving range and operating time. To develop an economical and effective battery electric bus system using fast-charging technology, fast-charging stations must be strategically deployed. Moreover, due to the instability of traffic conditions and travel demands, the energy consumption uncertainty of buses should also be considered. This study addresses the planning problem of fast-charging stations that is inherent in a battery electric bus system in light of the energy consumption uncertainty of buses. A robust optimization model that represents a mixed integer linear program is developed with the objective of minimizing the total implementation cost. The model is then demonstrated using a real-world bus system. The performances of deterministic solutions and robust solutions are compared under a worst-case scenario. The results demonstrate that the proposed robust model can provide an optimal plan for a fast-charging battery electric bus system that is robust against the energy consumption uncertainty of buses. The trade-off between system cost and system robustness is also addressed.

Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention

BackgroundLow grip strength in older inpatients is associated with poor healthcare outcomes including longer length of stay and mortality. Measuring grip strength is simple and inexpensive. However, it is not routinely used in clinical practice. We aimed to evaluate the implementation of grip strength measurement into routine clinical practice.MethodsThis implementation study was a mixed methods study based in five acute medical wards for older people in one UK hospital. Intervention design and implementation evaluation were based on Normalization Process Theory (NPT). A training program was developed and delivered to enable staff to measure grip strength and use a care plan for patients with low grip strength. Routine implementation and monitoring was assessed using the “implementation outcome variables” proposed by WHO: adoption, coverage, acceptability, fidelity, and costs analysis. Enablers and barriers of implementation were identified.ResultsOne hundred fifty-five nursing staff were trained, 63% in just 3 weeks. Adoption and monthly coverage of grip strength measurement varied between 25 and 80% patients across wards. 81% of female patients and 75% of male patients assessed had low grip strength (< 27 kg for men and < 16 kg for women). Staff and patients found grip measurement easy, cheap and potentially beneficial in identifying high-risk patients. The total cost of implementation across five wards over 12 months was less than £2302. Using NPT, interviews identified enablers and barriers. Enablers included: highly motivated ward champions, managerial support, engagement strategies, shared commitment, and integration into staff and ward daily routines. Barriers included lack of managerial and staff support, and high turnover of staff, managers and champions.ConclusionsTraining a large number of nurses to routinely implement grip strength measurement of older patients was feasible, acceptable and inexpensive. Champions’ motivation, managerial support, and shared staff commitment were important for the uptake and normalisation of grip strength measurement. A high percentage of older patients were identified to be at risk of poor healthcare outcomes and would benefit from nutritional and exercise interventions. Measuring grip strength in these patients could provide an opportunity to identify those with normal grip strength for fast tracking through admission to discharge thereby reducing length of stay.Trial registrationClinicaltrials.gov NCTO2447445. Registered May 18, 2015.

The WEAR methodology for prognostics and health management implementation in manufacturing

Prognostics and health management (PHM) uses process state information to inform decision making with the goal of improving maintenance activities, performance, safety, and reliability. In this paper, we present a new methodology for (i) targeting areas in a manufacturing setting that could benefit from a PHM system, and (ii) testing and comparing PHM strategies for implementation on the targeted areas. Our proposed WEAR methodology is inspired by its four principal steps: (1) World – identifying targets, (2) Experiments – collecting candidate PHM strategies, (3) Assess – evaluating the proposed strategies using simulation, and (4) Return – constructing a business case for PHM implementation. The goal of the methodology is to streamline the decision making process before installing a PHM system so that the impacts of PHM are maximized with regards to the manufacturing system as a whole, and the total cost of implementation is reduced. A case study is presented in which the WEAR methodology was implemented at a manufacturing facility in cooperation with an industry partner.

Application-Specific Residential Microgrid Design Methodology

In power systems, the traditional, non-interactive, and manually controlled power grid has been transformed to a cyber-dominated smart grid. This cyber-physical integration has provided the smart grid with communication, monitoring, computation, and controlling capabilities to improve its reliability, energy efficiency, and flexibility. A microgrid is a localized and semi-autonomous group of smart energy systems that utilizes the above-mentioned capabilities to drive modern technologies such as electric vehicle charging, home energy management, and smart appliances. Design, upgrading, test, and verification of these microgrids can get too complicated to handle manually. The complexity is due to the wide range of solutions and components that are intended to address the microgrid problems. This article presents a novel Model-Based Design (MBD) methodology to model, co-simulate, design, and optimize microgrid and its multi-level controllers. This methodology helps in the design, optimization, and validation of a microgrid for a specific application. The application rules, requirements, and design-time constraints are met in the designed/optimized microgrid while the implementation cost is minimized. Based on our novel methodology, a design automation, co-simulation, and analysis tool, called GridMAT, is implemented. Our experiments have illustrated that implementing a hierarchical controller reduces the average power consumption by 8% and shifts the peak load for cost saving. Moreover, optimizing the microgrid design using our MBD methodology considering smart controllers has decreased the total implementation cost. Compared to the conventional methodology, the cost decreases by 14% and compared to the MBD methodology where smart controllers are not considered, it decreases by 5%.

Multi-criteria optimization for a cost-effective design of an RFID-based meat supply chain

PurposeIn this paper, the authors investigated a proposed radio-frequency identification (RFID)-based meat supply chain to monitor quality and safety of meat products we purchase from supermarkets. The supply chain consists of farms, abattoirs and retailers. The purpose of this paper is to determine a cost-effective trade-off decision obtained from a developed multi-criteria optimization model based on three objectives. These objectives include customer satisfaction in percentage of product quantity as requested by customers, product quality in numbers of meat products and the total implementation cost. Furthermore, this work was aimed at determining the number and locations of farms and abattoirs that should be established and quantities of products that need to be transported between entities of the proposed supply chain.Design/methodology/approachTo this aim, a tri-criteria optimization model was developed. The considered criteria were used for minimizing the total implementation cost and maximizing customer satisfaction and product quality. In order to obtain Pareto solutions based on the developed model, four solution approaches were employed. Subsequently, a new decision-making algorithm was developed to select the superior solution approach in terms of values of the three criteria.FindingsA case study was applied to examine the applicability of the developed model and the performance of the proposed solution approaches. The computational results proved the applicability of the developed model in obtaining a trade-off among the considered criteria and solving the RFID-based meat supply chain design problem.Practical implicationsThe developed tri-criteria optimization model can be used by decision makers as an aid to design and optimize food supply chains.Originality/valueThis paper presents a development of first, a cost-effective optimization approach for a proposed RFID-based meat supply chain seeking a trade-off among three conflicting criteria; and second, a new decision-making algorithm which can be used for any multi-criteria problem to select the best Pareto solution.

The Saskatchewan/New Brunswick Healthy Start-D\xe9part Sant\xe9 intervention: implementation cost estimates of a physical activity and healthy eating intervention in early learning centers

BackgroundParticipation in daily physical activity and consuming a balanced diet high in fruits and vegetables and low in processed foods are behaviours associated with positive health outcomes during all stages of life. Previous literature suggests that the earlier these behaviours are established the greater the health benefits. As such, early learning settings have been shown to provide an effective avenue for exploring and influencing the physical activity and healthy eating behaviours of children before school entry. However, in addition to improving individual level health of children, such interventions may also result in a number of social benefits for the society. In fact, research among adult populations has shown that sufficient participation in physical activity can significantly lower hospital stays and physician visits, in turn leading to positive economic outcomes. To our knowledge there is very limited literature about economic evaluations of interventions implemented in early learning centers to increase physical activity and healthy eating behaviours among children. The primary purpose of this paper is to identify inputs and costs needed to implement a physical activity and healthy eating intervention (Healthy Start-Départ Santé (HS-DS)) in early learning centres throughout Saskatchewan and New Brunswick over the course of three years. In doing so, implementation cost is estimated to complete the first phase of a social return on investment analysis of this intervention.MethodsIn order to carry out this evaluation the first step was to identify the inputs and costs needed to implement the intervention, along with the corresponding outputs. With stakeholder interviews and using existing database, we estimated the implementation cost by measuring, valuing and monetizing each individual input.ResultsOur results show that the total annual cost of implementing HS-DS was $378,753 in the first year, this total cost decreased slightly in the second year ($356,861) and again in the third year ($312,179). On average, the total annual cost is about $350,000 which implies an annual cost of $285 per child. Among all inputs, time–cost accounted for the larger share of total resources need to implement the intervention. Overall, administration and support services accounted for the largest portion of the total implementation cost each year: 74% (year 1), 79% (year 2), and 75% (year 3).ConclusionsThe results from this study shed lights for future implementation of similar interventions in this context. It also helps to assess the cost effectiveness of future interventions.

Optimal Deployment of Dynamic Wireless Charging Facilities for an Electric Bus System

Diesel engine buses still make up the majority of the bus fleet in the United States, even with the problem of diesel exhaust and greenhouse gas emissions. Electric buses, which generate no emissions, are a promising green alternative for bus fleets. However, electric buses have a limited travel range and a time-consuming recharging process. Dynamic wireless charging, which allows electric buses to charge while traveling, could alleviate the drawbacks of electric buses. With dynamic wireless charging technology, electric buses can operate with smaller batteries, and the stationary recharging time at the base station can be shortened. The key design variables in deploying dynamic wireless charging facilities for an electric bus system are battery size and the location of the wireless charging facilities. This paper addresses the problem of simultaneously selecting the optimal locations for the wireless charging facilities and designing the battery size for an electric bus system. A mixed integer linear program was developed to minimize the total implementation cost. The model was demonstrated with a real-world bus system. The results demonstrate that the proposed model can solve the optimal deployment problem of dynamic wireless charging facilities for an electric bus system.

The fuzzy multi-objective distribution planner for a green meat supply chain

It is often a complex task for developing a product distribution plan of a supply chain (SC) network and a supportive decision tool can be useful for easing the role of decision-making. On the other hand, it has been increasingly becoming a demand to design a supply chain network considering the environmental impact as a new dimension as required by authorities in many countries. This paper describes a development of a product distribution planner for a three-echelon green meat supply chain (MSC) design in terms of issues including numbers and locations of facilities that should be opened in association with the product quantity flows. These issues were formulated into a fuzzy multi-objective programming model (FMOPM) with an aim to minimize the total cost of transportation and implementation, the amount of CO2 emissions in transportation and the distribution time of products from farms to abattoirs and from abattoirs to retailers, and maximize the average delivery rate in satisfying product quantity as requested by abattoirs and retailers. To optimize the four objectives simultaneously, three solution methods were investigated and used; which are the LP-metrics method, the ε-constraint method and the goal programming method. The best solution was determined using the Max-Min method by comparing the obtained Pareto solutions. A case study was examined based on the developed model that demonstrates its applicability in making an optimal product distribution plan in trade-offs among the four objectives.

Sustainability of school-located influenza vaccination programs in Florida

BackgroundSchool-located influenza vaccination (SLIV) programs are a promising strategy for increasing vaccination coverage among schoolchildren. However, questions of economic sustainability have dampened enthusiasm for this approach in the United States. We evaluated SLIV sustainability of a health department led, county-wide SLIV program in Alachua County, Florida. Based on Alachua's outcome data, we modeled the sustainability of SLIV programs statewide using two different implementation costs and at different vaccination rates, reimbursement amount, and Vaccines for Children (VFC) coverage. MethodsMass vaccination clinics were conducted at 69 Alachua County schools in 2013 using VFC (for Medicaid and uninsured children) and non-VFC vaccines. Claims were processed after each clinic and submitted to insurance providers for reimbursement ($5 Medicaid and $47.04 from private insurers). We collected programmatic expenditures and volunteer hours to calculate fixed and variable costs for two different implementation costs (with or without in-kind costs included). We project program sustainability for Florida using publicly available county-specific student populations and health insurance enrollment data. ResultsApproximately 42% (n=12,853) of pre-kindergarten – 12th grade students participated in the SLIV program in Alachua. Of the 13,815 doses provided, 58% (8042) were non-VFC vaccine. Total implementation cost was $14.95/dose or $7.93/dose if “in-kind” costs were not included. The program generated a net surplus of $24,221, despite losing $4.68 on every VFC dose provided to Medicaid and uninsured children. With volunteers, 99% of Florida counties would be sustainable at a 50% vaccination rate and average reimbursement amount of $3.25 VFC and $37 non-VFC. Without volunteers, 69% of counties would be sustainable at 50% vaccination rate if all VFC recipients were on Medicaid and its reimbursement increased from $5 to $10 (amount private practices receive). Conclusions and relevanceKey factors that contributed to the sustainability and success of an SLIV program are: targeting privately insured children and reducing administration cost through volunteers. Counties with a high proportion of VFC eligible children may not be sustainable without subsidies at $5 Medicaid reimbursement.

ANÁLISE SILVICULTURAL E ECONÔMICA DE PLANTIOS CLONAIS E SEMINAIS DE Tectona grandis L.f. EM SISTEMA TAUNGYA1

RESUMO O objetivo deste estudo foi realizar uma análise silvicultural e econômica de plantios clonais e seminais de Tectona grandis em monocultivo e em sistema taungya com Zea mays, no Município de Figueirópolis D'Oeste, MT. O experimento foi instalado em 2010 e compôs um fatorial 2x2 em blocos casualizados e quatro repetições. Avaliaram-se a altura total (H), o diâmetro a 5 cm (DAB) e a 1,3 m (DAP) de altura em relação ao nível do solo, a área basal, o volume, a sobrevivência e a estimativa e tendência de crescimento da teca na idade atual e futura, além da produção de silagem do milho. Foram realizadas análises das receitas e custos totais de implantação e manutenção do sistema. Plantas clonais em monocultivo e no sistema Taungya apresentaram maior crescimento em altura total, DAB e DAP em relação às seminais. No monocultivo e no sistema Taungya, a produção (m3 ha-1) de plantas clonais em relação às seminais foi 33 e 30% superior, respectivamente. Os custos com insumos e atividades de implantação da teca foram superiores e os de manutenção, inferiores no sistema Taungya em relação ao monocultivo, tanto para plantios clonais quanto seminais. No sistema Taungya com plantas clonais, o milho reduziu em 21% os custos totais de implantação e manutenção em relação ao monocultivo; nas plantas seminais, a redução foi de 27%. A teca no sistema Taungya cresce menos, porém apresenta tendência de recuperação após a retirada do milho, cuja presença amortiza custos de implantação e manutenção da teca em plantios clonais e seminais.

Research Of Computerization And Implementation Of The E-Prescription For Individual Pharmacies

The paper deals with establishment, implementation and development of electronic prescription or e-Prescription in context with e-Health solutions. It includes introduction of a numerous innovative solutions, which are to be committed for data information flow, data management and functionality as well as of establishment of a new feasible communication forms between doctors, patients and pharmacists. The aim of the study is to describe some technical aspects and functionality of implementation of e-Prescription system for medical institutions, patients and pharmacies; and, calculation of the total cost of implementation (TCI) for Latvian individual pharmacies. Several expecting financial aspects, which have encompassed evaluation of TCI, calculating payback time, ROI, NPV, and IRR are to be calculated. On the bases of these financial calculations, the primary investment of implementation of e-Prescription for individual pharmacies and initial costs are determined. Impact on individual parts of TCI with the scope to individual pharmacy size, location, existence or absence of formal information strategy has calculated. According to collected data, research paper shows how proposed electronic system is going to implement among Latvian individual pharmacies.

Assessment of RFID Investment in the Military Logistics Systems Through The Life Cycle Cost (LCC) Model

Radio Frequency Identification (RFID) is an emerging technology that has been recently used in numerous business and public fields. Most military applications of RFID have focused on logistics systems. Since RFID investment requires high initial cost and its benefits are hard to see in the short term, it needs an appropriate investment decision model. The purpose of this research is to propose a Life Cycle Cost (LCC) model for RFID integration into the Military Logistics System (MLS). The study primarily focuses on the question, whether the cost of integrating and operating the MLS with RFID is worth investing. The results of this study provide a strategic roadmap allowing decision makers to determine if the logistics system considered is a good candidate for RFID technology integration based on the comparison of the LCCs of the current and the RFID integrated MLS. This study also enlightens possible cost parameters and their impacts on the total cost of RFID technology implementation in MLS.

Models and algorithms for centralized control planes to optimize control traffic overhead

Carrier Ethernet has rapidly advanced to become an important technology in metro transport. However, the overlapping of control plane and data plane in contemporary Carrier Ethernet (CE) networks leads to complex and unmanageable networks. CE networks that use packet technologies ought to be more manageable, scalable and robust. Recently proposed network architecture, Omnipresent Ethernet (OE) recommends that the control and management plane in CE networks be decoupled from the forwarding and routing plane to overcome the problem mentioned earlier. In view of this, we investigate the possibility of a centralized control plane from OE perspective. A centralized control plane is a networking paradigm that abstracts and centralizes the control information of the network from the underlying distributed data-forwarding infrastructure. In this paper, we have focused on engineering and architectural issues related to the design of a centralized control plane for the networks built on OE Networking paradigm. Furthermore, the problem of control traffic overhead in managed networks is analyzed using an appropriate simulation model. A scheme to divide the network into smaller sub-networks is proposed so that the total control traffic is always below some threshold. An Integer Linear Program (ILP) for the controllers' placement in the partitioned network is presented. The ILP attempts to minimize the total control traffic, the total controllers' implementation cost and the overall response time in the network. Since the ILP solves the problem optimally for networks with a limited number of nodes, a heuristic approach is developed and presented for larger and real-time service-provider networks.

A detailed report of the resource use and costs associated with implementation of a short stay programme for breast cancer surgery.

BackgroundDespite the increased attention for assessing the effectiveness of implementation strategies, most implementation studies provide little or no information on its associated costs. The focus of the current study was to provide a detailed report of the resource use and costs associated with implementation of a short stay programme for breast cancer surgery in four Dutch hospitals.MethodsThe analysis was performed alongside a multi-centre implementation study. The process of identification, measurement and valuation of the implementation activities was based on recommendations for the design, analysis and reporting of health technology assessments. A scoring form was developed to prospectively determine the implementation activities at professional and implementation expert level. A time horizon of 5 years was used to calculate the implementation costs per patient.ResultsIdentified activities were consisted of development and execution of the implementation strategy during the implementation project. Total implementation costs over the four hospitals were €83.293. Mean implementation costs, calculated for 660 patients treated over a period of 5 years, were €25 per patient. Subgroup analyses showed that the implementation costs ranged from €3.942 to €32.000 on hospital level. From a local hospital perspective, overall implementation costs were €21 per patient, after exclusion of the costs made by the expert centre.ConclusionsWe provided a detailed case description of how implementation costs can be determined. Notable differences in implementation costs between hospitals were observed.Trial registrationISRCTN: ISRCTN77253391Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0270-9) contains supplementary material, which is available to authorized users.

Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: case study of Kassena-Nankana district of northern Ghana.

ObjectiveThis study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana.MethodsA descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009–2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost.ResultsTwenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128–lower than the financial cost by 26.5%.ConclusionsThe study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care.

Cost Analysis of Youth Violence Prevention

Effective violence interventions are not widely implemented, and there is little information about the cost of violence interventions. Our goal is to report the cost of a brief intervention delivered in the emergency department that reduces violence among 14- to 18-year-olds. Primary outcomes were total costs of implementation and the cost per violent event or violence consequence averted. We used primary and secondary data sources to derive the costs to implement a brief motivational interviewing intervention and to identify the number of self-reported violent events (eg, severe peer aggression, peer victimization) or violence consequences averted. One-way and multi-way sensitivity analyses were performed. Total fixed and variable annual costs were estimated at $71,784. If implemented, 4208 violent events or consequences could be prevented, costing $17.06 per event or consequence averted. Multi-way sensitivity analysis accounting for variable intervention efficacy and different cost estimates resulted in a range of $3.63 to $54.96 per event or consequence averted. Our estimates show that the cost to prevent an episode of youth violence or its consequences is less than the cost of placing an intravenous line and should not present a significant barrier to implementation.

Перспективные схемы пространственно-временной индексации для визуального моделирования масштабных индустриальных проектов

As opposed to traditional project planning and scheduling methods, 4D modeling technologies allow performing more comprehensive analysis taking into account both spatial and temporal factors. Such analysis enables to identify critical issues in early design and planning stages and to save significantly on the total project implementation costs. Unsurprisingly that there is a large interest to these emerging technologies and both free and commercial systems have been recently developed and applied in different industrial domains. However, being applied to large industrial projects and programs, most systems face significant problems relating to performance degradation and limited interactive capabilities what ultimately neglects the key benefits of visual 4D modeling technologies. In this paper a promising approach to rising up the performance and scalability of 4D modeling applications by means of indexing project data has been discussed. Three alternative indexing schemes have been proposed and described in conformity to the features of spatio-temporal coherence of arising dynamic scenes. These schemes have been investigated against the efficiency criteria to resolve typical requests connected with deployment and updates of indexes, reconstruction of scenes, analysis of visible objects, and animation of dynamic scenes. Conducted computational complexity analysis and obtained asymptotic estimates confirm the efficiency of the proposed indexing schemes and cause their introduction in industrial practice. Recommendations on their practical use have been also provided.

Estimating the costs of implementing the rotavirus vaccine in the national immunisation programme: the case of Malawi

Worldwide, rotavirus infections cause approximately 453,000 child deaths annually. Two licensed vaccines could be life- and cost-saving in low-income countries where the disease burden is highest. The aim of our study was to estimate the total cost of implementing the rotavirus vaccine in the national immunisation programme of a low-income country. Furthermore, the aim was to examine the relative contribution of different components to the total cost. Following the World Health Organization guidelines, we estimated the resource use and costs associated with rotavirus vaccine implementation, using Malawi as a case. The cost analysis was undertaken from a governmental perspective. All costs were calculated for a 5-years period (2012-2016) and discounted at 5%. The value of key input parameters was varied in a sensitivity analysis. The total cost of rotavirus vaccine implementation in Malawi amounted to US$ 18.5 million over a 5-years period. This translated into US$ 5.8 per child in the birth cohort. With GAVI Alliance financial support, the total cost was reduced to US$ 1.4 per child in the birth cohort. Approximately 83% of the total cost was attributed to vaccine purchase, while 17% was attributed to system costs, with personnel, transportation and cold chain as the main cost components. The total cost of rotavirus vaccine implementation in Malawi is high compared with the governmental health budget of US$ 26 per capita per year. This highlights the need for new financing opportunities for low-income countries to facilitate vaccine implementation and ensure sustainable financing.

The Costs of Developing, Implementing, and Operating a Safety Learning System in Community Practice

The cost of implementing safety systems in primary care has not been examined. One type of safety system is a safety learning system (SLS). An SLS has 2 components: a reporting that monitors patient safety incidents and a learning component that facilitated the development and implementation of improvement strategies. It is important to understand the costs of an SLS to determine if the improvement program is financially sustainable. To determine the costs of the development, implementation, and operation of the community-based SLS. Nineteen participating family physician clinics in Calgary, Alberta, were included (15 urban and 4 rural) consisting of 47 physicians, 53 office staff, 18 nurses, and 6 clinic managers. Costs of the SLS were determined by the ingredient method using micro-costing. The costs were divided into 3 stages: development, implementation, and operational. Development costs were processes required to create and initiate the SLS. Implementation costs were accrued as a result of establishing, running, and refining the SLS. Finally, operational costs were those related to maintaining the SLS. Costs were further broken down into fixed, marginal, and in kind; this approach will allow policy and decision makers to apply the appropriate costs to their own settings. The total development, implementation, and operational costs for the SLS in Canadian dollars were $77,011, $19,941, and $166,727, respectively, with a total cost of $263,679 over approximately a 4-year period. During this time, 270 incident reports were submitted, and 54 improvement cycles were implemented. The results provide quantitative data, which could be useful to legislators, policy makers, and other private and public sector payers of patient safety programs in determining the overall sustainability of an SLS.