Economic cost of age-related macular degeneration: a review of recent research

As the population of most developed countries ages so the prevalence of diseases such as age-related macular degeneration (AMD) are likely to increase. To facilitate planning and informed debate regarding making provisions for this disease it is important that we have a clear understanding of the economic impact of visual impairment associated with AMD. In this paper we assess the state of current knowledge based on a review of published evidence in scientific journals. Based on our assessment of the evidence we argue that the paucity of research studies on the subject and wide variation in estimates produced from the few studies available make it difficult to assess with confidence the likely average direct cost-of-illness associated with AMD. We further argue that significant gaps in our understanding of the costs of AMD (particularly in respect of indirect costs) also exist. Current research should be augmented by more comprehensive studies.

A Cluster Randomized Controlled Trial of an Adapted U.S. Model of Pharmaceutical Care for Nursing Home Residents in Northern Ireland (Fleetwood Northern Ireland Study): A Cost-Effectiveness Analysis

OBJECTIVES: To evaluate the cost-effectiveness of an adapted U.S. model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).
DESIGN: Economic evaluation alongside a cluster randomized controlled trial.
SETTING: Nursing homes in NI randomized to intervention (receipt of the adapted model of care; n511) or control (usual care continued; n511).
PARTICIPANTS: Residents aged 65 and older who provided informed consent (N5253; 128 intervention, 125 control) and who had full resource use data at 12 months.
INTERVENTION: Trained pharmacists reviewed intervention home residents’ clinical and prescribing information for 12 months, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to make changes. The control homes received usual care in which there was no pharmacist intervention.
MEASUREMENTS: The proportion of residents prescribed one or more inappropriate psychoactive medications (according to standardized protocols), costs, and a cost-effectiveness acceptability curve. The latter two outcomes are the focus for this article.
RESULTS: The proportions of residents receiving inappropriate psychoactive medication at 12 months in the intervention and control group were 19.5% and 50.4%, respectively. The mean cost of healthcare resources used per resident per year was $4,923 (95% con?dence interval.

Cost-Directed Refactoring for Parallel Erlang Programs

This paper presents a new programming methodology for introducing and tuning parallelism in Erlang programs, using source-level code refactoring from sequential source programs to parallel programs written using our skeleton library, Skel. High-level cost models allow us to predict with reasonable accuracy the parallel performance of the refactored program, enabling programmers to make informed decisions about which refactorings to apply. Using our approach, we demonstrate easily obtainable, significant and scalable speedups of up to 21 on a 24-core machine over the sequential code.

Research-informed design, management and maintenance of infrastructure slopes: development of a multi-scalar approach

The UK’s transport infrastructure is one of the most heavily used in the world. The performance of these networks is critically dependent on the performance of cutting and embankment slopes which make up £20B of the £60B asset value of major highway infrastructure alone. The rail network in particular is also one of the oldest in the world: many of these slopes are suffering high incidents of instability (increasing with time). This paper describes the development of a fundamental understanding of earthwork material and system behaviour, through the systematic integration of research across a range of spatial and temporal scales. Spatially these range from microscopic studies of soil fabric, through elemental materials behaviour to whole slope modelling and monitoring and scaling up to transport networks. Temporally, historical and current weather event sequences are being used to understand and model soil deterioration processes, and climate change scenarios to examine their potential effects on slope performance in futures up to and including the 2080s. The outputs of this research are being mapped onto the different spatial and temporal scales of infrastructure slope asset management to inform the design of new slopes through to changing the way in which investment is made into aging assets. The aim ultimately is to help create a more reliable, cost effective, safer and more resilient transport system.

Influence of Manufacturing Tolerance on Aircraft Direct Operating Cost (DOC)

The influence of manufacturing tolerance on direct operating cost (DOC) is extrapolated from an engine nacelle to be representative of an entire aircraft body. Initial manufacturing tolerance data was obtained from the shop floor at Bombardier Aerospace Shorts, Belfast while the corresponding costs were calculated according to various recurring elements such as basic labour and overtime labour, rework, concessions, and redeployment; along with the non-recurrent costs due to tooling and machinery, etc. The relation of tolerance to cost was modelled statistically so that the cost impact of tolerance change could be ascertained. It was shown that a relatively small relaxation in the assembly and fabrication tolerances of the wetted surfaces resulted in reduced costs of production that lowered aircraft DOC, as the incurred drag penalty was predicted and taken into account during the optimisation process.

Numerical Method for Cost-Weight Optimisation of Stringer-Skin Panels

The need to integrate cost into the early product definition process as an engineering parameter is addressed. The application studied is a fuselage panel that is typical for commercial transport regional jets. Consequently, a semi-empirical numerical analysis using reference data was coupled to model the structural integrity of thin-walled structures with regard to material failure and buckling: skin, stringer, flexural, and interrivet. The optimization process focuses on direct operating cost (DOC) as a function of acquisition cost and fuel burn. It was found that the ratio of acquisition cost to fuel burn was typically 4:3 and that there was a 10% improvement in the DOC for the minimal DOC condition over the minimal weight condition because of the manufacturing cost saving from having a reduced number of larger-area stringers and a slightly thicker skin than that preferred by the minimal weight condition. Also note that the minimal manufacturing cost condition was slightly better than the minimal weight condition, which highlights the key finding: The traditional minimal weight condition is a dated and suboptimal approach to airframe structural design.

Integrating Aircraft Cost Modelling into Conceptual Design

The article presents cost modeling results from the application of the Genetic-Causal cost modeling principle. Industrial results from redesign are also presented to verify the opportunity for early concept cost optimization by using Genetic-Causal cost drivers to guide the conceptual design process for structural assemblies. The acquisition cost is considered through the modeling of the recurring unit cost and non-recurring design cost. The operational cost is modeled relative to acquisition cost and fuel burn for predominately metal or composites designs. The main contribution of this study is the application of the Genetic-Causal principle to the modeling of cost, helping to understand how conceptual design parameters impact on cost, and linking that to customer requirements and life cycle cost.