Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment

Purpose: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. Methods: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of Sao Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. Results: Immunotherapy lasted from 8 to 12 weeks. All patients reported each cold-stored sachet with 5% imiquimod cream lasted 3 days. According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.40-1,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. Conclusions: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns. The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.

A knapsack problem as a tool to solve the production planning problem in small foundries

According to recent research carried out in the foundry sector, one of the most important concerns of the industries is to improve their production planning. A foundry production plan involves two dependent stages: (1) determining the alloys to be merged and (2) determining the lots that will be produced. The purpose of this study is to draw up plans of minimum production cost for the lot-sizing problem for small foundries. As suggested in the literature, the proposed heuristic addresses the problem stages in a hierarchical way. Firstly, the alloys are determined and, subsequently, the items that are produced from them. In this study, a knapsack problem as a tool to determine the items to be produced from furnace loading was proposed. Moreover, we proposed a genetic algorithm to explore some possible sets of alloys and to determine the production planning for a small foundry. Our method attempts to overcome the difficulties in finding good production planning presented by the method proposed in the literature. The computational experiments show that the proposed methods presented better results than the literature. Furthermore, the proposed methods do not need commercial software, which is favorable for small foundries. (C) 2010 Elsevier Ltd. All rights reserved.

Cost Management Practices and Strategic Perspectives: a study in the construction industry of the State of Parana

The purpose of this paper is to investigate the cost management practices of building industry companies of Parana that follow the typology of Porter's strategies. The sample comprises member companies of the Association of Construction Industries of the State of Parana (PR-SINDUSCON) operating in the segment of residential buildings. The data were collected by means of questionnaires sent to 317 SINDUSCON members. 69 were returned and 54 used for our research. Exploratory Factorial Analysis of the data allowed us to identify two groups of cost management practices. Analyses suggest equality between the adopted cost management practices and the Cost Control Planning (CCP) practices among the companies of the Group 1, regardless of the generic strategy adopted. The companies of the Group 2 that adopted the differentiation strategy seem to use mainly the ACR cost management practice. Our findings differ from those obtained by Chenhall insofar as companies that adopt low cost strategies tend to use managerial controls focused on cost control and rigid budgetary controls.