Optimal management of a goose flyway : migrant management at minimum cost

1. We adopt a ‘whole flyway’ approach to modelling scenarios for protecting migratory birds, aiming at efficient and cost-effective conservation of flyway habitat.

2. We developed a model to minimize flyway management costs while safeguarding a migrating bird population. The model assumes that the intensity of the birds’ use of sites can be manipulated by varying management regimes (with concomitant costs) and that the birds make optimal use of the conditions created along their flyway.

3. We used dynamic programming to find the sequence of migratory decisions that maximizes the fitness of the migrants given a range of management scenarios, followed by a management cost estimate of all these scenarios and selection of those scenarios yielding an optimal solution from both an economic and the migrants’ perspective.

4. Using the population of pink-footed geese Anser brachyrhynchus that breed in Svalbard as an example, we calculated that the cheapest management scenario given current compensation payment rates at the various goose stopover sites yielded a 35% cost saving over current management. This cheapest scenario provides a migration itinerary that is very similar to the current itinerary used by the geese. This is fortuitous since changing environmental conditions may put the migrants at risk.

5. Synthesis and application. Given the global threats to migratory birds, developing a framework for efficient and effective conservation of flyway habitat is an urgent need. Such a framework may likewise be used to assist in controlling migrants causing conflict with agriculture, such as several goose species, in an economic and responsible fashion. Our suggested exemplified framework identified large unexplainable differences in management costs between regions. Differences in management costs between staging sites for birds make big differences to the optimal management of a flyway. Hence, to achieve efficient and effective management of migratory birds, we firstly need an objective assessment of the cost of management in different locations, followed by a modelling approach as here advocated, and followed up by a collaborative action of managers along the entire flyway.

A preliminary analysis of the cost-effectiveness of the National Bowel Cancer Screening Program – demonstrating the potential value of comprehensive real world data

Background The complexity and cost of treating cancer patients is escalating rapidly and increasingly difficult decisions are being made regarding which interventions provide value for money. BioGrid Australia supports collection and analysis of comprehensive treatment and outcome data across multiple sites. Here we use preliminary data regarding the National Bowel Cancer Screening Program (NBCSP) and stage-specific treatment costs for colorectal cancer (CRC) to demonstrate the potential value of real world data for cost-effectiveness analyses (CEA).

Methods Data regarding the impact of NBCSP on stage at diagnosis was combined with stage-specific CRC treatment costs and existing literature. An incremental CEA was undertaken from a government healthcare perspective, comparing NBCSP to no-screening. The 2008 invited population (n=681,915) was modelled in both scenarios. Effectiveness was expressed as CRC-related life years saved (LYS). Costs and benefits were discounted at 3% per annum.

Results Over the lifetime and relative to no-screening, NBCSP was predicted to save 1,265 life-years, prevent 225 CRC cases and cost an additional $48.3 million, equivalent to a cost-effectiveness ratio of $38,217 per LYS. A scenario analysis assuming full participation improved this to $23,395.

Conclusions This preliminary CEA based largely on contemporary real world data suggests population-based FOBT screening for CRC is attractive. Planned ongoing data collection will enable repeated analyses over time, using the same methodology in the same patient populations, permitting an accurate analysis of the impact of new therapies and changing practice. Similar CEA using real world data related to other disease types and interventions appears desirable.

Analysis of the cost performance of structural building frames in Australia

The significance of this research is that it is the first comprehensive analysis of cost performance across Australia. It is well known that measuring cost performance is not an easy task; comparisons of building projects on a `like-for-like’ basis are uncommon, and rarely occur in the real world. However, this paper analyses 120 different structural frame models that represent various; structural designs, construction methods, grid spans, and locations.

The research produced price models that were representative of structural frames used in medium-rise non-residential buildings. It is based on pricing a number of standard building frame designs in five Australian cities. The results represent the cost of producing the same building in different locations, using similar building construction techniques. By utilizing a standard model, project variables like building quality, ground conditions and access were eradicated, thereby facilitating an unbiased comparison of cost performance. I addition, the results are an indicator of building productivity based on costs per square metre of various construction types.

This research provides the Australian industry with robust data about the relative cost performance of various structural building frames. In addition, this research has wider implications because the models may also become useful data for the measuring relative cost performance in other countries.

Cost factors affecting the design of ground-supported floors

The cost of concrete ground-supported floor slabs represents a significant proportion of the total capital cost of industrial projects. There are many structural design issues that impact on the concrete contractors’ method of construction. This is becoming more apparent with the use of new high-technology levelling and trowelling equipment, which has significantly increased the pour and finishing rates, resulting in much faster slab construction times compared with the traditional methods of construction. Selection of both the design and the construction methods exerts a large influence on the initial cost. According to the results of the research reported in this paper, it may be possible to save between 2-4 per cent of the building cost if high technology solutions are incorporated into the design and construction process. This paper investigates cost issues that impact on the design and construction of ground-supported floors for industrial buildings.

Life cycle cost analysis of silicon and organic building integrated photovoltaic systems (BiPV)

Despite the undisputed benefits associated with photovoltaic (PV) technology, the financial barrier acts as the major hurdle before it is seen as a commercial competitive form of renewable energy. Many studies have been performed outlining the life cycle energy benefits of PV technology. However, there has been limited number of studies dedicated to the life cycle cost impacts. The aim of this paper is to identify whether life cycle cost analysis is the best approach to determining the cost contributors or savings associated with this technology. This paper has been structured similarly to previous life cycle energy studies to consider the cost implications involved within each area of the products lifecycle. Amongst many new developments, traditional silicon based units have been challenged by the introduction of new organic systems; and recent studies highlight that these systems offer major cost reductions. Based on an analysis of current literature, this paper identifies that the recent growth and development of both organic and silicon based systems have had a considerable effect on the cost of PV cells. The competitive nature of the renewable energy market will also impact on a life cycle cost analysis; and any potential findings will valid for a limited timeframe.

Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective?

To determine the age- and BMD-specific burden of fractures in the community and the cost-effectiveness of targeted drug therapy, we studied a demographically well-categorized population with a single main health provider. Of 1224 women over 50 years of age sustaining fractures during 2 years, the distribution of all fractures was 11%, 20%, 33%, and 36% in those aged 50–59, 60–69, 70–79, and 80+ years, respectively. Osteoporosis (T score < −2.5) was present in 20%, 46%, 59%, and 69% in the respective age groups. Based on this sample and census data for the whole country, treating all women over 50 years of age in Australia with a drug that halves fracture risk in osteoporotic women and reduces fractures in those without osteoporosis by 20%, was estimated to prevent 18,000 or 36% of the 50,000 fractures per year at a total cost of $573 million (AUD). Screening using a bone mineral density of T score of −2.5 as a cutoff, misses 80%, 54%, 41%, and 31% of fractures in women in the respective age groups. An analysis of cost per averted fracture by age group suggests that treating women in the 50- to 59-year age group with osteoporosis alone costs $156,400 per averted fracture. However, in women aged over 80 years, the cost per averted fracture is $28,500. We infer that treating all women over 50 years of age is not feasible. Using osteoporosis and age (>60 years) as criteria for intervention reduces the population burden of fractures by 28% and is cost-effective but solutions to the prevention of the remaining 72% of fragility fractures remain unavailable.

Improving the cost-effectiveness of cardiovascular disease prevention in Australia : a modelling study

Background : Cardiovascular disease is the leading cause of death worldwide. Like many countries, Australia is currently changing its guidelines for cardiovascular disease prevention from drug treatment for everyone with 'high blood pressure' or 'high cholesterol', to prevention based on a patient's absolute risk. In this research, we model cost-effectiveness of cardiovascular disease prevention with blood pressure and lipid drugs in Australia under three different scenarios: (1) the true current practice in Australia; (2) prevention as intended under the current guidelines; and (3) prevention according to proposed absolute risk levels. We consider the implications of changing to absolute risk-based cardiovascular disease prevention, for the health of the Australian people and for Government health sector expenditure over the long term.

Methods : We evaluate cost-effectiveness of statins, diuretics, ACE inhibitors, calcium channel blockers and beta-blockers, for Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Epidemiological changes and health care costs are simulated by age and sex in a discrete time Markov model, to determine total impacts on population health and health sector costs over the lifetime, from which we derive cost-effectiveness ratios in 2008 Australian dollars per quality-adjusted life year.

Results : Cardiovascular disease prevention based on absolute risk is more cost-effective than prevention under the current guidelines based on single risk factor thresholds, and is more cost-effective than the current practice, which does not follow current clinical guidelines. Recommending blood pressure-lowering drugs to everyone with at least 5% absolute risk and statin drugs to everyone with at least 10% absolute risk, can achieve current levels of population health, while saving $5.4 billion for the Australian Government over the lifetime of the population. But savings could be as high as $7.1 billion if Australia could match the cheaper price of statin drugs in New Zealand.

Conclusions : Changing to absolute risk-based cardiovascular disease prevention is highly recommended for reducing health sector spending, but the Australian Government must also consider measures to reduce the cost of statin drugs, over and above the legislated price cuts of November 2010.

A review of the cost estimation issues in the tender preparation process in construction industry

Cost estimation process is undertaken to predict the total cost of the project. Studies indicate that one of the construction company failures in contracting is because of the uncertain, incorrect, and unrealistic cost estimation. Cost estimation process are heavily influenced by the complexity of the project, scale and scope of construction, market conditions, method of construction, site constraints, client’s financial position, buildability and the location of the project. However, there are other combinations factors that have not been studied thus far. Hence, this paper focuses on the review of other researchers’ findings in relation to cost estimation issues in the construction industry. Among the findings, it has been revealed that the cost estimation issues are related to accuracy, human factors, practical knowledge and insufficient cost data/information. The aim of this paper is to investigate these factors and determining other potential factors that may influence cost estimation process in the construction industry.

Construction cost performance of structural frames in Australia

This research is concerned with the comparative cost of building structural frames in Australia. The research has been undertaken to evaluate the cost performance of a number of technologies that are typically used in medium-rise commercial buildings of ten storeys. The research methodology is based on pricing a number of standard building frame designs in five Australian cities. The results represent the cost of producing the same building using different building construction designs. By utilising a standard model, project variables like building quality, ground conditions and access were eradicated, thereby facilitating an unbiased comparison of cost performance. The second stage of the research invoiced a focus group of industry experts who were asked to validate the results of the cost study. In addition, participants of the focus group were asked to comment on the preferred construction practice for each of the typical building designs. Results suggest that post-tensioned in situ concrete frames have the best cost performance for most buildings. However, other designs can have good cost performance under some circumstances. Findings suggest that the Australian construction industry has long cultural preference for the use of in situ concrete in structural frames.

Cost effectiveness of preventing falls and improving mobility in people with Parkinson disease : protocol for an economic evaluation alongside a clinical trial

Background Cost of illness studies show that Parkinson disease (PD) is costly for individuals, the healthcare system and society. The costs of PD include both direct and indirect costs associated with falls and related injuries.
Methods This protocol describes a prospective economic analysis conducted alongside a randomised controlled trial (RCT). It evaluates whether physical therapy is more cost effective than usual care from the perspective of the health care system. Cost effectiveness will be evaluated using a three-way comparison of the cost per fall averted and the cost per quality adjusted life year saved across two physical therapy interventions and a control group.
Conclusion This study has the potential to determine whether targetted physical therapy as an adjunct to standard care can be cost effective in reducing falls in people with PD.

The cost-effectiveness of the Dose Adjustment for Normal Eating (DAFNE) structured education programme: an update using the Sheffield Type 1 Diabetes policy model

AIMS: 
To estimate the cost-effectiveness of training in flexible intensive insulin therapy [as provided in the Dose Adjustment for Normal Eating (DAFNE) structured education programme] compared with no training for adults with Type 1 diabetes mellitus in the UK using the Sheffield Type 1 Diabetes Policy Model.

METHODS: 
The Sheffield Type 1 Diabetes Policy Model was used to simulate the development of long-term microvascular and macrovascular diabetes-related complications and the occurrence of diabetes-related adverse events in 5000 adults with Type 1 diabetes. Total costs and quality-adjusted life years were estimated from a National Health Service perspective over a lifetime horizon, discounted at a rate of 3.5%. The treatment effectiveness of DAFNE was modelled as a reduction in HbA1c that affected the risk of developing long-term diabetes-related complications. Probabilistic and structural sensitivity analyses were conducted.

RESULTS:
DAFNE resulted in greater life expectancy and reduced incidence of some diabetes-related complications compared with no DAFNE. DAFNE was found to generate an average of 0.0294 additional quality-adjusted life years for an additional cost of £426 per patient, leading to an incremental cost-effectiveness ratio of £14 400 compared with no DAFNE. There was a 54% probability that DAFNE would be cost-effective at a willingness-to-pay threshold of £20 000 per quality-adjusted life year.

CONCLUSIONS: 
The results of this study suggest that DAFNE is a cost-effective structured education programme for people with Type 1 diabetes and support its provision by the National Health Service in the UK.

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

Cost effectiveness of a sugar-sweetened beverage excise tax in the U.S.

INTRODUCTION: Reducing sugar-sweetened beverage consumption through taxation is a promising public health response to the obesity epidemic in the U.S. This study quantifies the expected health and economic benefits of a national sugar-sweetened beverage excise tax of $0.01/ounce over 10 years. METHODS: A cohort model was used to simulate the impact of the tax on BMI. Assuming ongoing implementation and effect maintenance, quality-adjusted life-years gained and disability-adjusted life-years and healthcare costs averted were estimated over the 2015-2025 period for the 2015 U.S. POPULATION: Costs and health gains were discounted at 3% annually. Data were analyzed in 2014. RESULTS: Implementing the tax nationally would cost $51 million in the first year. The tax would reduce sugar-sweetened beverage consumption by 20% and mean BMI by 0.16 (95% uncertainty interval [UI]=0.06, 0.37) units among youth and 0.08 (95% UI=0.03, 0.20) units among adults in the second year for a cost of $3.16 (95% UI=$1.24, $8.14) per BMI unit reduced. From 2015 to 2025, the policy would avert 101,000 disability-adjusted life-years (95% UI=34,800, 249,000); gain 871,000 quality-adjusted life-years (95% UI=342,000, 2,030,000); and result in $23.6 billion (95% UI=$9.33 billion, $54.9 billion) in healthcare cost savings. The tax would generate $12.5 billion in annual revenue (95% UI=$8.92, billion, $14.1 billion). CONCLUSIONS: The proposed tax could substantially reduce BMI and healthcare expenditures and increase healthy life expectancy. Concerns regarding the potentially regressive tax may be addressed by reduced obesity disparities and progressive earmarking of tax revenue for health promotion.

Cost effectiveness of an elementary school active physical education policy

INTRODUCTION: Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA, less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state "active PE" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA. METHODS: A cohort model was used to simulate the impact of an active PE policy on physical activity, BMI, and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014. RESULTS: An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23, 2.51) and cost $70.7 million (95% UI=$51.1, $95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15, $2.15), and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148, $3,100). From 2015 to 2025, the policy would cost $235 million (95% UI=$170 million, $319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million, $153 million). CONCLUSIONS: Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.

Modeling the cost effectiveness of child care policy changes in the U.S.

INTRODUCTION: Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities. METHODS: Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention's impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3% annually. Probabilistic sensitivity analyses simulated 95% uncertainty intervals (UIs) around outcomes. RESULTS: Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95% UI=$14.2, $134) million. The intervention is 94.7% likely to be cost saving by 2025. CONCLUSIONS: Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.