919 resultados para cost-per-wear model


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BACKGROUND: In many countries, decisions about the public funding of drugs are preferentially based on the results of randomized trials. For truly rare diseases, such trials are not typically available, and approaches by public payers are highly variable. In view of this, a policy framework intended to fairly evaluate these drugs was developed by the Drugs for Rare Diseases Working Group (DRDWG) at the request of the Ontario Public Drug Programs. OBJECTIVE: To report the initial experience of applying a novel evaluation framework to funding applications for drugs for rare diseases. METHODS: Retrospective observational cohort study. MEASURES: Clinical effectiveness, costs, funding recommendations, funding approval. KEY RESULTS: Between March 2008 and February 2013, eight drugs were evaluated using the DRDWG framework. The estimated average annual drug cost per patient ranged from 28,000 to 1,200,000 Canadian dollars (CAD). For five drugs, full evaluations were completed, specific funding recommendations were made by the DRDWG, and funding was approved after risk-sharing agreements with the manufacturers were negotiated. For two drugs, the disease indications were determined to be ineligible for consideration. For one drug, there was insufficient natural history data for the disease to provide a basis for recommendation. For the five drugs fully evaluated, 32 patients met the predefined eligibility criteria for funding, and five were denied based on predefined exclusion criteria. CONCLUSIONS: The framework improved transparency and consistency for evaluation and public funding of drugs for rare diseases in Ontario. The evaluation process will continue to be iteratively refined as feedback on actual versus expected clinical and economic outcomes is incorporated. © 2014 Society of General Internal Medicine.

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This research consists in studying the influence of the various type of construction systems of roofs with their energy efficiency as well as on the cost benefit for the commercial buildings on the temperatures condition of the city of Natal/RN. The main goal of this research is to analyze the cost benefit of the construction systems of roofs available on the market, taking into consideration the energy efficiency of the commercial buildings artificially air conditioned in order to be used by the projectors and to be adequated to the temperatures condition of the city of Natal/RN. The method of valuation of the cost benefit of roof systems consists in six steps: Features and simulation of the reference building; Analyze of sensitivity; Analyzes, features and simulation of alternatives of roof construction systems; Analyze of the cost of implementation; Analyze of the benefits of the alternatives comparing to the base case; And finally the analyze of the cost benefit. The model type chosen as reference was stores with pre molded buildings and system of roof with fiber ciment and ceiling . The thermal results showed the influence of the roof system on the energy efficiency of the building. The Final results of the simulations of the alternatives comes to a conclusion that the absortance is the variable that presents the best cost benefit relation and the reduction on the thermal transmittance still has limitations because of the high cost

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En la presente investigación se evaluó el efecto de la levadura Saccharomyces cerevisiae adicionada a la dieta basal de terneros sobre la Condición Corporal (CC), Alzada, Ganancia Diaria de Peso (GDP), Parámetros Hematológicos y Metabólicos en terneros de reemplazo. Se realizó en la granja Nero de la Universidad de Cuenca con 18 terneros Holstein Friesian de 4 a 6 meses de edad, entre 100 a 200 kg/PV, criados en pastoreo, todos con las mismas condiciones de suplementación y manejo nutricional; divididos en dos grupos, un control T1 (n1=9) alimentados con dieta basal y un experimental T2 (n2=9) adicionado a la dieta 15 g/ternero/día de levadura. Se usó un diseño de bloques completamente al azar (DBA) y los resultados fueron analizados con el programa SPSS. El peso y alzada se registró semanalmente para evaluar su GDP (gramos) y talla (cm), respectivamente. La CC y los parámetros sanguíneos fueron realizados en 5 momentos. Los resultados de GDP y Alzada fueron analizados con las pruebas estadísticas de Shapiro – Wilk y Levene al 5%, al realizar el (ADEVA) no se encontró diferencias estadísticas. La variable CC presento diferencia significativa (p <0.05). Al analizar los parámetros hematológicos se encontró diferencia estadística en glucosa (p <0.05). En el análisis financiero, se apreció que el grupo control tiene un menor costo por Kg de peso producido 0,84 USD vs 0,96 USD del grupo experimental. En conclusión, se pone en manifiesto que el empleo de S. cerevisiae como aditivo nutricional de terneros de remplazo criados al pastoreo, puede constituir como una alternativa que incrementa los parámetros de salud expresados en glucosa y condición corporal

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En la presente investigación se evaluó: la ganancia diaria de peso, consumo semanal, índice de productividad, mortalidad, conversión alimenticia, costo por kg de carne, pigmentación en tarsos, porcentaje de grasa y el efecto del extracto de quillaja como coccidiostato, bajo dos sistemas de crianza, intensiva y semi-intensiva. El extracto de quillaja fue utilizado al 0,1% de inclusión en el alimento. La investigación se llevó a cabo en la provincia del Azuay, cantón Cuenca, parroquia San Joaquín, sector Balzay Bajo. Se utilizaron 300 pollitos camperos de la estirpe Hubbard variedad redbro S de 1 día de edad. Las aves se distribuyeron de forma aleatoria en un diseño de bloques al azar con 3 tratamientos, cada uno con 5 repeticiones y con 20 pollitos por unidad experimental. Los tratamientos fueron: T1: testigo, aves alojadas en sistema intensivo; T2: aves alojadas en sistema intensivo, más una dieta modificada que consistía en la adición de extracto de quillaja al 0,1%; T3: sistema semi-intensivo con la misma dieta del T2, las aves de este tratamiento a partir del día 28 de edad tuvieron acceso a un área verde delimitada, la cual poseía una mezcla forrajera de raigrás-alfalfa y además se adicionaron a su alimentación residuos de hortalizas propias de la zona. La investigación duró 56 días, no se evidenciaron diferencias significativas en ganancia diaria de peso, índice de productividad, índice de conversión, costo por kg de carne y porcentaje de grasa (p>0,05), mientras que consumo semanal y mortalidad, mostraron diferencias significativas (p<0,05). En las demás variables se evidenció mejor intensidad de pigmentación en T3 (p<0,05), mientras que en la infestación por coccidios no se observó diferencia entre tratamientos (p>0,05), lo que indica que la aplicación de extracto de quillaja tuvo un efecto similar al programa anticoccidial utilizado en T1

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Neste trabalho foi realizada a análise econômica da produção de juvenis de tilápia-do-nilo em tanques-rede utilizando-se diferentes densidades de estocagem. O experimento foi desenvolvido em área aquícola, em delineamento de blocos casualizados, com quatro densidades de estocagem (100, 200, 300 e 400 peixes m-3), avaliadas com seis repetições, em dois períodos de criação: de março a abril de 2005 (52 dias - peso inicial de 43,08 ± 2,98 g e peso final de 262,14 ± 47,86 g) e de março a abril de 2006 (58 dias - peso inicial de 43,16 ± 5,34 g e peso final 314,24 ± 73,30 g). Foram avaliadas as seguintes variáveis econômicas: custo da ração mais custo do juvenil dividido pela biomassa, em R$ kg-1; porcentagem do custo da ração por quilo de peixe produzido sobre o preço de venda; porcentagem do custo do juvenil por quilo de peixe produzido sobre o preço de venda e; porcentagem dos custos da ração mais do juvenil por quilo de peixe produzido sobre o preço de venda. da menor densidade de estocagem (100) para a maior (400), ocorreu diminuição no ganho de peso diário e elevação do índice de conversão alimentar aparente, mas essa redução não comprometeu a taxa de sobrevivência. Entretanto, o ganho de biomassa aumentou com o adensamento de peixes. As maiores receitas líquidas foram obtidas nas densidades de estocagem de 100 e 200 peixes m-3. Os preços não remuneraram os custos operacionais (efetivo e total) em maiores densidades (300 e 400 peixes m-3). Os melhores resultados para a produção de juvenis de tilápia-do-nilo foram obtidos com densidades de até 200 peixes m-3.

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Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

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Questa tesi si propone di fornire un approccio multidisciplinare per la valutazione delle prestazioni di una tipologia di intervento sostenibile che consiste in un telaio in calcestruzzo armato (RCFramed skin) per la ristrutturazione integrata di edifici esistenti. Viene fornita una descrizione preliminare di tale tecnologia, con particolare attenzione al miglioramento simultaneo delle prestazioni strutturali (sismiche), non strutturali (energetiche) e alle questioni relative alla limitazione dell'invasività e dell'interruzione dell'uso della costruzione. La valutazione delle prestazioni dell'edificio nelle configurazioni pre e post intervento è effettuata, principalmente in termini di capacità sismica, ma anche del comportamento termo-igrometrico. In particolare, i benefici ottenuti sia dal punto di vista strutturale che energetico sono valutati con riferimento a tre diverse città appartenenti a tre differenti zone sismiche e climatiche. La fattibilità e la sostenibilità dell'intervento di adeguamento proposto sono indagate attraverso una valutazione LCA(Life Cycle Assessment) per l'impatto ambientale e LCC(Life Cycle Cost) per l’analisi economica. Infine, viene proposto un metodo per facilitare la selezione della soluzione di intervento ottimale per ogni sito, combinando l'aspetto strutturale con quello energetico, di impatto ambientale ed economico.

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In the present paper we consider a differentiated Stackelberg model, when the leader firm engages in an R&D process that gives an endogenous cost-reducing innovation. The aim is to study the licensing of the cost-reduction by a per-unit royalty and a fixed-fee. We analyse the implications of these types of licensing contracts over the R&D effort, the profits of the firms, the consumer surplus and the social welfare. By using comparative static analysis, we conclude that the degree of the differentiation of the goods plays an important role in the results.

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Un dels principals motius que ens va impulsar en l’elecció del tema és que es tracta d’untema que pot despertar curiositat entre la població.Un altre motiu, es que varem trobar que està íntimament relacionat amb els estudis queestem cursant, donat que afecta als pressupostos de l’estat i a la seva restricciópressupostària, i per tant, està directament relacionat amb la macroeconomia. En el nostrecas, reduirem l’àmbit d’estudi al territori català, de manera que estudiarem aquestes duesmalalties dins la despesa en sanitat pública catalana. A demés, estan finançades amb elsnostres impostos, i per tant la seva despesa afecta a la restricció pressupostària delsciutadans.L’elecció d’aquestes malalties no ha estat feta a l’atzar. Inicialment, varem pensar enestudiar els costos dels interns penitenciaris que patien aquestes malalties. Com que laSIDA i d’hepatitis C són les malalties més freqüents dins la presó, i les que tenen unscostos més característics donada la complexitat dels seus tractaments, varem pensar queserien prou representatives.No obstant, a mesura que ens anàvem endinsant en el tema, ens varem adonar que tambéseria molt interessant comparar el cost de les malalties amb el de les persones no recluses, iesbrinar si hi havia algun tipus de cost diferencial. És per això que varem decidir analitzaraquestes dues malalties tant dins com fora.Un altre factor que ens ha impulsat en l’elecció del tema és el fet que el nombre d’interns ales presons té un ritme de creixement constant que s’ha accelerat en els últims anys,sobretot degut a l’augment de la immigració. Això implica un augment progressiu de ladespesa, que es tradueix en una necessitat d’ingressos majors per tal de poder equilibrar larestricció de la qual parlàvem abans.També varem voler anar una mica més lluny i analitzar el pes d’aquestes malalties dins dela despesa que la generalitat ha establert per a la sanitat pública. Com les dues son MDO (malalties de declaració obligatòria ) estan finançades completament pel sector públic.L’objectiu era veure si representaven un cost tant elevat com pensàvem.OBJECTIUS DEL TREBALL:· Demostrar l’elevat cost que suposen certes malalties per l’estat.· Manifestar els canvis en el cost de les malalties amb l’evolució delstractaments.· Analitzar els costos sanitaris extres que es produeixen a les presons.· Destacar l’augment accelerat del nombre d’interns i l’augment del cost sanitarique això suposa. METODOLOGIA: Per tal de poder realitzar l’estudi comparatiu, hem hagut de calcular manualment els costosde les malalties, tot informant-nos del preu dels medicament, les dosis, el cost de lesconsultes externes,etc. A més, per a calcular el cost del tractament dins la presó, ens hemhagut d’informar dels aspectes més generals que envolten a un pres, per poder veure sirealment existeix un cost diferencial respecte la malaltia a l’exterior. Per obtenir aquestesdiverses informacions, ens hem hagut de posar en contacte amb el personal que treballa ala presó que hem pres com a model d’estudi.Així, podem dividir les nostres fonts d’informació en 3 categories:• Obtenció d’informació directament amb el personal de la presó:– Entrevista amb la directora d’infermeria de la Secretaria de ServeisPenitenciaris, Rehabilitació i Justícia Juvenil– Entrevista amb la Cap d’infermeria del Centre Quatre Camins.• Informació a partir de mostres facilitades pels propis funcionaris de la presó• Informació a partir d’estudis sobre el tema i de dades oficials, concretament lesdades oficials sobre els Pressupostos de la Generalitat.

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In this article we extend the rational partisan model of Alesina and Gatti (1995) to include a second policy, fiscal policy, besides monetary policy. It is shown that, with this extension, the politically induced variance of output is not always eliminated nor reduced by delegating monetary policy to an independent and conservative central bank. Further, in flation and output stabilisation will be affected by the degree of conservativeness of the central bank and by the probability of the less in flation averse party gaining power. Keywords: rational partisan theory; fiscal policy; independent central bank JEL Classi fication: E58, E63.

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By the turn of the twenty-first century, UNDP had embraced a new form of funding based on ‘cost-sharing’, with this source accounting for 51 per cent of the organisation’s total expenditure worldwide in 2000. Unlike the traditional donor - recipient relationship so common with development projects, the new cost-sharing modality has created a situation whereby UNDP local offices become ‘subcontractors’ and agencies of the recipient countries become ‘clients’. This paper explores this transition in the context of Brazil, focusing on how the new modality may have compromised UNDP’s ability to promote Sustainable Human Development, as established in its mandate. The great enthusiasm for this modality within the UN system and its potential application to other developing countries increase the importance of a systematic assessment of its impact and developmental consequences.

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Background: In areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective. Method: The cost-effectiveness of the Optimal (R) and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U. S. dollars. Sensitivity analysis was performed considering key model parameters. Results: In the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to Plasmodium falciparum and Plasmodium vivax, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US$ 549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for P. vivax were 0.90 and 0.98, respectively, and when its sensitivity for P. falciparum was 0.83, the RDT was more cost-effective than microscopy. Conclusion: Microscopy is more cost-effective than OptiMal (R) in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.

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This article discusses the impact on the profitability of firms under Complementary Law 102/2000 (which abrogated the Law 89/96 - Kandir Law) allowing the appropriation of ICMS credits, due to investment in fixed assets goods, at a ratio of 1/48 per month. The paper seeks to demonstrate how this new system - which resulted in the transformation of the ICMS as a value added tax (VAT) consumption-type to an income-type - leads to a loss of approximately 30% of the value of credits to be recovered and the effect it generates on the cost of investment and the profits for small, medium and large firms. From the methodological point of view, it is a descriptive and quantitative research, which proceeded in three stages. Initially, we have obtained estimated value of net sales and volume of investments, based on report Painel de Competitividade prepared by the Federacao das Indtustrias do Estado de Sao Paulo (Fiesp/Serasa). Based on this information, it was possible to obtain estimates of the factors of generation of debits and credits for ICMS, using the model Credit Control of Fixed Assets (CIAP). Finally, we have calculated three indicators: (i) present value of debt recovery/value of credits, (ii) present value of debt recovery / investment value, (iii) present value of debt recovery / sales profitability. We have conclude that the system introduced by Complementary Law 102/2000 implicates great opportunity cost for firms and that legislation should be reviewed from this perspective, aiming to ensure lower costs associated with investment projects.

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Soil erosion in the Philippine uplands is severe. Hedgerow intercropping is widely advocated as an effective means of controlling soil erosion from annual cropping systems in the uplands. However, few farmers adopt hedgerow intercropping even in areas where it has been vigorously promoted. This may be because farmers find hedgerow intercropping to be uneconomic compared to traditional methods of farming. This paper reports a cost-benefit analysis comparing the economic returns from traditional maize farming with those from hedgerow intercropping in an upland community with no past adoption of hedgerows. A simple erosion/productivity model, Soil Changes Under Agroforestry (SCUAF), is used to predict maize yields over 25 years. Economic data were collected through key informant surveys with experienced maize farmers in an upland community. Traditional methods of open-field farming of maize are economically attractive to farmers in the Philippine uplands. In the short term, establishment costs are a major disincentive to the adoption of hedgerow intercropping. In the long term, higher economic returns from hedgerow intercropping compared to open-field farming are realised, but these lie beyond farmers' limited planning horizons.