Дисертації з теми "Cost Consequences Analysis"

Leucodepletion, the removal of leucocytes from blood products improves the safety of blood transfusion by reducing adverse events associated with the incidental non-therapeutic transfusion of leucocytes. Leucodepletion has been shown to have clinical benefit for immuno-suppressed patients who require transfusion. The selective leucodepletion of blood products by bed side filtration for these patients has been widely practiced. This study investigated the economic consequences in Queensland of moving from a policy of selective leucodepletion to one of universal leucodepletion, that is providing all transfused patients with blood products leucodepleted during the manufacturing process. Using an analytic decision model a cost-effectiveness analysis was conducted. An ICER of $16.3M per life year gained was derived. Sensitivity analysis found this result to be robust to uncertainty in the parameters used in the model. This result argues against moving to a policy of universal leucodepletion. However during the course of the study the policy decision for universal leucodepletion was made and implemented in Queensland in October 2008. This study has concluded that cost-effectiveness is not an influential factor in policy decisions regarding quality and safety initiatives in the Australian blood sector.

Planners who are involved in locational decision making often use raster-based geographic information systems (GIS) to quantify the value of land in terms of suitability or cost for a certain use. From a computational point of view, this process can be seen as a transformation of one or more sets of values associated with a grid of cells into another set of such values through a function reflecting one or more criteria. While it is generally anticipated that different transformations lead to different ‘best’ locations, little has been known on how such differences arise (or do not arise). Examples of such spatial decision problems can be easily found in the literature and many of them concern the selection of a set of cells (to which the land use under consideration is allocated) from a raster surface of suitability or cost depending on context. To facilitate GIS’s algorithmic approach, it is often assumed that the quality of the set of cells can be evaluated as a whole by the sum of their cell values. The validity of this assumption must be questioned, however, if those values are measured on a scale that does not permit arithmetic operations. Ordinal scale of measurement in Stevens’s typology is one such example. A question naturally arises: is there a more mathematically sound and consistent approach to evaluating the quality of a path when the quality of each cell of the given grid is measured on an ordinal scale? The thesis attempts to answer the questions highlighted above in the context of path planning through a series of computational experiments using a number of random landscape grids with a variety of spatial and non-spatial structures. In the first set of experiments, we generated least-cost paths on a number of cost grids transformed from the landscape grids using a variety of transformation parameters and analyzed the locations and (weighted) lengths of those paths. Results show that the same pair of terminal cells may well be connected by different least-cost paths on different cost grids though derived from the same landscape grid and that the variation among those paths is affected by how given values are distributed in the landscape grid as well as by how derived values are distributed in the cost grids. Most significantly, the variation tends to be smaller when the landscape grid contains more distinct patches of cells potentially attracting or distracting cost-saving passage or when the cost grid contains a smaller number of low-cost cells. The second set of experiments aims to compare two optimization models, minisum and minimax (or maximin) path models, which aggregate the values of the cells associated with a path using the sum function and the maximum (or minimum) function, respectively. Results suggest that the minisum path model is effective if the path search can be translated into the conventional least-cost path problem, which aims to find a path with the minimum cost-weighted length between two terminuses on a ratio-scaled raster cost surface, but the minimax (or maximin) path model is mathematically sounder if the cost values are measured on an ordinal scale and practically useful if the problem is concerned not with the minimization of cost but with the maximization of some desirable condition such as suitability.
Planerare som arbetar bland annat med att fatta beslut som hänsyftar till vissa lokaler använder ofta rasterbaserade geografiska informationssystem (GIS) för att sätta ett värde på marken med avseende på lämplighet eller kostnad för en viss användning. Ur en beräkningssynpunkt kan denna process ses som en transformation av en eller flera uppsättningar värden associerade med ett rutnät av celler till en annan uppsättning sådana värden genom en funktion som återspeglar ett eller flera kriterier. Medan det generellt förväntas att olika omvandlingar leder till olika "bästa" platser, har lite varit känt om hur sådana skillnader uppstår (eller inte uppstår). Exempel på sådana rumsliga beslutsproblem kan lätt hittas i litteraturen och många av dem handlar om valet av en uppsättning celler (som markanvändningen övervägs tilldelas) från en rasteryta av lämplighet eller kostnad beroende på kontext. För att underlätta GISs algoritmiska tillvägagångssätt antas det ofta att kvaliteten på uppsättningen av celler kan utvärderas som helhet genom summan av deras cellvärden. Giltigheten av detta antagande måste emellertid ifrågasättas om dessa värden mäts på en skala som inte tillåter aritmetiska transformationer. Användning av ordinal skala enligt Stevens typologi är ett exempel av detta. En fråga uppstår naturligt: Finns det ett mer matematiskt sunt och konsekvent tillvägagångssätt för att utvärdera kvaliteten på en rutt när kvaliteten på varje cell i det givna rutnätet mäts med ordinalskala? Avhandlingen försöker svara på ovanstående frågor i samband med ruttplanering genom en serie beräkningsexperiment med hjälp av ett antal slumpmässigt genererade landskapsnät med en rad olika rumsliga och icke-rumsliga strukturer. I den första uppsättningen experiment genererade vi minsta-kostnad rutter på ett antal kostnadsnät som transformerats från landskapsnätverket med hjälp av en mängd olika transformationsparametrar, och analyserade lägen och de (viktade) längderna för dessa rutter. Resultaten visar att samma par ändpunkter mycket väl kan vara sammanbundna med olika minsta-kostnad banor på olika kostnadsraster härledda från samma landskapsraster, och att variationen mellan dessa banor påverkas av hur givna värden fördelas i landskapsrastret såväl som av hur härledda värden fördelas i kostnadsrastret. Mest signifikant är att variationen tenderar att vara mindre när landskapsrastret innehåller mer distinkta grupper av celler som potentiellt lockar eller distraherar kostnadsbesparande passage, eller när kostnadsrastret innehåller ett mindre antal låg-kostnad celler. Den andra uppsättningen experiment syftar till att jämföra två optimeringsmodeller, minisum och minimax (eller maximin) sökmodeller, vilka sammanställer värdena för cellerna som är associerade med en sökväg med summanfunktionen respektive maximum (eller minimum) funktionen. Resultaten tyder på att minisumbanemodellen är effektiv om sökningen av sökvägen kan översättas till det konventionella minsta kostnadsproblemet, vilket syftar till att hitta en väg med den minsta kostnadsvägda längden mellan två terminaler på en ratio-skalad rasterkostyta, men minimax (eller maximin) banmodellen är matematiskt sundare om kostnadsvärdena mäts i ordinär skala och praktiskt användbar om problemet inte bara avser minimering av kostnad men samtidigt maximering av någon önskvärd egenskap såsom lämplighet.

QC 20181002

The expenditures resulting from work accidents is increasing every year. Among the other work accidents, mine accidents result important loss of time, money and lives. From the point of view of mine accidents, studies about cost of mine accidents need some contributions. In this thesis, cost of mine accidents to worker, employer, and total economy of country will be analysed in the light of data from Ministry of Labour, Social Security and Social Insurance Institution, and Tü
rkiye Coal Enterprises. General Analysis is carried out within all industrial sectors, Mining sector, and Coal Mining sector. Detailed analysis is carried out within Western Lignite Company (GLi). Occupational accidents have vital importance for the mines from legal, human and economic aspects. The goal of every mine should be to minimize occupational accidents. The top management of every mine should prove their commitments to the occupational health and safety policy to carry out this goal by means of preparing and implementing an accident preventing program.

This thesis explores causal attribution statements on performance outcomes given in annual reports of UK listed rms. The objectives are three-fold. First, it analyses the nature and extent of attribution statements provided. Second, it explores corporate governance factors and rm-speci c characteristics that are related to the provision of attribution statements. Finally, it investigates the economic consequences of providing attribution statements by examining their association with the rm's cost of equity capital. Using data drawn from a sample of 142 UK rms listed on the London Stock Exchange, content analysis was used to measure the extent of attributions in the annual reports for the year 2006. The results show that the volume of attribution statement provision is generally low and variation across rms is low. Firms also show a strong tendency to explain performance with internal rather than with external reasons. The results from regression analysis show that the volume of attribution statements and the space given to internal and external attribution statements is associated with the proportion of non-executive directors, director share ownership, audit committee size, market value, gearing, pro tability and new share issues. With respect to the relationship between the attribution statements and the cost of capital, the PEG model was employed to estimate the cost of equity capital. The ndings indicate an association between attribution statement provision and the cost of equity capital, but only for rms with low analyst following. For these rms, more extensive performance explanations and more extensive internal explanations are associated with a higher cost of equity capital. However, attribution statements are unrelated to the cost of equity capital for rms with high analyst following. The thesis makes two contributions in the area of attribution determinants. First, it measures attribution provision with a measure that has not been previously applied in the literature to measure attribution statements. Second, it provides evidence on how rm-speci c characteristics and the rm's corporate governance mechanisms in uence the extent and the type of performance explanations provided by rms. The thesis makes four contributions regarding the e ect of attribution statements on the cost of capital. First, it uses a quantitative approach to directly estimate the cost of capital e ects of attribution statements. Second, it provides evidence that the association between attribution statements and the cost of equity capital is in uenced by an interaction between attribution statements and analyst following. Third, the thesis provides the rst evidence of the relationship between attribution statements and the cost of equity capital in a UK setting. Fourth, it provides evidence that the relationship between disclosure and the cost of equity capital is complex and is in uenced by interactions between disclosure and information intermediaries.

The 2008/2009 world financial crisis, as well as the 2010 onwards European sovereign debt crisis, retriggered the debate on costs and benefits of a European Monetary Union membership. This thesis examines whether Sweden experienced net costs or benefits in opting out the EMU, especially in comparison to Finland due to the close link between both economies, as well as cultural and geographical similarities. While both countries were drawing a convergent economic path from the 1990’s, in 1999, with the Euro adoption in Finland, the two Scandinavian economies chose different tracks in terms of monetary policies. Sweden opted to remain outside the EMU and maintain the floating exchange rate and the control of domestic monetary issues, while Finland chose to relinquish monetary policy autonomy and started to follow the rules and constraints of the European Central Bank. Furthermore, the paper analyzes the economic development of UK in comparison with France, due to the approximate size of both economies (one EMU member and the other an outsider), and also Germany, the EMU leader, and the Euro area as a whole. The data base from Eurostat and the Synthetic Counterfactual Method have shown that there were net benefits for Sweden not to had joined the EMU. Moreover, the paper presents the Theory of Optimum Currency Area, first introduced by Mundell in 1961 as the starting point on the discussion of costs and benefits of an EMU membership.

Psykisk ohälsa bland barn och unga är ett växande problem i Sverige. Kommunen bär den största samhällskostnaden för ett barn under uppväxten och därför är det extra viktigt att ta reda på hur resurser kan omfördelas i samhället för att gynna barns hälsa. Syftet med studien var att visa hur en investering i preventiva insatser kan förbättra barns psykiska hälsa och samtidigt spara på samhällets resurser. Kommunal statistik visar att barn i skolan som är i behov av särskilt stöd på grund av depression/ångest, ADHD och psykosocial problematik får insatser så som stöd från elevassistent, lärare eller placerad i särskild undervisningsgrupp. Kostnader för dessa insatser varierar mellan 4424-26000 kronor per barn och månad. Dessa kostnader kan ställas i relation till kostnader för universella preventiva skolprogram som har en bevisad positiv effekt på barns psykiska hälsa, vars driftskostnader för en hel intervention som mest är 1097 kronor per barn. Analysen visar att en omfördelning av resurserna till preventiva interventioner, såsom skolprogram, kan vara en lyckosam satsning för kommunen, både ekonomiskt och hälsomässigt då det kan förbättra barns psykiska hälsa men också leda till samhällsbesparingar.
Children’s mental ill-health is a growing public health problem in Sweden and for the municipality, being an important financial actor during a child’s upbringing, it is crucial to put resources where they give positive effect on the problem. The overall aim of the study is to describe how investing in prevention programs at children’s schools can improve children’s mental health and reduce the societal costs. Municipality statistics show that children in need of special support in school because of depression/anxiety, ADHD and psychosocial problems receive actions such as personal assistant, teacher or placed in a special education group. The cost of these actions varies between 4424-26000 Swedish krona [SEK] per child and month. These costs can be put in relation to preventive universal school interventions that have the highest cost of 1097 SEK per child and have a proven effect on child mental health. The analysis shows that preventing child mental ill-health can save societal costs and provide a healthier life for children compared to the current standard practice of targeting the children’s problems only after they have occurred.

Class of 2005 Abstract
Objectives: The purpose of this retrospective investigation is to compare the quantity, importance, and associated cost implications of drug-related problems identified (and ultimately resolved) through order entry/verification versus other clinical activities of a decentralized critical care pharmacist. Methods: The data from this study was collected by one decentralized pharmacist assigned to a surgical intensive care unit. A standard form was used to document all interventions during the period of this observation. For the purposes of this retrospective evaluation the following data will be extracted from the existing database: amount of time spent performing various clinical activities, how drug-related problems were identified (e.g., order entry verification versus chart reviews), the time it took to identify and resolve drug-related problems, a general description of interventions, the importance of the intervention, and the estimated economic impact associated with interventions. Results: In only a 41⁄2 month period, 111 patients would have likely experienced an adverse drug event had the ICU pharmacist not intervened. This equals a cost avoidance to the institution of anywhere from $200,000 to $280,000 for as little on average of 15-30 minutes of the pharmacist time. Implications: As previous studies have shown, the presence of a pharmacist in an ICU is crucial to lowering the incidence of adverse drug events. Our results have proven the interventions pharmacist make during team rounding and chart review are not only cost effective, but substantially improve patient care.

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Tese (Doutoramento)
IPEN/T
Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP

Hazardous materials are substances that, if not regulated, can pose a threat to human populations and their environmental health, safety or property when transported in commerce. About 1.5 million tons of hazardous material shipments are transported by truck in the US annually, with a steady increase of approximately 5% per year. The objective of this study was to develop a routing tool for hazardous material transport in order to facilitate reduced environmental impacts and less transportation difficulties, yet would also find paths that were still compelling for the shipping carriers as a matter of trucking cost. The study started with identification of inhalation hazard impact zones and explosion protective areas around the location of hypothetical hazardous material releases, considering different parameters (i.e., chemicals characteristics, release quantities, atmospheric condition, etc.). Results showed that depending on the quantity of release, chemical, and atmospheric stability (a function of wind speed, meteorology, sky cover, time and location of accidents, etc.) the consequence of these incidents can differ. The study was extended by selection of other evaluation criteria for further investigation because health risk as an evaluation criterion would not be the only concern in selection of routes. Transportation difficulties (i.e., road blockage and congestion) were incorporated as important factor due to their indirect impact/cost on the users of transportation networks. Trucking costs were also considered as one of the primary criteria in selection of hazardous material paths; otherwise the suggested routes would have not been convincing for the shipping companies. The last but not least criterion was proximity of public places to the routes. The approach evolved from a simple framework to a complicated and efficient GIS-based tool able to investigate transportation networks of any given study area, and capable of generating best routing options for cargos. The suggested tool uses a multi-criteria-decision-making method, which considers the priorities of the decision makers in choosing the cargo routes. Comparison of the routing options based on each criterion and also the overall suitableness of the path in regards to all the criteria (using a multi-criteria-decision-making method) showed that using similar tools as the one proposed by this study can provide decision makers insights in the area of hazardous material transport. This tool shows the probable consequences of considering each path in a very easily understandable way; in the formats of maps and tables, which makes the tradeoffs of costs and risks considerably simpler, as in some cases slightly compromising on trucking cost may drastically decrease the probable health risk and/or traffic difficulties. This will not only be rewarding to the community by making cities safer places to live, but also can be beneficial to shipping companies by allowing them to advertise as environmental friendly conveyors.

Introduction : La tyrosinémie de type I est une maladie génétique sévère. Elle se caractérise par des manifestations hépatiques, rénales et neurologiques. Depuis 1994, le NTBC représente la thérapie de première ligne. Ce médicament a conduit à une amélioration radicale de la morbidité et du pronostic de la maladie. Objectif : Évaluer les coûts directs des soins de santé reliés au traitement de cette maladie. Cette évaluation économique a été effectuée en trois groupes dont, un groupe historique de patients non traités; un groupe traitement tardif et un groupe traitement précoce par NTBC. Méthode : L’analyse coûts-conséquences inclut les coûts des hospitalisations, des services médicaux et des thérapies associées. Les données proviennent des banques de la RAMQ, de Med-Echo et des dossiers hospitaliers. Résultats : Le NTBC est associé à une réduction significative des hospitalisations, des séjours aux soins intensifs et des greffes hépatiques. Les coûts hospitaliers sont significativement moindres pour les groupes traités (13 979 $, 6 347 $ et 673 $ par année-patient pour les groupes historique, traitement tardif et traitement précoce,respectivement; valeur p < 0,0001). Les coûts des hospitalisations pour greffes par année-patient sont de 4 676$ pour le groupe historique et de 3 567 $ pour le groupe traitement tardif. Les coûts du NTBC par année-patient sont de 66 965 $ et de 51 493 $ pour les groupes traitement tardif et traitement précoce, respectivement. Conclusion : Les résultats démontrent l’impact majeur du NTBC sur la réduction de l’utilisation des ressources de santé, des greffes hépatiques et des coûts associés.
Introduction : Tyrosinemia type I is a severe genetic disorder. Symptoms include hepatic,renal and neurological manifestations. NTBC became the first-line therapy in 1994. This drug has led to a drastic improvement in the prognosis. Objective : To evaluate direct medical costs of healthcare services related to the treatment for this disease. This economic evaluation was conducted among the 3 following groups: an historical group of untreated patients, a late-treatment group and an early-treatment group with NTBC. Methods : The costs-consequences analysis includes costs incurred by hospitalizations, medical services and related treatments. Data are derived from the RAMQ and Med-Echo administrative databases and patients’ hospital charts. Results : NTBC treatment is associated with a significant reduction in hospitalizations, intensive care unit stays and liver transplantations. The cost of hospitalizations is significantly less for both treated groups (13,979 $, 6,347 $ and 673 $ per year-patient for the historical group, the late-treatment and the early-treatment group, respectively; pvalue< 0,0001). The cost of hospitalizations for liver transplantations per year-patient is 4,676 $ for the historical group and 3,567 $ for the late-treatment group. The cost of NTBC per year-patient is 66,965$ and 51,493$ for the late-treatment and the earlytreatment groups, respectively. Conclusion : These results demonstrate that NTBC treatment results in a major reduction in healthcare resources utilization, liver transplantations and associated costs.
Réalisé dans le cadre d'un mandat de l'Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) du CHU Sainte-Justine