Organized blood pressure control programs to prevent stroke in Australia : would they be cost-effective?

Background and Purpose—: High blood pressure (BP) is the most important modifiable stroke risk factor. Worldwide high BP in many people is uncontrolled or people are unaware of their BP status. We aimed to assess whether a program of organized multidisciplinary care and medication would be cost-effective for improving BP control for the prevention of stroke.

Methods—: A novel aspect was to simulate the intervention to match recent primary care initiatives (eg, new Medicare reimbursement items) to ensure policy relevance. Current practice and additional costs of each intervention were included using the best available evidence. The differences in the cost per quality-adjusted life year (QALY) gained for the interventions were compared against current practice. Cost-effectiveness was defined as cost per QALY gained was less than Australian dollars (AUD) 50 000 (societal perspective; reference year 2004). The robustness of estimates was assessed with probabilistic multivariable uncertainty analysis.

Results—: For primary prevention, the median cost per QALY gained was AUD11 068 (95% uncertainty interval AUD5201 to AUD18 696) in those aged 75 years or older and was AUD17 359 (95% uncertainty interval AUD10 516 to AUD26 036) in those aged 55 to 84 years with >=15% absolute risk of stroke. Primary prevention interventions were not cost-effective if aged younger than 50 years. The median cost per QALY gained for secondary prevention was AUD1811 and AUD4704, depending on which medications were modeled.

Conclusions—: Organized care for BP control targeted at specific populations offers excellent value over current practice. Organized care for secondary prevention provided the greatest benefits and strongest cost-effectiveness. Translation into clinical practice requires improved use of relevant Medicare policy in Australia.

Cost planning and control : case study of design economics for constructability and prefabrication construction

Cost management includes planning and control, and constructability1 and prefabrication construction are two main design economics factors for early cost planning decision. Despite the fact that constructability and prefabrication have been considered in design and cost planning, there is no guarantee if the intention meets the expectation. This requires on-going control during construction stage. In fact, prefabrication construction has been encouraged for some years, application is not always positive. One of the reasons is its constructability. This paper investigates the appropriate research methodology to determine how design for prefabrication and constructability will contribute to cost planning through control and review during construction stage. Through a study of an Australian residential project using prefabrication in structural concrete, internal partitioning and internal fit-out, this research concludes that case study is a viable choice. Prefabrication construction does provide a positive impact on the major project objectives: time, cost and quality. Cost reduction is due to saving in time related preliminaries as a direct result of time reduction of onsite activities whilst quality is ensured due to better control of prefabricated components inside the factories. However, it can only be achieved after considering constructability: suitable materials choice, design for available skills, use of available plant, and clear communication. The keys are through plan at design phase and control in construction stage.

Control loop for finding initial translator position of linear synchronous motor

This article presents a simple and reliable method for controlling the relative orientation between the two magnetic fields of a permanent magnet synchronous motor. Finding the initial (at motor powering- up time) value of this relative location is essential for the proper operation of the motor. After showing the system controllability, the utilized feedback control loop finds this initial relative orientation quickly and accurately. Further, using the proposed method allows considerable cost saving, as a transducer that is usually used for this purpose can be eliminated. The cost saving is most obvious in the case of linear motors and angle motors with large diameters. The way the problem is posed is an essential part of this work, and it is the reason behind the apparent simplicity of the solution. The method proposed relies on a single sensor, and it was tested when a relative encoder was used.

Habitat manipulation and rodent damage control: reducing rodent damage in Australian macadamia orchards

This paper examines the relationship between adjacent non-crop vegetation and rodent (Rattus rattus) damage in Australian macadamia (Macadamia integrifolia) orchard systems. Orchards adjacent to structurally diverse, non-crop vegetation dominated by woody weeds exhibited significantly higher damage when compared to orchards adjacent to managed grasslands. This relationship formed the basis for a rodent damage reduction strategy utilising habitat manipulation. Structurally diverse, non-crop habitats were modified to grasslands leading to a reduction in rodent damage of 65%. This strategy was cost-effective and has the potential to be long-term with minimal effort needed to maintain sites in a modified state. Habitat manipulation is a process whereby the resource load in a system is reduced and hence rodent densities cannot reach levels where they cause significant crop damage. This paper provides empirical evidence to support habitat manipulation as a practical, cost-effective control strategy for rodent pests.

Development of low cost motion-sensing system

Micro-electro-mechanical system (MEMS) technology offers sensors with lower cost, smaller size, lower power consumption. In this paper, a kind of low cost motion-sensing system based MEMS sensors is developed. The objective of the design is low cost, small volume and light weight in order to be used in many fields. The constituting principle of the system is described. Algorithms and hardware of the system are researched. And the definition of coordinate, calculation of pose angle, transform of acceleration and calculation of the velocities and displacement of the moving object are presented with corresponding mathematics model and algorithms. The experiments are carried out in principle and results are given. It is proved that the low cost motion-sensing system is effective and correct.

Differences between differentiators and cost leaders in market research and internal CRM usage

The Porter strategy types of Differentiation and Cost Leadership are put forward as strategies leading to competitive advantage (Porter 1980). These types have quite contrasting implementation guidelines in terms of human resources, organisational structure, job design decision-making process, control systems, and information systems. These internal contrasts suggest Differentiators and Cost Leaders require contrasting roles for market research and internal CRM systems. Very few studies have explored the contingent role business strategy may have in explaining contrasting roles in marketing information systems or market research.

This study involved a cross-industry postal survey of 240 Australian marketing managers. One contribution of this study was to find market research having quite different roles in supporting Marketing (i.e. brand) Differentiators compared to Product (i.e. innovative feature) Differentiators. Surprisingly only one market research role differed when comparing Cost Leaders with Marketing Differentiator strategies. A final contribution was to find that no one strategy having a greater reliance on internal CRM systems in supporting decisionmaking.

Solution to robotic landmine detection through use of path planning and motor control

Low cost robotic detectors are a promising new approach to combat the disturbing landmine crisis. In this paper a low-cost robotic solution is proposed, we present several control techniques used to improve the precision of the robotic motion. A P and PD controller is applied, and it is concluded that a cascaded control system provides a more stable and accurate response. Two search patterns for landmine detection are considered, rectangular and spiral, these are used to analyse the effectiveness of the control system.

Estimating the user cost of soil erosion in tea smallholdings in Sri Lanka

Soil erosion in developing countries is a widespread problem causing considerable economic damage. It still remains an intractable problem in many countries. Available research findings on costs of soil erosion indicate them to be high. Soil erosion continues to be a problem due to the difficulties of estimating the economic damages and attendant difficulties in developing effective control policies. This paper considers soil to be a nonrenewable resource and estimates the marginal user costs using a yield damage function. Results indicate user costs to be low for individual farms. The low user costs are due to some of the assumptions made with respect to a number of parameters such as prices of tea, costs, and technological developments. The results also indicate that marginal user costs are sensitive to prices, soil depth and soil loss.

A flow control methodology for the rapid generation of vehicle traffic models

This paper presents a conveyor-based methodology to model complex vehicle flows common to factory and distribution warehouse facilities. The AGV and human path modelling techniques available in many commercial discrete event simulation packages require extensive knowledge and time to implement even the simplest flow control rules for multiple vehicle interaction. Although discrete event simulation is accepted as an effective tool to model vehicle delivery movements, human paths and delivery schedules for modern assembly lines, the time to generate accurate models is a significant limitation of existing simulation-based optimisation methodologies. The flow control method has been successfully implemented using two commercial simulation packages. It provides a realistic visual representation, as well as accurate statistical results, and reduces the model development process cost.

A haptically enabled low-cost reconnaissance platform for law enforcement

Traditionally, the control system of a modern teleoperated mobile robot consists of one or more two-dimensional joysticks placed on a control interface. While this simplistic interface allows an operator to remotely drive the platform, feedback is limited to visual information supplied by on-board cameras. Significant advances in the field of haptics have the potential to meaningfully enhance situational awareness of a remote robot. The focus of this research is the augmentation of Deakin University's OzBot trade MkIV mobile platform to include haptic control methodologies. Utilising the platform's inertial measurement unit, a remote operator has the ability to gain knowledge of the vehicle's operating performance and terrain while supplying a finer level of control to the drive motors. Our development of a generic multi-platform ActiveX allows the easy implementation of haptic force feedback to many computer based robot controllers. Furthermore, development of communication protocols has progressed with Joint Architecture for Unmanned Systems (JAUS) compliance in mind. The haptic force control algorithms are presented along with results highlighting the benefits of haptic operator feedback on the MklV OzBot trade chassis.

On-line tool condition monitoring and control system in forging processes

Cold bulk metal forming has made large-scale production of small complex solid parts economically feasible. Tooling used in metal forming poses many uncertainties in the preliminary cost estimation and production process and continual tool replacement and maintenance dramatically reduces productivity and raises manufacturing cost. In order to tackle this, an on-line tool condition monitoring system using artificial neural network (ANN) to integrate information from multiple sensors for forging process has been developed. Together with the force, acoustic emission signals and process conditions, information developed from theoretical models is integrated into the ANN tool monitoring system to predict tool life and provide the maintenance schedule.

Auditing construction costs during building design : a case study of cost planning in action

Building cost planning was originally developed in the framework of traditional procurement methods with conventional documentation, tendering and administration processes. With the advent of alternative forms of procurement with more fluid approaches to design stages and documentation, the need for sound cost planning does not appear to diminish. As a process established on solid theoretical foundations, cost planning should be robust enough to adapt and flourish in a variety of procurement environments. However, little documentation and analysis of transformed and adapted forms of cost planning appear to have been made. This case study of a design-construct company in Melbourne, Australia, presents and explores a contemporary form of building cost planning integrated into a design cost management approach adopted by a construction company experienced in alternative forms of procurement. The article traces this process on a design-construct project from inception to the end of the design development stage and tender. Whilst the fundamental framework of cost planning remains intact, the focus and detail in each of the stages are guided by the company's priority for greater financial control over the cost and value implications of design and other decisions. This recently established working model of design cost management in this company has been designed to deliver added value to the client through a better balance of time, cost and quality in each project.

The potential for tobacco control to reduce PBS costs for smoking-related cardiovaccular disease

Objective: To estimate Pharmaceutical Benefits Scheme (PBS) subsidies for drugs to treat smoking-related cardiovascular disease (CVD) in 2001-02, and over the period of the government's Intergenerational Report (IGR), assuming current smoking prevalence rates and a 5% absolute reduction.

Design and setting: An Australian epidemiological study, using prescribing data, aetiological fraction methodology, and IGR trends.

Main outcome measures: Estimated smoking-related PBS subsidy costs in 2001-02 and predicted cumulative subsidies until 2041-42, under current and reduced smoking prevalence assumptions.

Results: The PBS costs of smoking-related CVD in 2001-02 were $126 million, 9.77% of the cost of drugs for CVD and 2.96% of total PBS subsidies. The cumulative difference in these costs over the 40-year period with a 5% drop in smoking prevalence was predicted to be $4.5 billion, a 17% reduction. The saving would be $1.14 billion discounting future costs at 5% per year.

Conclusions: Further investment in tobacco control interventions could curb the increasing cost of the PBS and contribute to government efforts to ensure the viability of Australia's healthcare-financing programs. The net present value of a campaign to reduce smoking prevalence was estimated at $1 billion, with an internal rate of return of 33%.

Cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children

Objective
 To assess from a societal perspective the incremental cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children. The intervention was modelled on the LEAP (live, eat and play) trial, a randomised controlled trial conducted by the Centre for Community Child Health, Melbourne, Australia in 2002–2003. This study was undertaken as part of the assessing cost-effectiveness (ACE) in obesity project which evaluated, using consistent methods, 13 interventions targeting unhealthy weight gain in children and adolescents.
Method
A logic pathway was used to model the effects of the intervention compared to no intervention on body mass index (BMI) and health outcomes (disability-adjusted life years—DALYs). Disease costs and health benefits were tracked until the cohort of eligible children reached the age of 100 years or death. Simulation-modelling techniques were used to present a 95% uncertainty interval around the cost-effectiveness ratio. The intervention was also assessed against a series of filters (‘equity’, ‘strength of evidence’, ‘acceptability’, ‘feasibility’, sustainability’ and ‘side-effects’) to incorporate additional factors that impact on resource allocation decisions.
Results
The intervention, as modelled, reached 9685 children aged 5–9 years with a BMI z-score of ≥3.0, and cost $AUD6.3M (or $AUD4.8M excluding time costs). It resulted in an incremental saving of 2300 BMI units which translated to 511 DALYs. The cost-offsets stemming from the intervention totalled $AUD3.6M, resulting in a net cost per DALY saved of $AUD4670 (dominated; $0.1M) (dominated means intervention costs more for less effect).
Conclusion
Compared to a ‘no intervention’ control group, the intervention was cost-effective under current assumptions, although the uncertainty intervals were wide. A key question related to the long-term sustainability of the small incremental weight loss reported, based on the 9-month follow-up results for LEAP.

The role of trust in joint venture control : a theoretical framework

This paper develops a theoretical framework and a number of propositions for systematically studying the role of trust in the control and performance of Joint Ventures, a prominent form of inter-firm alliance. The proposed framework is more complete than the frameworks available in the extant literature because it incorporates both transaction related risks and the partner related risks which are likely to impact on the reliance on particular control patterns. Partner-related risks in joint ventures are represented by the level of inter-partner trust, while transaction-related risks are represented by the Transaction Cost Economics (TCE) variables of asset specificity, task complexity, performance measurability, and environmental uncertainty.

The framework also links one of the established management control typologies (i.e., behaviour, outcome, and social) to two of the alliance control patterns (bureaucratic-based pattern, and trust-based pattern) identified in the literature on alliance control.