Economic analysis of transarterial chemoembolization (TACE) versus stereotactic body radiotherapy (SBRT) for the treatment of hepatocellular carcinoma (HCC).

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 508-508
Author(s):  
Francis W. Nugent ◽  
Amy Packard ◽  
Klaudia Hunter ◽  
Amir Qamar ◽  
Keith E. Stuart ◽  
...  
Keyword(s):  
Outpatient Treatment ◽  
Symptom Management ◽  
Local Treatment ◽  
Tumor Burden ◽  
Opportunity Costs ◽  
Class A ◽  
Institutional Cost ◽  
The Cost ◽  
Average Contribution ◽  
Clinical Trial Information

508 Background: For HCC patients undergoing liver transplantation (LT), local treatment as a "bridge" is standard to decrease tumor burden. The most common treatment is TACE, but the best and cheapest bridging modality is unclear. We prospectively compared SBRT to TACE as a bridge for HCC patients undergoing LT. We then compared the cost of the two strategies. Methods: From 9/2014-1/2017, 31 patients within Milan Criteria with C-P Class A/B cirrhosis were randomized to TACE vs. SBRT. TACE patients received 2 treatments one month apart utilizing DEBDOX beads (n = 17) and were hospitalized for symptom management. Patients receiving SBRT (n = 14) received outpatient treatment comprising 5 fractions of radiation using fiducials. Using EPSI, the institutional cost accounting and clinical data base, all patients treated were analysed. Financial and cost data was used to calculate the average contribution margin (total payment minus direct cost) for each type of treatment and then multiplied for each patient by the number of treatments involved. Results: See table. Conclusions: SBRT costs less than TACE to treat HCC. Given reduced reimbursement for hospitalizations post-TACE, additional opportunity costs may be available at given institutions depending on bed availability. Clinical trial information: NCT02182687. [Table: see text]

Indwelling pleural catheter for outpatient management of tuberculous empyema

2020 ◽  
Vol 13 (3) ◽  
pp. e233213 ◽  
Author(s):  
Ambreen Iqbal Muhammad ◽  
Joseph Gavin ◽  
Alex Wilkinson
Keyword(s):  
Outpatient Treatment ◽  
Symptom Management ◽  
Pleural Effusions ◽  
Outpatient Management ◽  
Cost Of Treatment ◽  
Indwelling Pleural Catheter ◽  
Intermittent Drainage ◽  
Pleural Catheter ◽  
The Cost ◽  
Hospital Acquired

The use of indwelling pleural catheters (IPC) is well established in the treatment of malignant pleural effusions. They allow symptom management with intermittent drainage without requiring overnight admission to hospital. However, little is known about their effectiveness in the treatment of pleural infections. Here, we present a case where an IPC is used in the therapeutic management of tuberculous empyema. The IPC enabled outpatient treatment, allowed the patient to return to work and reduced the cost of treatment and the risk of hospital-acquired complications.

scholarly journals SWK-11. ASSESSMENT OF THE INDIRECT COSTS ASSOCIATED WITH PROTON THERAPY TREATMENT FOR ALBERTA PATIENTS REFERRED OUT OF COUNTRY

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii466-iii466
Author(s):  
Karina Black ◽  
Jackie Middleton ◽  
Sunita Ghosh ◽  
David Eisenstat ◽  
Samor Patel
Keyword(s):  
United States ◽  
Proton Therapy ◽  
Malignant Tumors ◽  
Indirect Costs ◽  
The United States ◽  
Current Data ◽  
Opportunity Costs ◽  
Proton Treatment ◽  
Out Of Pocket Expenses ◽  
The Cost

Abstract BACKGROUND Proton therapy for benign and malignant tumors has dosimetric and clinical advantages over photon therapy. Patients in Alberta, Canada are referred to the United States for proton treatment. The Alberta Heath Care Insurance Plan (AHCIP) pays for the proton treatment and the cost of flights to and from the United States (direct costs). This study aimed to determine the out-of-pocket expenses incurred by patients or their families (indirect costs). METHODS Invitation letters linked to an electronic survey were mailed to patients treated with protons between 2008 and 2018. Expenses for flights for other family members, accommodations, transportation, food, passports, insurance, and opportunity costs including lost wages and productivity were measured. RESULTS Fifty-nine invitation letters were mailed. Seventeen surveys were completed (28.8% response rate). One paper survey was mailed at participant request. Nine respondents were from parent/guardian, 8 from patients. All patients were accompanied to the US by a family member/friend. Considerable variability in costs and reimbursements were reported. Many of the accompanying family/friends had to miss work; only 3 patients themselves reported missed work. Time away from work varied, and varied as to whether it was paid or unpaid time off. CONCLUSIONS Respondents incurred indirect monetary and opportunity costs which were not covered by AHCIP when traveling out of country for proton therapy. Prospective studies could help provide current data minimizing recall bias. These data may be helpful for administrators in assessing the societal cost of out-of-country referral of patients for proton therapy.

Parents' Time Is Worth Money

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 466-466
Author(s):  
DOUGLAS RICHARDSON
Keyword(s):  
Intensive Care ◽  
Cost Effectiveness ◽  
Economic Analysis ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Waiting Times ◽  
Opportunity Costs ◽  
Home Management ◽  
Tacit Assumption ◽  
The Cost

To the Editor.— I was delighted to see Donn's letter about the cost effectiveness of home management of bronchopulmonary dysplasia.1 Such contributions are vital in helping to curb the rapidly rising costs of neonatal intensive care. However, his economic analysis is flawed. By tacit assumption, he omits any consideration of the opportunity costs to the parents. To omit this presumes that the parents' time is worth little or nothing, as we often seem to indicate by the long patient waiting times in our offices.

scholarly journals An Analysis of the Influence of Electable(s) on Democracy in Pakistan (1988-2019)

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Usman Khan, Dr. Aziz ur Rahman, Dr. Muhammad Kashif
Keyword(s):  
State Power ◽  
Power Structure ◽  
Diverse Group ◽  
Parliamentary Democracy ◽  
Personal Communications ◽  
Class A ◽  
The Cost ◽  
Personal Interests

This paper explores the impacts and influence of electable(s) on parliamentary democracy in Pakistan during the last three decades (1988-2019). The paper argues that Alavi’s state power structure, dominated by civil-military bureaucracy, has undergone a change in the last few decades. New forces like intermediate class, a segment of superior courts’ judges and some of the politicians known as electable(s) have been able to occupy space in the Pakistani state power structure. This paper argues that electable(s) remain connected with the powerful establishment only for the purpose to obtain their personal interests at the cost of weakening parliamentary democracy in Pakistan. Data is collected through personal communications with a diverse group of people having expertise in their respective fields  

scholarly journals ANALISIS DIFFERENTIAL COST DAN OPPORTUNITY COST DALAM PENGAMBILAN KEPUTUSAN MEMBELI ATAU MEMPRODUKSI SENDIRI PADA INDUSTRI RUMAH PANGGUNG WOLOAN

2015 ◽  
Vol 13 (03) ◽  
Author(s):  
Romeo Fersi Mongdong ◽  
Jenny Morasa ◽  
Heince Wokas
Keyword(s):  
Cost Analysis ◽  
Analytical Method ◽  
Opportunity Cost ◽  
Raw Materials ◽  
Quantitative Result ◽  
Opportunity Costs ◽  
Business World ◽  
Differential Costs ◽  
The Right ◽  
The Cost

The business world today is characterized by increasing competition among existing companies. Competition occurs in all sectors of the economy both industry, trade, and services. One of the decisions that must be taken in planning at every alternative is to buy or produce itself a component of raw materials. Differential cost are related to the opportunity cost, which is the differential cost incurred costs as a result of certain decisions while the opportunity cost is the cost incurred when choosing a decision. The purpose of this study to analyze the differential costs and opportunity costs in the decision to buy or produce their own on Industri Rumah Panggung Woloan. The analytical method used is descreptive quantitative. Result of the differential cost analysis showed that the right decisions can be taken by the management company the manufactures its own because getting a hihgter differential gain, compared to buying from outside. While the opportunity cost of the buying raw materials from outside is more profitable, thus producing itself becomes more expensive. Should the leadership Industri Rumah Panggung Woloan produce their own wood from the outside becauseit would be more adventageous, compared to taking wood there are kept alone.

scholarly journals Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold

2015 ◽  
Vol 19 (14) ◽  
pp. 1-504 ◽  
Author(s):  
Karl Claxton ◽  
Steve Martin ◽  
Marta Soares ◽  
Nigel Rice ◽  
Eldon Spackman ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Effects ◽  
The Other ◽  
Opportunity Costs ◽  
Best Estimate ◽  
The Cost ◽  
The Impact ◽  
The Relationship ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

BackgroundCost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement. There are no empirical estimates of the cost-effectiveness threshold used by the National Institute for Health and Care Excellence.Objectives(1) To provide a conceptual framework to define the cost-effectiveness threshold and to provide the basis for its empirical estimation. (2) Using programme budgeting data for the English NHS, to estimate the relationship between changes in overall NHS expenditure and changes in mortality. (3) To extend this mortality measure of the health effects of a change in expenditure to life-years and to QALYs by estimating the quality-of-life (QoL) associated with effects on years of life and the additional direct impact on QoL itself. (4) To present the best estimate of the cost-effectiveness threshold for policy purposes.MethodsEarlier econometric analysis estimated the relationship between differences in primary care trust (PCT) spending, across programme budget categories (PBCs), and associated disease-specific mortality. This research is extended in several ways including estimating the impact of marginal increases or decreases in overall NHS expenditure on spending in each of the 23 PBCs. Further stages of work link the econometrics to broader health effects in terms of QALYs.ResultsThe most relevant ‘central’ threshold is estimated to be £12,936 per QALY (2008 expenditure, 2008–10 mortality). Uncertainty analysis indicates that the probability that the threshold is < £20,000 per QALY is 0.89 and the probability that it is < £30,000 per QALY is 0.97. Additional ‘structural’ uncertainty suggests, on balance, that the central or best estimate is, if anything, likely to be an overestimate. The health effects of changes in expenditure are greater when PCTs are under more financial pressure and are more likely to be disinvesting than investing. This indicates that the central estimate of the threshold is likely to be an overestimate for all technologies which impose net costs on the NHS and the appropriate threshold to apply should be lower for technologies which have a greater impact on NHS costs.LimitationsThe central estimate is based on identifying a preferred analysis at each stage based on the analysis that made the best use of available information, whether or not the assumptions required appeared more reasonable than the other alternatives available, and which provided a more complete picture of the likely health effects of a change in expenditure. However, the limitation of currently available data means that there is substantial uncertainty associated with the estimate of the overall threshold.ConclusionsThe methods go some way to providing an empirical estimate of the scale of opportunity costs the NHS faces when considering whether or not the health benefits associated with new technologies are greater than the health that is likely to be lost elsewhere in the NHS. Priorities for future research include estimating the threshold for subsequent waves of expenditure and outcome data, for example by utilising expenditure and outcomes available at the level of Clinical Commissioning Groups as well as additional data collected on QoL and updated estimates of incidence (by age and gender) and duration of disease. Nonetheless, the study also starts to make the other NHS patients, who ultimately bear the opportunity costs of such decisions, less abstract and more ‘known’ in social decisions.FundingThe National Institute for Health Research-Medical Research Council Methodology Research Programme.

scholarly journals Cost-effectiveness of the Hall Technique in a Randomized Trial

2018 ◽  
Vol 98 (1) ◽  
pp. 61-67 ◽  
Author(s):  
F. Schwendicke ◽  
J. Krois ◽  
M. Robertson ◽  
C. Splieth ◽  
R. Santamaria ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Dental Treatment ◽  
Treatment Costs ◽  
Primary Molars ◽  
Opportunity Costs ◽  
Data Set ◽  
Dental Practitioners ◽  
Patient Reported ◽  
The Cost ◽  
Hall Technique

Clinical and patient-reported outcomes were reported for carious primary molars treated with the Hall technique (HT) as compared with conventional carious tissue removal and restorations (i.e., conventional restoration [CR]) in a 5-y randomized controlled practice-based trial in Scotland. We interrogated this data set further to investigate the cost-effectiveness of HT versus CR. A total of 132 children who had 2 matched occlusal/occlusal-proximal carious lesions in primary molars ( n = 264 teeth) were randomly allocated to HT or CR, provided by 17 general dental practitioners. Molars were followed up for a mean 5 y. A societal perspective was taken for the economic analysis. Direct dental treatment costs were estimated from a Scottish NHS perspective (an NHS England perspective was taken for a sensitivity analysis). Initial, maintenance, and retreatment costs, including rerestorations, endodontic treatments, and extractions, were estimated with fee items. Indirect/opportunity costs were estimated with time and travel costs from a UK perspective. The primary outcome was tooth survival. Secondary outcomes included 1) not having pain or needing endodontic treatments/extractions and 2) not needing rerestorations. Cost-effectiveness and acceptability were estimated from bootstrapped samples. Significantly more molars in HT survived (99%, 95% CI: 98% to 100%) than in CR (92%; 87% to 97%). Also, the proportion of molars retained without pain or requiring endodontic treatment/extraction was significantly higher in HT than CR. In the base case analysis (NHS Scotland perspective), cumulative direct dental treatment costs (Great British pound [GBP]) of HT were 24 GBP (95% CI: 23 to 25); costs for CR were 29 (17 to 46). From an NHS England perspective, the cost advantage of HT (29 GBP; 95% CI: 25 to 34) over CR (107; 86 to 127) was more pronounced. Indirect/opportunity costs were significantly lower for HT (8 GBP; 95% CI: 7 to 9) than CR (19; 16 to 23). Total cumulative costs were significantly lower for HT (32 GBP; 95% CI: 31 to 34) than CR (49; 34 to 69). Based on a long-term practice-based trial, HT was more cost-effective than CR with HT retained for longer and experiencing less complications at lower costs.

Epilogue

2020 ◽  
pp. 206-210
Author(s):  
James S.J. Schwartz
Keyword(s):  
Space Environment ◽  
Opportunity Costs ◽  
Scientific Exploration ◽  
The Future ◽  
Future Value ◽  
Human Habitation ◽  
A Priority ◽  
Space Environments ◽  
The Cost

This concluding chapter argues that scientific exploration of the space environment should remain a priority even if space settlements are established, and even if technological breakthroughs decrease the cost of spaceflight enough to increase spaceflight activities by orders of magnitude. It addresses the enduring need to engage in scientific examination in order to establish the viability of space environments for human habitation. It also reaffirms the value of scientific exploration, knowledge, and understanding—which will only become more significant in space societies, if they are ever established. The Epilogue concludes by addressing the possible development of revolutionary technologies, the opportunity costs associated with prioritizing scientific exploration, and the future value of scientific exploration, knowledge, and understanding in space.

scholarly journals A Nested Land Uses–Landscapes–Livelihoods Approach to Assess the Real Costs of Land-Use Transitions: Insights from Southeast Asia

Land ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 11 ◽  
Author(s):  
Guillaume Lestrelin ◽  
Jean-Christophe Castella ◽  
Qiaohong Li ◽  
Thoumthone Vongvisouk ◽  
Nguyen Dinh Tien ◽  
...  
Keyword(s):  
Land Use ◽  
Land Use Changes ◽  
Forest Degradation ◽  
Economic Benefits ◽  
Opportunity Costs ◽  
Costs And Benefits ◽  
Wide Range ◽  
Forested Areas ◽  
Mitigate Climate Change ◽  
The Cost

Reducing emissions from deforestation and forest degradation (REDD+) is viewed as an effective way to mitigate climate change by compensating stewards of forested areas for minimizing forestland conversion and protecting forest services. Opportunity costs assess the cost of foregone opportunity when preserving the forest instead of investing in an alternative activity or resource use. This paper questions the calculation method of opportunity costs using averaged economic benefits and co-benefits of different land-use transitions. We propose a nested approach to land-use transitions at the interface between landscapes and livelihoods and assessing a wide range of potential socio-ecological costs and benefits. Combining household surveys and focus groups with participatory mapping, we applied the approach in villages of Laos, Vietnam and China positioned along a broad transition trajectory from subsistence shifting cultivation to intensive commercial agriculture. By looking beyond the economics of land use, we highlight important linkages between land-use changes and livelihood differentiation, vulnerability and inequalities. Our results show the importance of addressing the impacts of land-use transitions on a wide range of potential ecological and socioeconomic costs and benefits at multiple levels.

scholarly journals Sewage cleaning by using a phase separator

2020 ◽  
Vol 164 ◽  
pp. 01020
Author(s):  
Nikolay S. Serpokrylov ◽  
Alla S. Smolyanichenko ◽  
Elena V. Yakovleva
Keyword(s):  
Industrial Wastewater ◽  
Local Treatment ◽  
Industrial Plant ◽  
Urgent Problem ◽  
Laboratory Studies ◽  
Active Experiment ◽  
Preliminary Purification ◽  
Treatment Facilities ◽  
The Cost ◽  
Phase Separator

This article proposes a solution to the urgent problem of treating oil-, fat-containing wastewater. A phase separator of dispersions for preliminary purification of industrial wastewater contaminated with fats is proposed, its effectiveness in the treatment of wastewater at local treatment facilities of an industrial plant for the production of sunflower oil is tested. In order to reduce the cost of acquiring reagents and increase the efficiency of purification of fat-containing wastewater, the use of carbide sludge and sodium hydroaluminate was studied. Laboratory studies conducted by the method of an active experiment.

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