Estimating quality costs in an automotive stamping plant through the use of simulation

The pressures of modern manufacturing require that the quality-cost benefits are determined when evaluating new procedures or alternative operating policies. Traditionally, cost reports and other quality metrics have been used for this purpose. However, the interactions between the main quality cost drivers cannot be understood at the superficial level and the effect that a new process or an alternative operating policy may have on quality costs is difficult to determine. An alternative to the traditional costing methods is simulation. The current work uses simulation to evaluate quality costs in an automotive stamping plant where the quality control is determined by operator inspection of their own work. Self-inspection quality control provides instantaneous feedback of quality problems, allowing for quick rectification. However, the difficult nature of surface finish inspection of automotive panels can create inspection and control errors. A simulation model was developed to investigate the cost effects of inspection and control errors and it was found that inspection error had a significant effect in increasing total quality cost, with the magnitude of this increase dependent on the level of control. Further, the simulation found that the lowest cost quality control policy was that which allowed a number of defective panels to accumulate before resetting the press-line.

Survey on demand side sensitivity to power quality in Ireland

Power systems require a reliable supply and good power quality. The impact of power supply interruptions is well acknowledged and well quantified. However, a system may perform reliably without any interruptions but may have poor power quality. Although poor power quality has cost implications for all actors in the electrical power systems, only some users are aware of its impact. Power system operators are much attuned to the impact of low power quality on their equipment and have the appropriate monitoring systems in place. However, over recent years certain industries have come increasingly vulnerable to negative cost implications of poor power quality arising from changes in their load characteristics and load sensitivities, and therefore increasingly implement power quality monitoring and mitigation solutions. This paper reviews several historical studies which investigate the cost implications of poor power quality on industry. These surveys are largely focused on outages, whilst the impact of poor power quality such as harmonics, short interruptions, voltage dips and swells, and transients is less well studied and understood. This paper examines the difficulties in quantifying the costs of poor power quality, and uses the chi-squared method to determine the consequences for industry of power quality phenomenon using a case study of over 40 manufacturing and data centres in Ireland.

Vertical Differentiation and Entry Deterrence: A Reconsideration

In this work we emphasize why market coverage should be considered endogenous for a correct analysis of entry deterrence in vertical differentiation models and discuss the implications of this endogeneity for that analysis. We consider contexts without quality costs and also contexts with convex fixed quality costs.

Fatores influenciadores da gestão da qualidade e independência do auditor: um estudo de caso

Dissertação apresentada ao Instituto Superior de Contabilidade para obtenção do Grau de Mestre em Auditoria Orientada por: Doutora Alcina Dias

Implementación de la administración de costos de calidad en TGS : impresora de valores

Basándose en la necesidad manifiesta de la empresa Thomas Greg & Sons de Colombia por controlar los costos en los que incurre por adoptar un Sistema de Gestión de Calidad, se realizó una investigación de los procesos que realiza la empresa a nivel productivo y el esquema de costos que utiliza a nivel organizacional, con el fin de proponer y concebir un modelo de administración de costos de la calidad y de la no calidad que sea conforme a lo esperado por la alta gerencia y que contribuya significativamente al control de costos.

Utilização de técnicas de planejamento de experimentos na análise de viabilidade de alterações no processo de pintura de grades Antracite em uma indústria automotiva

The search for better performance and competitive advantage in the current market scenario has made organizations keep their focus on quality planning and the use of effective techniques aimed at continuous improvement and optimization of processes and resources. The situation is not different for the painting process in the automotive industry, which has a significant amount of variables and influential external factors. This work, developed at General Motors in São José dos Campos, aims to analyze the feasibility of changing the painting process of the pickup S10 railings in the Antracite color located in the main line to the another line located in a Painting Repair Booth at the plant and, therefore, to study the possibility about reducing the window of cure for Antracite’s enamel by using Design of Experiments’ techniques. Applying this method is possible to find the best arrangement among studied factors of Painting Repair Booth that are, in this case, the Temperature, in Celsius degrees, and Skid’s Steps, in seconds, and it’s also possible to get their behavior according to quality requirements specified by GM rules for the Brightness and Paint Adhesion on the part. As a result, it can conclude that is possible to paint the S10 Antracite railings in the painting process’ line of Painting Repair Booth, and with the new configuration obtained by the Design of Experiments for the process variables, there are significant gains related to the parts’ quality, costs reduction and the optimization of production capacity, much in the main line as in the line of the Painting Repair Booth

Aplicación de la metodología Six Sigma para solucionar problemas de calidad en una empresa metalmecánica

En la actualidad muchas compañías enfocan sus esfuerzos en la chequera del cliente generando con esto una cortina de humo al interior de la empresa que hace que se descuiden los costos, se conviva con actividades que no agregan valor y se desconozcan las causas de los principales problemas de calidad que afectan al cliente. Este es el caso de la compañía metalmecánica objeto de esta investigación, la cual venía sobrellevando altos niveles de inventarios, reprocesos, problemas de calidad, falta de corresponsabilidad del personal, y otras situaciones que la estaban dejando vulnerable ante la competencia. Este fue el motivo que inspiró esta investigación en aras de validar una metodología de mejora continua para identificar, analizar, proponer, evaluar y reducir los costos de no calidad y sus implicaciones, de una forma ordenada, rigurosa y disciplinada. Posterior a la implementación del plan de acción los resultados no se hicieron esperar y la compañía mejoró su servicio al cliente sin incurrir en excesos de inventario, al igual que disminuyó sus sobrecostos de producción, los cuales eran generados en gran medida por problemas de calidad. Pero lo más significativo es que asimiló que esta metodología es un proceso continuo que no puede parar y que todo el personal de la empresa debe estar implicado.

Custos da gestão da qualidade na manutenção e sustentação dos Sistemas de Armas da Força Aérea

Atualmente, as organizações tendem a desenvolverem-se com o objetivo de se tornarem mais eficazes e eficientes. Neste contexto, esta investigação visa propor um modelo que permita calcular os Custos da Qualidade (CQ) na manutenção e sustentação dos Sistemas de Armas da Força Aérea (FA), contribuindo para a melhoria contínua do Sistema de Gestão da Qualidade e Aeronavegabilidade (SGQA). Assim, neste estudo é avaliada a utilização do modelo “Prevenção, Avaliação e Falhas” (PAF) para o cálculo dos CQ no SGQA, a forma como os Sistemas de Informação (SI) podem contribuir para este cálculo e qual a estrutura do sistema que deverá integrar e operacionalizar este modelo. Esta investigação desenvolve-se mediante um raciocínio hipotético-dedutivo, utilizando uma estratégia qualitativa aplicada num estudo de caso ao SA Epsilon Tb-30. Após apresentar um enquadramento teórico, são testadas as hipóteses identificadas através de análise documental e entrevistas a elementos com funções-chave neste âmbito. Verifica-se então a possibilidade de utilizar o modelo PAF para o cálculo dos CQ no SGQA. Contudo, é necessário adaptar os SI e os processos do sistema para a sua operacionalização. Finalmente, é proposto um plano para implementação do modelo de CQ, assim como são apresentadas algumas recomendações para o seu desenvolvimento. Abstract: Nowadays, the organizations tend to self-develop in order to increase their efficiency and effectiveness. In this context, this study has the purpose to propose a Quality Cost (CQ) model within the scope of maintenance and sustainability of Portuguese Air Force (FA) weapon systems, contributing to the continuous improvement of its Airworthiness and Quality Management System (SGQA). Therefore, throughout this study is evaluated the implementation of Prevention, Appraisal and Failure (PAF) model for CQ calculation, how the Information Systems (SI) can contribute for this calculus and what SGQA structure should integrate and operationalize this model. In this investigation is used a hypothetical-deductive reasoning, through a qualitative strategy applied to a case study in Epsilon TB-30 aircraft. After presenting an initial theoretical study, the raised hypotheses are tested through the relevant document analysis and interviews with elements in key functions within this scope. With this study it’s shown the possibility to use PAF model to calculate CQ of the SGQA. However, it’s necessary to adapt the SI and the system processes to get the operationalization of this model. Finally, an implementation plan of the evaluated CQ model is proposed, and some recommendations are made for its future development.

Os custos relacionados com a qualidade na prática fiscal das empresas portuguesas. Comparative case study

Todas as organizações deveriam preocupar-se com a análise dos custos da qualidade, dado que essa análise, para além de permitir identificar aspetos a melhorar, é uma ferramenta fundamental para os próprios órgãos de gestão dessas organizações. Esta análise sobre os custos da qualidade também deveria incidir sobre as atividades da empresa relacionadas com a sua prática fiscal. Porém, a literatura não apresenta qualquer referência à relação entre essas duas temáticas: custos da qualidade e fiscalidade empresarial. Nesse sentido, o presente trabalho de investigação analisa a relação entre os princípios dos custos da qualidade e a fiscalidade empresarial em Portugal. Pelo que, optou-se pela metodologia case study, mais especificamente pela metodologia comparative case study, por se entender, e se ter demonstrado, ser a metodologia que melhor se adequa à complexidade do tema em análise. Este trabalho, para além de relacionar os custos da qualidade e a fiscalidade empresarial, permitiu apresentar e aplicar uma metodologia para implementação do modelo Prevention – Appraisal – Faillure (PAF), com o objetivo de diminuir os custos da qualidade na prática fiscal e atingir o nível económico da qualidade, bem como um índice de eficiência, que permite, a todo o momento, determinar o nível de eficiência atingido e a forma de o melhorar. Nesse sentido, concluiu-se que a generalidade das empresas portuguesas não aplica os princípios dos custos da qualidade ao seu departamento fiscal ou à sua prática fiscal, quer essa atividade seja executada internamente na empresa, quer seja executada externamente; Costs related to the quality of fiscal practice in Portuguese firms. Comparative case study Abstract: Every organization should be concerned about analyzing its quality costs, since that analysis, besides allowing identification of aspects to improve is a fundamental tool for the management organs of those organizations. This analysis of quality costs should also be carried out on firms’ activities related to their fiscal practice. However, no reference is found in the literature to the relationship between these two: quality costs and business taxation. This research analyzes the relationship between the principles of quality costs and business taxation in Portugal. So being, and to carry out this study, the case study methodology was chosen, more specifically the comparative case study methodology, through the understanding, and previous demonstration, that it is the most appropriate methodology for the complexity of the subject analyzed. Besides relating quality costs to business taxation, this study allowed presentation and application of a methodology for implementing the Prevention – Appraisal – Failure (PAF) model in companies’ fiscal practice which decreases the costs of this practice, reach the economic level of quality as well as an efficiency index, which allows at any time to determine the achieved level of efficiency and how to improve it. All in all, what this study demonstrated is that Portuguese companies, in general, do not apply the principles of quality costs to their taxation department or fiscal practice, whether that activity is performed internally in the firm or externally.

Planeamento e controlo dos custos da qualidade nas empresas certificadas

A presente dissertação aborda a importância do planeamento e controlo dos custos da qualidade para a gestão da qualidade, postura fundamental na estratégia das organizações, que procuram vantagens competitivas para assegurarem a sua continuidade num mundo globalizado. Apesar do movimento da qualidade estar intimamente associado à certificação dos sistemas de gestão da qualidade, os mesmos, por si só, não são suficientes para assegurar a competitividade das organizações nos mercados altamente competitivos. Hoje em dia, as empresas dispõem, regra geral, de menos recursos do que no passado, o que as obriga a geri-los de forma mais criteriosa e racional. Assim, as organizações, cada vez mais, têm que ser eficientes na sua gestão e procuram medir a qualidade em termos monetários, através de sistemas de gestão de custos da qualidade, destacando assim a validade e utilidade do planeamento e controlo dos custos da qualidade, como instrumento de gestão. Assim sendo, este estudo apresenta como objetivo principal conhecer os procedimentos adotados no planeamento e controlo dos custos da qualidade nas empresas portuguesas certificadas, bem como verificar se elaboram relatórios de gestão que permitam determinar o retomo financeiro dos investimentos efetuados em qualidade. Os resultados obtidos evidenciam uma reduzida adesão da maioria das empresas respondentes em relação à implementação de sistemas formais, que quantificam e controlam os custos de qualidade, bem como à identificação explícita e isolada dos custos da qualidade nos relatórios de gestão. Também ficou averiguado o baixo nível de controlo dos investimentos efetuados em qualidade e, evidentemente, tal procedimento acarreta dificuldades na quantificação dos retornos obtidos nas empresas portuguesas certificadas. ABSTRACT: The present dissertation approaches the importance of planning and control quality costs for the management of quality, a key element for the strategy of the organizations that seek out competitive advantages to assure the continuity in a globalized world. Despite of the movement of the quality being intimately associated to the certification of the quality management systems, they are not enough to assure the competitiveness of organizations in highly competitive markets. Presently, organizations are facing a reduction in the amount of available resources, forcing them to manage those resources in a more discerning and rational way. More and more, the organizations have to be efficient and attempt to measure the quality in financial terms, through cost of quality management systems, thus showing the validity and usefulness of planning and control the costs of quality as a management instrument. ln this way, the main purpose of the study is to know the practices adopted by certified Portuguese companies concerning to the planning and control of quality costs, as well as to know if those companies are preparing management reports that allow them to verify the financial return of the investments in quality. The results showed that only a few number of the inquired companies have implemented formal systems that quantify and control the quality costs, and identify in an explicit and segregate way the quality costs in management reports. The results also showed the low level of control related to the investments in quality and the resultant problems in quantifying the returns of quality investments by the certified Portuguese companies.

Implementação de um sistema de gestão da qualidade nas organizações escolares

A Qualidade é um dos fatores dinâmicos de competitividade e é, incontestavelmente, um dos pilares fundamentais para a construção do sucesso das organizações. O conceito de Qualidade não é de fácil definição, dado que é algo complexo e de difícil consenso. E muitas são as noções de Qualidade existentes na literatura, mas todas elas convergem num sentido único da busca da melhoria contínua e da excelência. Por outro lado, a implementação da Contabilidade de Gestão (designadamente o Custeio Baseado em Atividades - ABC) numa organização, sobretudo numa instituição de ensino, fornece recursos suficientes para a identificação dos melhores indutores de custo. Assim, toma-se inevitável observar as atividades, inquirir os colaboradores internos e externos, desenvolver e aplicar métodos quantitativos que monitorizem os processos e os procedimentos e, especialmente, que exista o empenho da gestão de topo, de modo a que a estratégia e a qualidade organizacional se inter-relacionem. Este trabalho apresenta diversos aspetos referentes à temática dos custos da qualidade (ou da não qualidade), a própria técnica contemporânea ABC e os principais resultados obtidos através da aplicação de listas de verificação e de um inquérito por questionário, junto dos alunos, colaboradores docentes e não docentes, com o objetivo de analisar a situação dos custos da qualidade baseados na contabilidade e avaliar o grau de satisfação/motivação com a qualidade do serviço prestado na sede do Agrupamento de Escolas do concelho de Estremoz. Os resultados do presente estudo evidenciaram alguns benefícios e dificuldades da aplicabilidade da Gestão da Qualidade numa instituição de ensino. A cultura organizacional deste tipo de instituições será um dos aspetos a ter em consideração, de modo a que os princípios da Gestão da Qualidade sejam implementados de forma harmoniosa e que poderá encaminhar essas organizações num verdadeiro percurso de qualidade, numa filosofia de melhoria contínua até à excelência. ABSTRACT: As a crucial factor for competitiveness, quality is undoubtedly one of the foundations on which a successful organization rests. The complexity surrounding the notion of quality makes it hard to reach a consensus about its meaning, and that is why it has so many different definitions. However, all of them have one thing in common - that it involves a continuous search for improvement and excellence. Nowadays, an organization that uses accounting methods to support management (namely the Activity-based Costing method) has the necessary means to identify where the main costs are originating from, particularly if the organization is somehow related to teaching. It is therefore inevitable to study activities, inquire everyone involved in the organization's activities, as well as develop and apply quantitative methods to monitor processes and procedures. Moreover, it is especially important that top management is fully committed to quality in order to reflect it on its strategy. This work focuses on several aspects pertaining costs associated with quality- and lack of quality­ and shows the Activity-based Costing method in particular, as well as the main results gathered from the verification lists and questionnaires made to students, teachers and staff, with the purpose of analyzing - based on accounting - the amount of costs derived from quality, and evaluating the degree of satisfaction and/or motivation as regards the quality of service provided at a group of schools in Portuguese region of Estremoz. The results of this study show that there are some benefits in applying quality management to teaching institutions, but there are also some difficulties. The organizational culture of these institutions is one aspect that should be taken into consideration, so that quality management principles can be implemented harmoniously. This may direct these organizations to the true path of quality, so they can continuously seek improvement and achieve excellence.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Implementation costs of Agricultural Management Practices for Water Quality Improvement in the Great Barrier Reef Catchments. CSIRO: Water for Healthy Country National Research Flagship

Executive summary. In this report we analyse implementation costs and benefits for agricultural management practices, grouped into farming systems. In order to do so, we compare plot scale gross margins for the dominant agricultural production systems (sugarcane, grazing and banana cultivation) in the NRM regions Wet Tropics, Burdekin Dry Tropics and Mackay Whitsundays. Furthermore, where available, we present investment requirements for changing to improved farming systems. It must be noted that transaction costs are not captured within this project. For sugarcane, this economic analysis shows that there are expected benefits to sugarcane growers in the different regions through transitions to C and B class farming systems. Further transition to A-class farming systems can come at a cost, depending on the capital investment required and the length of the investment period. Obviously, the costs and benefits will vary for each individual grower and will depend on their starting point and individual property scenario therefore each circumstance needs to be carefully considered before making a change in management practice. In grazing, overall, reducing stocking rates comes at a cost (reduced benefits). However, when operating at low utilisation rates in wetter country, lowering stocking rates can potentially come at a benefit. With win-win potential, extension is preferred to assist farmer in changing management practices to improve their land condition. When reducing stocking rates comes at a cost, incentives may be applicable to support change among farmers. For banana cultivation, the results indicate that the transition to C and B class management practices is a worthwhile proposition from an economic perspective. For a change from B to A class farming systems however, it is not worthwhile from a financial perspective. This is largely due to the large capital investment associated with the change in irrigation system and negative impact in whole of farm gross margin. Overall, benefits will vary for each individual grower depending on their starting point and their individual property scenario. The results presented in this report are one possible set of figures to show the changes in profitability of a grower operating in different management classes. The results in this report are not prescriptive of every landholder. Landholders will have different costs and benefits from transitioning to improved practices, even if similar operations are practiced, hence it is recommended that landholders that are willing to change management undertake their own research and analysis into the expected costs and benefits for their own soil types and property circumstances.

Health-Related Quality of Life, Costs and Treatment of Inflammatory Rheumatic Diseases in Routine Practice : With special emphasis on biological drugs

Rheumatoid arthritis (RA) and other chronic inflammatory joint diseases already begin to affect patients health-related quality of life (HRQoL) in the earliest phases of these diseases. In treatment of inflammatory joint diseases, the last two decades have seen new strategies and treatment options introduced. Treatment is started at an earlier phase; combinations of disease-modifying anti-rheumatic drugs (DMARDs) and corticosteroids are used; and in refractory cases new drugs such as tumour necrosis factor (TNF) inhibitors or other biologicals can be started. In patients with new referrals to the Department of Rheumatology of the Helsinki University Central Hospital, we evaluated the 15D and the Stanford Health Assessment Questionnaire (HAQ) results at baseline and approximately 8 months after their first visit. Altogether the analysis included 295 patients with various rheumatic diseases. The mean baseline 15D score (0.822, SD 0.114) was significantly lower than for the age-matched general population (0.903, SD 0.098). Patients with osteoarthritis (OA) and spondyloarthropathies (SPA) reported the poorest HRQoL. In patients with RA and reactive arthritis (ReA) the HRQoL improved in a statistically significant manner during the 8-month follow-up. In addition, a clinically important change appeared in patients with systemic rheumatic diseases. HAQ score improved significantly in patients with RA, arthralgia and fibromyalgia, and ReA. In a study of 97 RA patients treated either with etanercept or adalimumab, we assessed their HRQoL with the RAND 36-Item Health Survey 1.0 (RAND-36) questionnaire. We also analysed changes in clinical parameters and the HAQ. With etanercept and adalimumab, the values of all domains in the RAND-36 questionnaire increased during the first 3 months. The efficacy of each in improving HRQoL was statistically significant, and the drug effects were comparable. Compared to Finnish age- and sex-matched general population values, the HRQoL of the RA patients was significantly lower at baseline and, despite the improvement, remained lower also at follow-up. Our RA patients had long-standing and severe disease that can explain the low HRQoL also at follow-up. In a pharmacoeconomic study of patients treated with infliximab we evaluated medical and work disability costs for patients with chronic inflammatory joint disease during one year before and one year after institution of infliximab treatment. Clinical and economic data for 96 patients with different arthritis diagnoses showed, in all patients, significantly improved clinical and laboratory variables. However, the medical costs increased significantly during the second period by 12 015 (95% confidence interval, 6 496 to 18 076). Only a minimal decrease in work disability costs occurred mean decrease 130 (-1 268 to 1 072). In a study involving a switch from infliximab to etanercept, we investigated the clinical outcome in 49 patients with RA. Reasons for switching were in 42% failure to respond by American College of Rheumatology (ACR) 50% criteria; in 12% adverse event; and in 46% non-medical reasons although the patients had responded to infliximab. The Disease Activity Score with 28 joints examined (DAS28) allowed us to measure patients disease activity and compare outcome between groups based on the reason for switching. In the patients in whom infliximab was switched to etanercept for nonmedical reasons, etanercept continued to suppress disease activity effectively, and 1-year drug survival for etanercept was 77% (95% CI, 62 to 97). In patients in the infliximab failure and adverse event groups, DAS28 values improved significantly during etanercept therapy. However, the 1-year drug survival of etanercept was only 43% (95% CI, 26 to 70) and 50% (95% CI, 33 to 100), respectively. Although the HRQoL of patients with inflammatory joint diseases is significantly lower than that of the general population, use of early and aggressive treatment strategies including TNF-inhibitors can improve patients HRQoL effectively. Further research is needed in finding new treatment strategies for those patients who fail to respond or lose their response to TNF-inhibitors.