Cost evaluation and comparison of three decision strategies to revascularize : results of the suspected CAD protocol of the european CMR registry

Background: Cardiac magnetic resonance (CMR) is accepted as a method to assess suspected coronary artery disease (CAD). Nonetheless, invasive coronary angiography (CXA) combined or not with fractional flow reserve (FFR) remains the main diagnostic test to evaluate CAD. Little data exist on the economic impact of the use of these procedures in a population with a low to intermediate pre-test probability. Objective: To compare the costs of 3 decision strategies to revascularize a patient with suspected CAD: 1) strategy guided by CMR 2) hypothetical strategy guided by CXA-FFR, 3) hypothetical strategy guided by CXA alone.

Low-Cost Rural Surface Alternatives: Demonstration Project, TR-664, 2015

The goals of this project were to implement several stabilization methods for preventing or mitigating freeze-thaw damage to granular surfaced roads and identify the most effective and economical methods for the soil and climate conditions of Iowa. Several methods and technologies identified as potentially suitable for Iowa were selected from an extensive analysis of existing literature provided with Iowa Highway Research Board (IHRB) Project TR-632. Using the selected methods, demonstration sections were constructed in Hamilton County on a heavily traveled two-mile section of granular surfaced road that required frequent maintenance during previous thawing periods. Construction procedures and costs of the demonstration sections were documented, and subsequent maintenance requirements were tabulated through two seasonal freeze-thaw periods. Extensive laboratory and field tests were performed prior to construction, as well as before and after the two seasonal freeze-thaw periods, to monitor the performance of the demonstration sections. A weather station was installed at the project site and temperature sensors were embedded in the subgrade to monitor ground temperatures up to a depth of 5 ft and determine the duration and depths of ground freezing and thawing. An economic analysis was performed using the documented construction and maintenance costs, and the estimated cumulative costs per square yard were projected over a 20-year timeframe to determine break-even periods relative to the cost of continuing current maintenance practices. Overall, the sections with biaxial geogrid or macadam base courses had the best observed freeze-thaw performance in this study. These two stabilization methods have larger initial costs and longer break-even periods than aggregate columns, but counties should also weigh the benefits of improved ride quality and savings that these solutions can provide as excellent foundations for future paving or surface upgrades.

Minimally invasive fixation versus conservative treatment of undisplaced scaphoid fractures: a cost-effectiveness study.

This study compares the direct and indirect costs of conservative and minimally invasive treatment for undisplaced scaphoid fractures. Costs data concerning groups of non-operated and operated patients were analysed. Direct costs were higher in operated patients. Although highly variable, indirect costs were significantly smaller in operated patients and the total costs were higher in non-operated patients. In conclusion, operative treatment of scaphoid fractures is initially more expensive than conservative treatment but markedly decreases the work compensation costs.

Robust parametric indirect estimates of the expected cost of a hospital stay with covariates and censored data.

We consider the problem of estimating the mean hospital cost of stays of a class of patients (e.g., a diagnosis-related group) as a function of patient characteristics. The statistical analysis is complicated by the asymmetry of the cost distribution, the possibility of censoring on the cost variable, and the occurrence of outliers. These problems have often been treated separately in the literature, and a method offering a joint solution to all of them is still missing. Indirect procedures have been proposed, combining an estimate of the duration distribution with an estimate of the conditional cost for a given duration. We propose a parametric version of this approach, allowing for asymmetry and censoring in the cost distribution and providing a mean cost estimator that is robust in the presence of extreme values. In addition, the new method takes covariate information into account.

Soil Conservation Cost Share: SFY 2015 Annual Report, October 2015

Annual report of soil conservation in Iowa.

Soil Conservation Cost Share: SFY 2014 Annual Report, October 2015

Annual report of soil conservation in Iowa.

Fitness cost and impaired survival in penicillin-resistant Streptococcus gordonii isolates selected in the laboratory.

Cycling of Streptococcus gordonii (115 times) with penicillin resulted in a MIC increase of more than 100-fold, from 0.008 to 2 microg/ml. The 2-microg/ml MIC maximum was already reached after 36 passages but resulted in impaired fitness. Although the MIC did not increase further, fitness was partially recovered during the 79 additional cycles.

Evaluation of Low-Cost Treatments on Rural Two-Lane Curves, TR-579, 2012

The objective of this project was to evaluate low-cost measures to reduce speeds on high-crash horizontal curves. The researchers evaluated two low-cost treatments in Iowa to determine their effectiveness in reducing speeds on rural two-lane roadways. This report summarizes how the research team selected sites and collected data, and the results. The team selected six sites. Retroreflective post treatments were added to existing chevrons at four sites and on-pavement curve markings were added at two sites. The researchers collected speed data before and after installation of the two treatments. The study compared several speed metrics to assess the effectiveness of the treatments. Overall, both were moderately effective in reducing speeds. The most significant impact of the treatments was in reducing the percentage of vehicles traveling over the posted or advisory speed by 5, 10, 15, or 20 or more mph. This result suggests that the treatments are most effective in reducing high-end speeds.

A low-cost trap for Cerambycidae monitoring in forest plantations in Brazil

The objective of this work was to evaluate the use of a low-cost trap to capture Cerambycidae in different seasons in planted forests in Brazil. Thirty polyethylene-terephthalate trap bottles per hectare were used, disposed at every 50 m. The traps were red painted and contained glass flasks with a mixture of ethanol, methanol and benzaldehyde. There were soap and water at the trap bottom. The traps were checked biweekly for beetle presence. Sampling time required one minute per sample, and traps were easy to use. Total sampling cost, including materials and labor, was US$ 13.46 per sample. Six Cerambycidae species were captured along the dry and rainy seasons.

Low-cost MR-compatible moving heart phantom.

For the development and evaluation of cardiac magnetic resonance (MR) imaging sequences and methodologies, the availability of a periodically moving phantom to model respiratory and cardiac motion would be of substantial benefit. Given the specific physical boundary conditions in an MR environment, the choice of materials and power source of such phantoms is heavily restricted. Sophisticated commercial solutions are available; however, they are often relatively costly and user-specific modifications may not easily be implemented. We therefore sought to construct a low-cost MR-compatible motion phantom that could be easily reproduced and had design flexibility. A commercially available K'NEX construction set (Hyper Space Training Tower, K'NEX Industries, Inc., Hatfield, PA) was used to construct a periodically moving phantom head. The phantom head performs a translation with a superimposed rotation, driven by a motor over a 2-m rigid rod. To synchronize the MR data acquisition with phantom motion (without introducing radiofrequency-related image artifacts), a fiberoptic control unit generates periodic trigger pulses synchronized to the phantom motion. Total material costs of the phantom are US$ < 200.00, and a total of 80 man-hours were required to design and construct the original phantom. With schematics of the present solution, the phantom reproduction may be achieved in approximately 15 man-hours. The presented MR-compatible periodically moving phantom can easily be reproduced, and user-specific modifications may be implemented. Such an approach allows a detailed investigation of motion-related phenomena in MR images.

Report on a Review of the Iowa Homeland Security and Emergency Management Department, E911 Cost Data for the period July 1, 2012 through June 30, 2014

Report on a Review of the Iowa Homeland Security and Emergency Management Department, E911 Cost Data for the period July 1, 2012 through June 30, 2014

Profile, cost and pattern of prescriptions for polymedicated patients in Catalonia (Spain).

OBJECTIVES: Polypharmacy is one of the main management issues in public health policies because of its financial impact and the increasing number of people involved. The polymedicated population according to their demographic and therapeutic profile and the cost for the public healthcare system were characterised. DESIGN: Cross-sectional study. SETTING: Primary healthcare in Barcelona Health Region, Catalonia, Spain (5 105 551 inhabitants registered). PARTICIPANTS: All insured polymedicated patients. Polymedicated patients were those with a consumption of ≥16 drugs/month. MAIN OUTCOMES MEASURES: The study variables were related to age, gender and medication intake obtained from the 2008 census and records of prescriptions dispensed in pharmacies and charged to the public health system. RESULTS: There were 36 880 polymedicated patients (women: 64.2%; average age: 74.5±10.9 years). The total number of prescriptions billed in 2008 was 2 266 830 (2 272 920 total package units). The most polymedicated group (up to 40% of the total prescriptions) was patients between 75 and 84 years old. The average number of prescriptions billed monthly per patient was 32±2, with an average cost of 452.7±27.5. The total cost of those prescriptions corresponded to 2% of the drug expenditure in Catalonia. The groups N, C, A, R and M represented 71.4% of the total number of drug package units dispensed to polymedicated patients. Great variability was found between the medication profiles of men and women, and between age groups; greater discrepancies were found in paediatric patients (5-14 years) and the elderly (≥65 years). CONCLUSIONS: This study provides essential information to take steps towards rational drug use and a structured approach in the polymedicated population in primary healthcare.

An Estimate of the Cost to Resurface Pavements and Bridges Damaged by Studded Tires, 1972

This report contains an estimate of the cost of highway resurfacing necessitated by damage from studded tires. The total is $95,620,000 for the twenty-five years from 1971 to 1996. This total includes $51,937,000 to resurface pavements and bridges on Interstate routes and $43,683,000 for other Primary highways. The estimate for Interstate routes includes those sections now open to traffic and those planned for completion by November 1974. The estimate for other Primary routes includes rural and municipal sections open to traffic as of November 1970. The estimate was prepared by computing the cost of expected pavement and bridge resurfacing costs for the twenty-five year period assuming continued use of studded tires, then subtracting from this the expected resurfacing ) cost for the same period assuming that the use of' studded tires is prohibited. The total figure, $95,620,000, should be regarded as a conservative estimate of the cost which may be avoided by prohibiting the use of studded tires in Iowa. The conservative nature of the estimate may be demonstrated by the following examples of the guidelines used iri its preparation. 1. Only mainline pavements were included in the cost estimate for the Interstate routes. The connecting loops, exit ramps and entrance ramps at Interstate interchanges contain many additional miles of pavement subject to wear by studded tires. This pavement was omitted from the estimate because reliable ' information about the rate of pavement wear at such locations is not available. As a result, the Interstate resurfacing costs are underestimated. 2. Several other costs were also omitted from the estimate because of a lack of sufficient information. These include the cost of repairing damage caused by studded tires to city streets other than those designated as Primary routes, the damage to pavements and bridges on the more-heavily travelled Secondary roads, and the damage to pavement traffic markings on all highway systems. Experience indicates that portland cement concrete pavements in Iowa have a normal service life of twenty-five years before resurfacing becomes necessary. The service life for asphalt pavements is thirteen years. In making this cost estimate, the need for resurfacing was attributed to wear from studded tires only when the normal service life of the pavement was shortened by that wear. Consequently, this cost estimate does not account for the reduced safety and convenience to Iowa motorists during the time when pavement wear caused by studded tires is significant but less than the critical amount.

Cost Analysis of Long-Term Treatment of Patients with Symptomatic Gastroesophageal Reflux Disease (GERD) with Esomeprazole On-Demand Treatment or Esomeprazole Continuous Treatment: An Open, Randomized, Multicenter Study in Switzerland.

Objectives: To assess the difference in direct medical costs between on-demand (OD) treatment with esomeprazole (E) 20 mg and continuous (C) treatment with E 20 mg q.d. from a clinical practice view in patients with gastroesophageal reflux disease (GERD) symptoms. Methods: This open, randomized study (ONE: on-demand Nexium evaluation) compared two long-term management options with E 20 mg in endoscopically uninvestigated patients seeking primary care for GERD symptoms who demonstrated complete relief of symptoms after an initial treatment of 4 weeks with E 40 mg. Data on consumed quantities of all cost items were collected in the study, while data on prices during the time of study were collected separately. The analysis was done from a societal perspective. Results: Forty-nine percent (484 of 991) of patients randomized to the OD regimen and 46% (420 of 913) of the patients in the C group had at least one contact with the investigator that would have occurred nonprotocol-driven. The difference of the adjusted mean direct medical costs between the treatment groups was CHF 88.72 (95% confidence interval: CHF 41.34-153.95) in favor of the OD treatment strategy (Wilcoxon rank-sum test: P < 0.0001). Adjusted direct nonmedical costs and productivity loss were similar in both groups. Conclusions: The adjusted direct medical costs of a 6-month OD treatment with esomeprazole 20 mg in uninvestigated patients with symptoms of GERD were significantly lower compared with a continuous treatment with E 20 mg once a day. The OD therapy represents a cost-saving alternative to the continuous treatment strategy with E.

Low Cost Fly Ash - Sand Stabilization Roadway, Construction Report, HR-259, 1986

Fly ash, a by-product of coal-fired electricity generating plants, has for years been promoted as a material suitable for highway construction. Disposal of the large quantities of fly ash produced is expensive and creates environmental concerns. The pozzolanic properties make it promotable as a partial Portland cement replacement in pc concrete, a stabilizer for soil and aggregate in embankments and road bases, and a filler material in grout. Stabilizing soils and aggregates for road construction has the potential of using large quantities of fly ash. Iowa Highway Research Board Project HR-194, "Mission-Oriented Dust Control and Surface Improvement Processes for Unpaved Roads", included short test sections of cement, fly ash, and salvaged granular road material mixed for a base in western Iowa. The research showed that cement fly ash aggregate (CFA) has promise as a stabilizing agent in Iowa. There are several sources of sand that when mixed with fly ash may attain strengths much greater than fly ash mixed with salvaged granular road material at little additional cost