The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: A Markov model informed by a randomised controlled trial

Objectives: To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active, primarily through the use of personalised SMS text-messages. Design: A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. Setting: This study considers the cost-effectiveness of MobileMums in Queensland, Australia. Participants: A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland, Australia. Data sources: The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort, treatment effects and resource utilisation were all informed by this trial. Main outcome measures: The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. Results: The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. Conclusions: At a cost-effectiveness threshold of 64 000 AUD, MobileMums would likely be a cost-effective use of healthcare resources in Queensland, Australia. Trial registration number: Australian Clinical Trials Registry; ACTRN12611000481976.

An actor-critic algorithm with function approximation for discounted cost constrained Markov decision processes

We develop in this article the first actor-critic reinforcement learning algorithm with function approximation for a problem of control under multiple inequality constraints. We consider the infinite horizon discounted cost framework in which both the objective and the constraint functions are suitable expected policy-dependent discounted sums of certain sample path functions. We apply the Lagrange multiplier method to handle the inequality constraints. Our algorithm makes use of multi-timescale stochastic approximation and incorporates a temporal difference (TD) critic and an actor that makes a gradient search in the space of policy parameters using efficient simultaneous perturbation stochastic approximation (SPSA) gradient estimates. We prove the asymptotic almost sure convergence of our algorithm to a locally optimal policy. (C) 2010 Elsevier B.V. All rights reserved.

Reinforcement learning with average cost for adaptive control of traffic lights at intersections

We propose for the first time two reinforcement learning algorithms with function approximation for average cost adaptive control of traffic lights. One of these algorithms is a version of Q-learning with function approximation while the other is a policy gradient actor-critic algorithm that incorporates multi-timescale stochastic approximation. We show performance comparisons on various network settings of these algorithms with a range of fixed timing algorithms, as well as a Q-learning algorithm with full state representation that we also implement. We observe that whereas (as expected) on a two-junction corridor, the full state representation algorithm shows the best results, this algorithm is not implementable on larger road networks. The algorithm PG-AC-TLC that we propose is seen to show the best overall performance.

Graphene on Paper: A Simple, Low-Cost Chemical Sensing Platform

Graphene layers have been transferred directly on to paper without any intermediate layers to yield G-paper. Resistive gas sensors have been fabricated using strips of G-paper. These sensors achieved a remarkable lower limit of detection of similar to 300 parts per trillion (ppt) for NO2, which is comparable to or better than those from other paper-based sensors. Ultraviolet exposure was found to dramatically reduce the recovery time and improve response times. G-paper sensors are also found to be robust against minor strain, which was also found to increase sensitivity. G-paper is expected to enable a simple and inexpensive low-cost flexible graphene platform

Report on Knowledge Exchange workshop Cost models for keeping knowledge: economic models for digital preservation

Organised by Knowledge Exchange & the Nordbib programme 11 June 2012, 8:30-12:30, Copenhagen Adjacent to the Nordbib conference 'Structural frameworks for open, digital research' Participants in break out discussion during the workshop on cost modelsThe Knowledge Exchange and the Nordbib programme organised a workshop on cost models for the preservation and management of digital collections. The rapid growth of the digital information which a wide range of institutions must preserve emphasizes the need for robust cost modelling. Such models should enable these institutions to assess both what resources are needed to sustain their digital preservation activities and allow comparisons of different preservation solutions in order to select the most cost-efficient alternative. In order to justify the costs institutions also need to describe the expected benefits of preserving digital information. This workshop provided an overview of existing models and demonstrated the functionality of some of the current cost tools. It considered the specific economic challenges with regard to the preservation of research data and addressed the benefits of investing in the preservation of digital information. Finally, the workshop discussed international collaboration on cost models. The aim of the workshop was to facilitate understanding of the economies of data preservation and to discuss the value of developing an international benchmarking model for the costs and benefits of digital preservation. The workshop took place in the Danish Agency for Culture and was planned directly prior to the Nordbib conference 'Structural frameworks for open, digital research'

100 Gb/s uncooled DWDM using orthogonal coding for low-cost datacommunication links

We demonstrate a 10 x 10 Gb/s uncooled DWDM system using orthogonal coding on adjacent carriers, assuming the use of a monolithically integrated sources. A power saving of 72% is expected over traditional WDM. © 2014 OSA.

Valuing maternity care: a comparison of stated preference methods with an application to cost-benefit analysis

This research investigates whether a reconfiguration of maternity services, which collocates consultant- and midwifery-led care, reflects demand and value for money in Ireland. Qualitative and quantitative research is undertaken to investigate demand and an economic evaluation is performed to evaluate the costs and benefits of the different models of care. Qualitative research is undertaken to identify women’s motivations when choosing place of delivery. These data are further used to inform two stated preference techniques: a discrete choice experiment (DCE) and contingent valuation method (CVM). These are employed to identify women’s strengths of preferences for different features of care (DCE) and estimate women’s willingness to pay for maternity care (CVM), which is used to inform a cost-benefit analysis (CBA) on consultant- and midwifery-led care. The qualitative research suggests women do not have a clear preference for consultant or midwifery-led care, but rather a hybrid model of care which closely resembles the Domiciliary Care In and Out of Hospital (DOMINO) scheme. Women’s primary concern during care is safety, meaning women would only utilise midwifery-led care when co-located with consultant-led care. The DCE also finds women’s preferred package of care closely mirrors the DOMINO scheme with 39% of women expected to utilise this service. Consultant- and midwifery-led care would then be utilised by 34% and 27% of women, respectively. The CVM supports this hierarchy of preferences where consultant-led care is consistently valued more than midwifery-led care – women are willing to pay €956.03 for consultant-led care and €808.33 for midwifery-led care. A package of care for a woman availing of consultant- and midwifery-led care is estimated to cost €1,102.72 and €682.49, respectively. The CBA suggests both models of care are cost-beneficial and should be pursued in Ireland. This reconfiguration of maternity services would maximise women’s utility, while fulfilling important objectives of key government policy.

Cost-effectiveness of electricity energy efficiency programs

We analyze the cost-effectiveness of electric utility ratepayer-funded programs to promote demand-side management (DSM) and energy efficiency (EE) investments. We specify a model that relates electricity demand to previous EE DSM spending, energy prices, income, weather, and other demand factors. In contrast to previous studies, we allow EE DSM spending to have a potential longterm demand effect and explicitly address possible endogeneity in spending. We find that current period EE DSM expenditures reduce electricity demand and that this effect persists for a number of years. Our findings suggest that ratepayer funded DSM expenditures between 1992 and 2006 produced a central estimate of 0.9 percent savings in electricity consumption over that time period and a 1.8 percent savings over all years. These energy savings came at an expected average cost to utilities of roughly 5 cents per kWh saved when future savings are discounted at a 5 percent rate. Copyright © 2012 by the IAEE. All rights reserved.

Low-cost digital signature architecture suitable for radio frequency identification tags

Continuing achievements in hardware technology are bringing ubiquitous computing closer to reality. The notion of a connected, interactive and autonomous environment is common to all sensor networks, biosystems and radio frequency identification (RFID) devices, and the emergence of significant deployments and sophisticated applications can be expected. However, as more information is collected and transmitted, security issues will become vital for such a fully connected environment. In this study the authors consider adding security features to low-cost devices such as RFID tags. In particular, the authors consider the implementation of a digital signature architecture that can be used for device authentication, to prevent tag cloning, and for data authentication to prevent transmission forgery. The scheme is built around the signature variant of the cryptoGPS identification scheme and the SHA-1 hash function. When implemented on 130 nm CMOS the full design uses 7494 gates and consumes 4.72 mu W of power, making it smaller and more power efficient than previous low-cost digital signature designs. The study also presents a low-cost SHA-1 hardware architecture which is the smallest standardised hash function design to date.

A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace

Background: Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer’s perspective.

Methods: Employees used a ‘loyalty card’ to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates.

Results: The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.

Conclusions: The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer’s perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable “business model” which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges.

A Reappraisal of the Safety and Cost-Effectiveness of Statin Therapy in Primary Prevention

Statins are among the most investigated drugs of all time. There is now a wealth of evidence supporting their use in the primary and secondary prevention arenas. The reduction in event recurrence has since been demonstrated across all levels of risk and in elderly patients. As a result, it is now accepted practice for statins to be prescribed universally in secondary prevention unless contraindicated. The extension of this policy into the primary prevention setting is more problematic, with moral and financial issues arising from the long-term treatment of many young apparently healthy individuals. For these reasons it is necessary to prove not only the financial sustainability of such a strategy but also the long-term safety of statins and the degree of benefit that might be expected.

Coordinating Inventory Control and Pricing Strategies with Random Demand and Fixed Ordering Cost: The Finite Horizon Case

We analyze a finite horizon, single product, periodic review model in which pricing and production/inventory decisions are made simultaneously. Demands in different periods are random variables that are independent of each other and their distributions depend on the product price. Pricing and ordering decisions are made at the beginning of each period and all shortages are backlogged. Ordering cost includes both a fixed cost and a variable cost proportional to the amount ordered. The objective is to find an inventory policy and a pricing strategy maximizing expected profit over the finite horizon. We show that when the demand model is additive, the profit-to-go functions are k-concave and hence an (s,S,p) policy is optimal. In such a policy, the period inventory is managed based on the classical (s,S) policy and price is determined based on the inventory position at the beginning of each period. For more general demand functions, i.e., multiplicative plus additive functions, we demonstrate that the profit-to-go function is not necessarily k-concave and an (s,S,p) policy is not necessarily optimal. We introduce a new concept, the symmetric k-concave functions and apply it to provide a characterization of the optimal policy.

Coordinating Inventory Control and Pricing Strategies with Random Demand and Fixed Ordering Cost: the Infinite Horizon Case

We analyze an infinite horizon, single product, periodic review model in which pricing and production/inventory decisions are made simultaneously. Demands in different periods are identically distributed random variables that are independent of each other and their distributions depend on the product price. Pricing and ordering decisions are made at the beginning of each period and all shortages are backlogged. Ordering cost includes both a fixed cost and a variable cost proportional to the amount ordered. The objective is to maximize expected discounted, or expected average profit over the infinite planning horizon. We show that a stationary (s,S,p) policy is optimal for both the discounted and average profit models with general demand functions. In such a policy, the period inventory is managed based on the classical (s,S) policy and price is determined based on the inventory position at the beginning of each period.

The impact of a minimum pension on old age poverty and its budgetary cost. Evidence from Latin America

This paper examines the impact on old age poverty and the fiscal cost of universal minimum oldage pensions in Latin America using recent household survey data for 18 countries. Alleviatingold age poverty requires different approach from other age groups and a minimum pension islikely to be the only alternative available. First we measure old age poverty rates for all countries.Second we discuss the design of minimum pensions schemes, means-tested or not, as wellas the disincentive effects that they are expected to have on the economic and social behavior ofhouseholds including labor supply, saving and family solidarity. Third we use the household surveysto simulate the fiscal cost and the impact on poverty rates of alternative minimum pensionschemes in the 18 countries. We show that a universal minimum pension would substantiallyreduce poverty among the elderly except in Argentina, Brazil, Chile and Uruguay where minimumpension systems already exist and poverty rates are low. Such schemes have much tobe commended in terms of incentives, spillover effects and administrative simplicity but have ahigh fiscal cost. The latter is a function of the age at which benefits are awarded, the prevailinglongevity, the generosity of benefits, the efficacy of means testing, and naturally the fiscal capacityof the country.

The low cost phenomenon

LCC Market Development - In 1996 low cost airlines (LCCs) accounted for only 1.4% of intra-European Union capacity. By the end of 2002, low cost airlines had captured 12% of all intra-EU capacity - Currently LCCs have a 30% market share of scheduled European point-to-point passengers. According to AEA forecasts, the LC market is expected to increase to 43% of European traffic by 2011. - In 2006 140 million passengers were carried by LCCs. - Low-fare airlines have increased their presence from 13% of city pairs in 2003 to 26% in 2007. 96% of new city-pairs between 2005 and 2007 were added by LCCs. - The United Kingdom still sees the highest number of low-cost flights, followed by Spain, which has been making up a lot of ground over the last year. This is followed by Italy and Germany with slightly fewer flights. These four countries contribute to roughly three quarters of low-cost departures. France is fifth in this list with only 5% of LC flights. - easyJet and Ryanair continue to be the biggest players in the European LCC market accounting for about 40% of all LCC capacity. The top two are followed by Airberlin, which contributes another 10% leaving three carriers in control of half the European low-cost market.