scholarly journals Fresh Water Supply Aboard Ocean-Going Merchant Ships: The Economic Merit of Distillation From the Sea

1969 ◽  
Vol 6 (02) ◽  
pp. 134-146
Author(s):  
J. B. Woodward
Keyword(s):  
Fresh Water ◽  
Annual Cost ◽  
Attractive Alternative ◽  
General Belief ◽  
Merchant Ship ◽  
Average Annual Cost ◽  
Domestic Use ◽  
The Cost ◽  
Cost Differences ◽  
Significant Factors

The average annual cost of obtaining fresh water for boiler feed and domestic use by distillation from the sea is calculated for two distinct types of merchant ship, and compared to the cost of carrying purchased shore water for these uses. Results are presented as annual cost differences between the alternatives as functions of voyage length, with other significant factors as parameters. These results confirm the general belief that distillation is to be preferred, even if shore water did not typically require redistillation before use. Circumstances in which shore water might nonetheless be an attractive alternative are pointed out.

scholarly journals P019 Audit of prostanoid use in severe Raynaud’s and adherence to treatment of digital ulcers in patients with SSc NHSE pathway: commissioning policy cost analysis and alternative therapeutic pathway proposed

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Adam Young ◽  
Bridget Griffiths ◽  
Josephine Vila
Keyword(s):  
Annual Cost ◽  
Hospital Admissions ◽  
Digital Ulcers ◽  
Channel Blockers ◽  
Electronic Patient Records ◽  
Oral Medications ◽  
Blood Monitoring ◽  
Average Annual Cost ◽  
Policy Cost ◽  
The Cost

Abstract Background/Aims  Severe Raynaud’s phenomenon (RP) can lead to digital ulcers (DU), ischaemia, infection and gangrene. In 2015, NHS England published a commissioning policy enabling the use of bosentan for digital ulceration in SSc in patients refractory to intravenous 6-8 weekly prostanoid in combination with sildenafil following standard therapy (including calcium channel blockers (CCB), ACE inhibitors, losartan and fluoxetine). Bosentan is licensed to prevent new DUs in SSc. Specialist MDT ratification and Blueteq registration is required. RCTs showed bosentan reduced the formation of new DU by 30-50% in at risk individuals. It is a well-tolerated drug. It is now off-patent so its cost has reduced from £22,000 to £650 per year. Aim  To audit current departmental practice in patients receiving prostanoid (epoprostenol) for severe RP from any cause and check adherence to the patient pathway for treatment escalation prior to prostanoid therapy. To determine approximate costs of alternative therapeutic approaches. Methods  We retrospectively audited patients attending our day unit for epoprostenol infusions over a 12-month period between 2018 and 2019. Using our centre’s admissions database and electronic patient records, we identified which oral medications patients were currently co-prescribed or had previously trialled. Using pharmacy data and tariff costings, we calculated the cost of epoprostenol infusions and oral medications with blood monitoring. Results  Between 2018 and 2019, 73 patients attended for epoprostenol infusions: 31 SSc, 25 RP, 17 other diagnoses (mixed/undifferentiated CTD, SLE, vasculitis). The mean number of epoprostenol infusions per patient per year was 5.92 days (range 1-25). The percentage of patients who had first been trialled on the following medications include: CCB 77.4%, ACEi/ARB 41.1%, fluoxetine 9.59%, sildenafil 87.1% and tadalafil 25.8%. In the SSc group 22.6% had also trialled bosentan. Only 2 SSc patients (6.45%) had trialled all of the drugs on the pathway prior to prostanoid reflecting the relative lack of efficacy of some first line therapies. The departmental tariff per prostanoid infusion is £450, resulting in an estimated average annual cost of £2700 per patient. The annual cost of supplying bosentan 125mg twice daily plus blood monitoring for the first year is approximately £1350. Conclusion  Epoprostenol is used in our unit for patients with severe RP from a range of conditions. Sildenafil and CCB have been trialled in the majority of our patients prior to escalation. Only a minority of patients have received bosentan according to current guidelines and licensing. Given the reduction in cost, combined with the importance of avoiding hospital admissions with COVID-19, we would suggest that bosentan could be used earlier in the treatment pathway for a broader range of indications. NHSE is revising the SSc commissioning policy. Disclosure  A. Young: None. B. Griffiths: None. J. Vila: None.

Cost comparisons of five leading brands of the Antiplatelet drug, Clopidogrel, available in an Indian town

2019 ◽  
Vol 8 (8) ◽  
pp. 1734
Author(s):  
Vikram A. Rajadnya
Keyword(s):  
Annual Cost ◽  
Major Part ◽  
Financial Stress ◽  
Antiplatelet Drugs ◽  
Antiplatelet Drug ◽  
Front Seat ◽  
The Cost ◽  
Economic Considerations ◽  
Cost Differences ◽  
Yearly Cost

Background: Antiplatelet drugs need to be prescribed lifelong, for most of the selected patients, once started. Price disparity can lead to large financial stress on the patients, especially when cost related aspects are not paid heed to by the prescribing physician. This study was conducted to compare the cost, to the patient, of five most commonly prescribed preparations of different brands of Clopidogrel seventy five milligram, in Kolhapur city.Methods: The present study was undertaken during February 2019 to June 2019. Authors purchased a strip of 10 tablets each of the five leading brands of Clopidogrel seventy five milligram. The prices of the strip of 10 tablets of each of the five chosen brands were compared. Finally, the yearly cost of each of these five different preparations, was compared directly as well as using percentages. The data was collected, analyzed and presented in tabular forms and figures.Results: The data of the cost of five different brands of a single antiplatelet drug, Clopidogrel seventy five milligram shows that the annual cost of the costliest among the five brands of this drug is almost three times that of the cheapest brand, or in other words almost 300 percent that of the cheapest brand.Conclusions: The cost differences between the five brands were not negligible. India, with a major part of the population being very sensitive to the cost of medications, the prescribing physician must select the preparation wisely. The most costly preparation of Clopidogrel can significantly add to the the financial stress on the patient’s yearly expenditure. Thus, Pharmaco economic considerations must take a front seat while making a decision to prescribe medicines, especially in a country like India.

scholarly journals Why Do Some Firms Spend So Much on Medical Care? Accounting for Variation

2000 ◽  
Vol 3 (1) ◽  
Author(s):  
Matthew Eichner ◽  
Mark McClellan ◽  
David A. Wise
Keyword(s):  
Health Care ◽  
Health Care Cost ◽  
Health Care Expenditures ◽  
Cost Of Treatment ◽  
Consistent Method ◽  
The Difference ◽  
The Cost ◽  
Cost Differences ◽  
Average Expenditure

We are engaged in a long-term project to analyze the determinants of health care cost differences across firms. An important first step is to summarize the nature of expenditure differences across plans. The goal of this article is to develop methods for identifying and quantifying those factors that account for the wide differences in health care expenditures observed across plans.We consider eight plans that vary in average expenditure for individuals filing claims, from a low of $1,645 to a high of $2,484. We present a statistically consistent method for decomposing the cost differences across plans into component parts based on demographic characteristics of plan participants, the mix of diagnoses for which participants are treated, and the cost of treatment for particular diagnoses. The goal is to quantify the contribution of each of these components to the difference between average cost and the cost in a given firm. The demographic mix of plan enrollees accounts for wide differnces in cost ($649). Perhaps the most noticeable feature of the results is that, after adjusting for demographic mix, the difference in expenditures accounted for by the treatment costs given diagnosis ($807) is almost as wide as the unadjusted range in expenditures ($838). Differences in cost due to the different illnesses that are treated, after adjusting for demographic mix, also accounts for large differences in cost ($626). These components of cost do not move together; for example, demographic mix may decrease expenditure under a particular plan while the diagnosis mix may increase costs.Our hope is that understanding the reasons for cost differences across plans will direct more focused attention to controlling costs. Indeed, this work is intended as an important first step toward that goal.

A comprehensive assessment of the cost of multiple sclerosis in the United States

1998 ◽  
Vol 4 (5) ◽  
pp. 419-425 ◽  
Author(s):  
Kathryn Whetten-Goldstein ◽  
Frank A Sloan ◽  
Larry B Goldstein ◽  
Elizabeth D Kulas
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Insurance ◽  
Informal Care ◽  
Annual Cost ◽  
Lifetime Cost ◽  
The United States ◽  
Personal Health ◽  
Secondary Sources ◽  
The Cost

Comprehensive data on the costs of multiple sclerosis is sparse. We conducted a survey of 606 persons with MS who were members of the National Multiple Sclerosis Society to obtain data on their cost of personal health services, other services, equipment, and earnings. Compensation of such cost in the form of health insurance, income support, and other subsidies was measured. Survey data and data from several secondary sources was used to measure costs incurred by comparable persons without MS. Based on the 1994 data, the annual cost of MS was estimated at over $34 000 per person, translating into a conservative estimate of national annual cost of $6.8 billion, and a total lifetime cost per case of $2.2 million. Major components of cost were earnings loss and informal care. Virtually all persons with MS had health insurance, mostly Medicare/Medicaid. Health insurance covered 51 per cent of costs for services, excluding informal care. On average, compensation for earnings loss was 27 per cent. MS is very costly to the individual, health care system, and society. Much of the cost (57 per cent) is in the form of burdens other than personal health care, including earnings loss, equipment and alternations, and formal and informal care. These costs often are not calculated.

Abstract P241: One-Year Cost-Effectiveness of Cytochrome P450 2C19 Genotype-Guided Antiplatelet Therapy in Patients With Acute Coronary Syndromes

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Scott L Charland ◽  
Barnabie C Agatep ◽  
Daniel C Malone ◽  
Eric J Stanek
Keyword(s):  
Cytochrome P450 ◽  
Cost Effectiveness ◽  
Antiplatelet Therapy ◽  
Annual Cost ◽  
Extensive Metabolizers ◽  
Cyp2c19 Genotype ◽  
Event Management ◽  
Test Cost ◽  
Cytochrome P450 2C19 ◽  
The Cost

OBJECTIVES: Cytochrome P450 2C19 (CYP2C19) genotype has been shown to affect cardiovascular (CV) outcomes for clopidogrel but not prasugrel. This study evaluates the cost-effectiveness of CYP2C19-guided vs. routine antiplatelet therapy in ACS patients. METHODS: We constructed a literature-based, decision analytic, Markov model (TreeAge 2009) to estimate the cost-effectiveness of CYP2C19-guided aspirin plus either clopidogrel or prasugrel therapy vs. no genotyping. Post-initial ACS CV events were based on the TRITON-TIMI 38 study and related costs were derived primarily using 2007 Healthcare Cost and Utilization Project DRGs for nonfatal MI and stroke, CV death, intracranial hemorrhage, other life-threatening bleed, and minor bleed. Additional costs and disease-state utilities were obtained from other published sources. All costs were adjusted to 2009 $US using the Consumer Price Index medical care component. The model allowed for clopidogrel/prasugrel discontinuation and aspirin monotherapy. Model sensitivity was assessed using 1-way and multi-way analysis of influential parameters. RESULTS: The base case model demonstrated that CYP2C19 genotype guided antiplatelet therapy yielded lower overall annual cost and greater efficacy vs. no genotyping ( Table ). The model was sensitive to (in declining order): clopidogrel cost/day ($1 to $5.78), prasugrel cost/day ($4.09 to $ 6.81), % CYP2C19 extensive metabolizers on clopidogrel (60% to 100%), CYP2C19 test cost ($60 to $250), and monthly CV event management cost. A threshold value for clopidogrel at <$2.14/day favored the no genotyping strategy. However, the genotyping strategy was dominant when clopidogrel cost =$1/day and a CYP2C19 test cost threshold of <$125 on 2-way analysis. CONCLUSIONS: CYP2C19 genotype-guided clopidogrel or prasugrel therapy is cost-effective for up to 1 year in ACS patients, and can remain a preferred strategy at a hypothetical generic clopidogrel cost of $1.00/day. Table Strategy1 Annual Cost Incremental Cost Quality Adjusted Life Year (QALY) Incremental QALY Cost/QALY Incremental Cost Effectiveness (ICER) CYP2C19 Genotype-Guided $ 3,211 0.7212 $ 4,452 No Gentoyping $ 3,331 $120 0.6767 - (0.0445) $ 4,921 (Dominated) 1Base case values:Drug wholesale acquisition cost/day: clopidogrel $4.62, prasugrel $5.45; Baseline post-ACS utility = 0.83; Monthly cost for post-CV event management = $351; CYP2C19 genotyping =$185; After genotyping: 80% of extensive metabolizers, 20% of intermediate metabolizers and 10% of poor metabolizers on clopidogrel; 80% on clopidogrel without genotyping; Willingness to pay = $200

EXPLORING TWO COST-ADJUSTMENT METHODS FOR SELECTION BIAS IN A SMALL SAMPLE: USING A FETAL CARDIOLOGY DATASET

2014 ◽  
Vol 30 (3) ◽  
pp. 325-332 ◽  
Author(s):  
Hema Mistry
Keyword(s):  
Selection Bias ◽  
Small Sample ◽  
Economic Evaluations ◽  
Scoring Methods ◽  
Regression Analyses ◽  
Cost Estimates ◽  
Propensity Scoring ◽  
The Cost ◽  
Cost Differences ◽  
Direct Referral

Objectives: In economic evaluations of healthcare technologies, situations arise where data are not randomized and numbers are small. For this reason, obtaining reliable cost estimates of such interventions may be difficult. This study explores two approaches in obtaining cost estimates for pregnant women screened for a fetal cardiac anomaly.Methods: Two methods to reduce selection bias in health care: regression analyses and propensity scoring methods were applied to the total mean costs of pregnancy for women who received specialist cardiac advice by means of two referral modes: telemedicine and direct referral.Results: The observed total mean costs of pregnancy were higher for the telemedicine group than the direct referral group (4,918 versus 4,311 GBP). The regression model found that referral mode was not a significant predictor of costs and the cost difference between the two groups was reduced from 607 to 94 GBP. After applying the various propensity score methods, the groups were balanced in terms of sizes and compositions; and again the cost differences between the two groups were smaller ranging from -62 (matching “by hand”) to 333 GBP (kernel matching).Conclusions: Regression analyses and propensity scoring methods applied to the dataset may have increased the homogeneity and reduced the variance in the adjusted costs; that is, these methods have allowed the observed selection bias to be reduced. I believe that propensity scoring methods worked better for this dataset, because after matching the two groups were similar in terms of background characteristics and the adjusted cost differences were smaller.

scholarly journals Exploring drug cost and disease outcome in rheumatoid arthritis patients treated with biologic and targeted synthetic DMARDs in Norway in 2010–2019 – a country with a national tender system for prescription of costly drugs

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Alen Brkic ◽  
Andreas P. Diamantopoulos ◽  
Espen Andre Haavardsholm ◽  
Bjørg Tilde Svanes Fevang ◽  
Lene Kristin Brekke ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Annual Cost ◽  
Treatment Costs ◽  
Disease Outcomes ◽  
Health Authorities ◽  
Das28 Remission ◽  
Synthetic Dmards ◽  
Data Files ◽  
The Mean ◽  
The Cost

Abstract Background In Norway, an annual tender system for the prescription of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) has been used since 2007. This study aimed to explore annual b/tsDMARDs costs and disease outcomes in Norwegian rheumatoid arthritis (RA) patients between 2010 and 2019 under the influence of the tender system. Methods RA patients monitored in ordinary clinical practice were recruited from 10 Norwegian centers. Data files from each center for each year were collected to explore demographics, disease outcomes, and the prescribed treatment. The cost of b/tsDMARDs was calculated based on the drug price given in the annual tender process. Results The number of registered RA patients increased from 4909 in 2010 to 9335 in 2019. The percentage of patients receiving a b/tsDMARD was 39% in 2010 and 45% in 2019. The proportion of b/tsDMARDs treated patients achieving DAS28 remission increased from 42 to 67%. The estimated mean annual cost to treat a patient on b/tsDMARDs fell by 47%, from 13.1 thousand euros (EUR) in 2010 to 6.9 thousand EUR in 2019. The mean annual cost to treat b/tsDMARDs naïve patients was reduced by 75% (13.0 thousand EUR in 2010 and 3.2 thousand EUR in 2019). Conclusions In the period 2010–2019, b/tsDMARD treatment costs for Norwegian RA patients were significantly reduced, whereas DAS28 remission rates increased. Our data may indicate that the health authorities’ intention to reduce treatment costs by implementing a tender system has been successful.

scholarly journals Assessment of the Extent and Causes of Fuelwood Collection in the Surrounding Communities of Kasewe Reserved Forest, Sierra Leone

2021 ◽  
Vol 25 (7) ◽  
pp. 1271-1276
Author(s):  
A.H. Koroma ◽  
A. Mansaray ◽  
A. Sesay
Keyword(s):  
Sierra Leone ◽  
High Frequency ◽  
Cost Effective ◽  
Forest Degradation ◽  
Sustainable Utilization ◽  
Factors Affecting ◽  
Cooking Process ◽  
Domestic Use ◽  
Preferred Species ◽  
Significant Factors

Seven (7) communities living in and around the Kasewe forest reserved were sampled to assess the extent and causes of fuelwood collection from the reserved forest involving 50 individuals in stratified random technique with a view to evaluate the degree and reasons for fuelwood collection from the Kasewe reserved forest. Data obtained indicate a high frequency of fuelwood harvest in the forest throughout the year. The significant factors affecting such decisions were availability and accessibility, ensure fast cooking process, and cost-effective. In addition, fuelwood activities were intensive throughout the year but peaks late dry season. Hence 48 (96%) of respondents stated forest degradation as one of the significant threats posed by fuelwood collectors to the forest. The study indicates that 100% of the collector are unemployed this was mainly the reason why residents of those communities collect fuelwood from the reserved forest. However, this study concluded that fuelwood collectors were selective over the kind of species they harvest, but the preferred species were not replanted. Fuelwood in the study area is not restricted to domestic use as it is also sold to augment local income. The sale of fuelwood is probably the biggest threat to sustainable utilization of fuelwood and the forest. Therefore, this study recommends that alternatives sources of livelihood and energy be created, among other recommendations for resident communities that will reduce the frequency of harvest from the forest.

scholarly journals Design of Multiple Mailboxes

2020 ◽  
Vol 318 ◽  
pp. 01041
Author(s):  
Athena Baronos ◽  
Odysseas Manoliadis ◽  
Aristeidis Pavlidis
Keyword(s):  
3D Visualization ◽  
Building Blocks ◽  
Design Stage ◽  
Extensive Literature ◽  
3D Design ◽  
3D Cad ◽  
Domestic Use ◽  
The Right ◽  
The Cost ◽  
Apartment Complexes

In today’s world the design of multiple mailboxes comes to cover the evolution of logistics in delivering mail where the postman is not required to visit every user. In this research the 3D visualization is used for the design of multiple mailboxes for domestic use. It concerns the design of mailboxes in ergonomic building blocks and apartment complexes in 3D design so that they can be easily manufactured. Between the advantages of this design will be rapid production of ready-made products production of prototypes that enables testing at the design stage and reduces the time and the cost of production. The design when done with 3D CAD can be manufactured with modern machine tooling methods. In this paper after an extensive Literature Review the postal multiple mailboxes is used as a case study in the use of 3D CAD for 3D printing. A methodology is proposed that enables the examination of prototypes at the design stage according to specifications and allows the manufacturing department of a company to prepare the right tools and begin installing production lines. Conclusively this method gives the advantage of designing the product and supporting the production of scaffolds that can be functionally and ergonomically tested before finalizing the production.

scholarly journals On financing the state assignments to higher education institutions to perform research and development projects

2021 ◽  
Vol 50 (2) ◽  
pp. 119-135
Author(s):  
Yu.D. Shmidt ◽  
◽  
L.A. Krokhmal ◽  
N.V. Ivashina ◽  
◽  
...  
Keyword(s):  
Higher Education ◽  
Research And Development ◽  
Higher Education Institutions ◽  
Planning Period ◽  
Research Activities ◽  
Russian Higher Education ◽  
Scientific Potential ◽  
The Cost ◽  
The University ◽  
Significant Factors

The paper presents the issues of higher education institutions research activities efficiency and financing. Empirical data on the Russian higher education institutions research activities efficiency have been investigated. A new model for higher education institutions research activities public financing has been suggested. The model developed a methodology for calculating subsidies for basic, guaranteed funding of scientific activities of universities, designed to compensate for the cost of simple reproduction of their scientific potential. The integral index, which allows accounting the influence of statistically significant factors on the total amount of research and development work performed by the University, is formed and justified by methods of econometric modeling. The proposed approach allows us to calculate the amount of guaranteed funding for the scientific activities of each university in the planning period with a known amount of financial resources allocated for the basic financing of scientific activities of universities in the country.

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