Economic evaluation and its place in dentistry

Objective: This review intends to examine current research surrounding economic assessment in the delivery of dental care. Economic evaluation is an acknowledged method of analysing dental care systems by means of efficiency, effectiveness, efficacy and availability. Though this is a widely used method in medicine, it is underappreciated in dentistry. As the delivery of health care changes there has been recent demand by the public, the profession, and those funding dental treatment to investigate current practices regarding programs themselves and resource allocation.
Methods: A meta-analysis was conducted regarding health economics. The initial search was carried out using Pubmed, Google Scholar, Science Direct, and The Cochrane Library with search terms “health AND economics AND dentistry”. A secondary search was conducted with the terms “heath care AND dentistry AND”. The third part of the entry was changed to address the aims and included the following terms: “cost benefit analysis”, “efficiency criteria”, “supply & demand”, “cost-effectiveness”, “cost minimisation”, “cost utility”, “resource allocation”, “QALY”, and “delivery and economics”. Limits were applied to all searches to only include papers published in English within the last eight years.
Results: Preliminary results demonstrated a limited number of economic evaluations conducted in dentistry. Those that were carried out were mainly confined to the United Kingdom. Furthermore analysis was mainly restricted to restorative dentistry, followed by orthodontics, and maxillofacial surgery, thereby demonstrating a need for investigation in all fields of dentistry.
Conclusion: Health economics has been overlooked in the past regarding delivery of dental care and resource allocation. Economic appraisal is a crucial part of generating an effective and efficient dental care system. It is becoming increasingly evident that there is a need for economic evaluation in all dental fields.

Experimental study of abattoir wastewater treatment from an economic perspective

The most cost effective treatment scheme for effluent from Midfield Meats, an abattoir in Warrnambool, Australia, was evaluated via a series of laboratory and commercial scale experiments. Effectiveness was measured in terms of suspended solids (SS) and biological oxygen demand (BOD) reduction. Economic assessment was based on predicted reduction in trade waste charges versus infrastructure and running costs. From the range of potential treatment technologies, those deemed most appropriate for trialling included pre-screening, sedimentation, coagulation and flocculation treatment and dissolved air floatation (DAF). Prior to evaluation of treatment types, flow, loads and contaminant characterisation of the waste streams was conducted to aid in selection of treatment type and capacity. Prescreening was found to be the most cost effective, followed by sedimentation, coagulation and flocculation treatment and finally DAF. The most economical treatment scheme that satisfied the requirements of Midfield Meats included a combination of prescreening and sedimentation. DAF and coagulation and flocculation treatment satisfactorily treated the wastewater, however were not cost effective under the current trade waste agreement.

Jamaica: Report of the macro socio-economic effects of the events in western Kingston area 22 May- 7 June 2010

.--I. Background.--II. The affected population.--III. Sectoral analysis of damage and loss.--IV. The macro socio economic effect of the event.--V. Conclusions and recommendations

Contribution to economic evaluation of systems that value animal welfare at farm

The demand for "welfare friendly" products increases as public conscience and perception on livestock production systems grow. The public and policy-makers demand scientific information for education and to guide decision processes. This paper describes some of the last decade contributions made by scientists on the technical, economical and market areas of farm animal welfare. Articles on animal welfare were compiled on the following themes: 1) consumer behavior, 2) technical and economical viability, 3) public regulation, and 4) private certification policies. Most studies on the economic evaluation of systems that promote animal welfare involved species destined to produce export items, such as eggs, beef and pork. Few studies were found on broilers, dairy cows and fish, and data regarding other species, such as horses, sheep and goats were not found. Scientists understand that farm animal welfare is not only a matter of ethics, but also an essential tool to gain and maintain markets. However, it is unfortunate that little attention is paid to species that are not economically important for exports. Studies that emphasize on more humane ways to raise animals and that provide economic incentives to the producer are needed. An integrated multidisciplinary approach is necessary to highlight the benefits of introducing animal welfare techniques to existing production systems.

The Economics of State Aid for the Rescue and Restructuring of Firms in Difficulty: Theoretical Considerations, Empirical Analysis and Proposals for Reform. Bruges European Economic Research (BEER) Papers 27/September 2013

State aid for rescue and restructuring (R&R) of companies in difficulty causes a significant distortion of competition. It prevents the market from eliminating inefficient companies. Because of this, the European Commission has to be specially strict when it assesses rescue or restructuring aid. This paper examines recent cases of corporate restructuring partly funded with public money. It explains the main aspects of the current guidelines which are applicable to R&R State Aid and establishes a theoretical framework for the economic assessment of R&R aid. It then analyses decisions adopted by the European Commission concerning R&R state aid during the period 2000-2013. It finds that there is little economic rationale in the granting of R&R aid. The paper concludes by applying the lessons drawn from the empirical analysis to the anticipated revision of the R&R guidelines in the context of the State Aid Modernisation process.

A techno-economic comparison of power production by biomass fast pyrolysis with gasification and combustion

This paper presents an assessment of the technical and economic performance of thermal processes to generate electricity from a wood chip feedstock by combustion, gasification and fast pyrolysis. The scope of the work begins with the delivery of a wood chip feedstock at a conversion plant and ends with the supply of electricity to the grid, incorporating wood chip preparation, thermal conversion, and electricity generation in dual fuel diesel engines. Net generating capacities of 1–20 MWe are evaluated. The techno-economic assessment is achieved through the development of a suite of models that are combined to give cost and performance data for the integrated system. The models include feed pretreatment, combustion, atmospheric and pressure gasification, fast pyrolysis with pyrolysis liquid storage and transport (an optional step in de-coupled systems) and diesel engine or turbine power generation. The models calculate system efficiencies, capital costs and production costs. An identical methodology is applied in the development of all the models so that all of the results are directly comparable. The electricity production costs have been calculated for 10th plant systems, indicating the costs that are achievable in the medium term after the high initial costs associated with novel technologies have reduced. The costs converge at the larger scale with the mean electricity price paid in the EU by a large consumer, and there is therefore potential for fast pyrolysis and diesel engine systems to sell electricity directly to large consumers or for on-site generation. However, competition will be fierce at all capacities since electricity production costs vary only slightly between the four biomass to electricity systems that are evaluated. Systems de-coupling is one way that the fast pyrolysis and diesel engine system can distinguish itself from the other conversion technologies. Evaluations in this work show that situations requiring several remote generators are much better served by a large fast pyrolysis plant that supplies fuel to de-coupled diesel engines than by constructing an entire close-coupled system at each generating site. Another advantage of de-coupling is that the fast pyrolysis conversion step and the diesel engine generation step can operate independently, with intermediate storage of the fast pyrolysis liquid fuel, increasing overall reliability. Peak load or seasonal power requirements would also benefit from de-coupling since a small fast pyrolysis plant could operate continuously to produce fuel that is stored for use in the engine on demand. Current electricity production costs for a fast pyrolysis and diesel engine system are 0.091/kWh at 1 MWe when learning effects are included. These systems are handicapped by the typical characteristics of a novel technology: high capital cost, high labour, and low reliability. As such the more established combustion and steam cycle produces lower cost electricity under current conditions. The fast pyrolysis and diesel engine system is a low capital cost option but it also suffers from relatively low system efficiency particularly at high capacities. This low efficiency is the result of a low conversion efficiency of feed energy into the pyrolysis liquid, because of the energy in the char by-product. A sensitivity analysis has highlighted the high impact on electricity production costs of the fast pyrolysis liquids yield. The liquids yield should be set realistically during design, and it should be maintained in practice by careful attention to plant operation and feed quality. Another problem is the high power consumption during feedstock grinding. Efficiencies may be enhanced in ablative fast pyrolysis which can tolerate a chipped feedstock. This has yet to be demonstrated at commercial scale. In summary, the fast pyrolysis and diesel engine system has great potential to generate electricity at a profit in the long term, and at a lower cost than any other biomass to electricity system at small scale. This future viability can only be achieved through the construction of early plant that could, in the short term, be more expensive than the combustion alternative. Profitability in the short term can best be achieved by exploiting niches in the market place and specific features of fast pyrolysis. These include: •countries or regions with fiscal incentives for renewable energy such as premium electricity prices or capital grants; •locations with high electricity prices so that electricity can be sold direct to large consumers or generated on-site by companies who wish to reduce their consumption from the grid; •waste disposal opportunities where feedstocks can attract a gate fee rather than incur a cost; •the ability to store fast pyrolysis liquids as a buffer against shutdowns or as a fuel for peak-load generating plant; •de-coupling opportunities where a large, single pyrolysis plant supplies fuel to several small and remote generators; •small-scale combined heat and power opportunities; •sales of the excess char, although a market has yet to be established for this by-product; and •potential co-production of speciality chemicals and fuel for power generation in fast pyrolysis systems.

Coal-fired Power Plants with Flexible Amine-based CCS and Co-located Wind Power: Environmental, Economic and Reliability Outcomes

Carbon Capture and Storage (CCS) technologies provide a means to significantly reduce carbon emissions from the existing fleet of fossil-fired plants, and hence can facilitate a gradual transition from conventional to more sustainable sources of electric power. This is especially relevant for coal plants that have a CO2 emission rate that is roughly two times higher than that of natural gas plants. Of the different kinds of CCS technology available, post-combustion amine based CCS is the best developed and hence more suitable for retrofitting an existing coal plant. The high costs from operating CCS could be reduced by enabling flexible operation through amine storage or allowing partial capture of CO2 during high electricity prices. This flexibility is also found to improve the power plant’s ramp capability, enabling it to offset the intermittency of renewable power sources. This thesis proposes a solution to problems associated with two promising technologies for decarbonizing the electric power system: the high costs of the energy penalty of CCS, and the intermittency and non-dispatchability of wind power. It explores the economic and technical feasibility of a hybrid system consisting of a coal plant retrofitted with a post-combustion-amine based CCS system equipped with the option to perform partial capture or amine storage, and a co-located wind farm. A techno-economic assessment of the performance of the hybrid system is carried out both from the perspective of the stakeholders (utility owners, investors, etc.) as well as that of the power system operator.

In order to perform the assessment from the perspective of the facility owners (e.g., electric power utilities, independent power producers), an optimal design and operating strategy of the hybrid system is determined for both the amine storage and partial capture configurations. A linear optimization model is developed to determine the optimal component sizes for the hybrid system and capture rates while meeting constraints on annual average emission targets of CO2, and variability of the combined power output. Results indicate that there are economic benefits of flexible operation relative to conventional CCS, and demonstrate that the hybrid system could operate as an energy storage system: providing an effective pathway for wind power integration as well as a mechanism to mute the variability of intermittent wind power.

In order to assess the performance of the hybrid system from the perspective of the system operator, a modified Unit Commitment/ Economic Dispatch model is built to consider and represent the techno-economic aspects of operation of the hybrid system within a power grid. The hybrid system is found to be effective in helping the power system meet an average CO2 emissions limit equivalent to the CO2 emission rate of a state-of-the-art natural gas plant, and to reduce power system operation costs and number of instances and magnitude of energy and reserve scarcity.

The Economic Case for Electric Mining Equipment and Technical Considerations Relating to their Implementation

Underground hardrock mining can be very energy intensive and in large part this can be attributed to the power consumption of underground ventilation systems. In general, the power consumed by a mine’s ventilation system and its overall scale are closely related to the amount of diesel power in operation. This is because diesel exhaust is a major source of underground air pollution, including diesel particulate matter (DPM), NO2 and heat, and because regulations tie air volumes to diesel engines. Furthermore, assuming the size of airways remains constant, the power consumption of the main system increases exponentially with the volume of air supplied to the mine. Therefore large diesel fleets lead to increased energy consumption and can also necessitate large capital expenditures on ventilation infrastructure in order to manage power requirements. Meeting ventilation requirements for equipment in a heading can result in a similar scenario with the biggest pieces leading to higher energy consumption and potentially necessitating larger ventilation tubing and taller drifts. Depending on the climate where the mine is located, large volumes of air can have a third impact on ventilation costs if heating or cooling the air is necessary. Annual heating and cooling costs, as well as the cost of the associated infrastructure, are directly related to the volume of air sent underground. This thesis considers electric mining equipment as a means for reducing the intensity and cost of energy consumption at underground, hardrock mines. Potentially, electric equipment could greatly reduce the volume of air needed to ventilate an entire mine as well as individual headings because they do not emit many of the contaminants found in diesel exhaust and because regulations do not connect air volumes to electric motors. Because of the exponential relationship between power consumption and air volumes, this could greatly reduce the amount of power required for mine ventilation as well as the capital cost of ventilation infrastructure. As heating and cooling costs are also directly linked to air volumes, the cost and energy intensity of heating and cooling the air would also be significantly reduced. A further incentive is that powering equipment from the grid is substantially cheaper than fuelling them with diesel and can also produce far fewer GHGs. Therefore, by eliminating diesel from the underground workers will enjoy safer working conditions and operators and society at large will gain from a smaller impact on the environment. Despite their significant potential, in order to produce a credible economic assessment of electric mining equipment their impact on underground systems must be understood and considered in their evaluation. Accordingly, a good deal of this thesis reviews technical considerations related to the use of electric mining equipment, especially ones that impact the economics of their implementation. The goal of this thesis will then be to present the economic potential of implementing the equipment, as well as to outline the key inputs which are necessary to support an evaluation and to provide a model and an approach which can be used by others if the relevant information is available and acceptable assumptions can be made.

Feasibility study for thermal treatment of solid tire wastes in Bangladesh by using pyrolysis technology

In this study on the basis of lab data and available resources in Bangladesh, feasibility study has been carried out for pyrolysis process converting solid tire wastes into pyrolysis oils, solid char and gases. The process considered for detailed analysis was fixed-bed fire-tube heating pyrolysis reactor system. The comparative techno-economic assessment was carried out in US$ for three different sizes plants: medium commercial scale (144 tons/day), small commercial scale (36 tons/day), pilot scale (3.6 tons/day). The assessment showed that medium commercial scale plant was economically feasible, with the lowest unit production cost than small commercial and pilot scale plants for the production of crude pyrolysis oil that could be used as boiler fuel oil and for the production of upgraded liquid-products.

Fischereiökonomische Forschung in Deutschland – Ergebnisse zur deutschen Fischereiflotte aus einem EU-Verbundprojekt

The economic situation of the German fishing fleet, economic indicators and backgrounds have been analysed in the overall framework of the EU-Concerted Action ‘Economic Assessment of European fishing fleets’. Trends in number of vessels, employment on board and catches for main target species are decreasing. This development may clearly be related to bad fish stock conditions, missing investment op-portunities for vessels and the short-term fishing quota man-agement system. To facilitate fisheries economics research a better data collection system is needed. As a consequence economic advice may be given for the development of a long-term sustainable management system.

Análise parcial dos custos do protocolo assistencial da Casa de Parto David Capistrano Filho/Município do Rio de Janeiro: contribuição da enfermagem obstétrica

Trata-se de um estudo de Avaliação Econômica Parcial cujo objeto é os custos diretos do protocolo assistencial da Casa de Parto David Capistrano Filho/RJ. O objetivo geral é realizar analise dos custos diretos assistenciais destinados ao ciclo gravídico puerperal na Casa de Parto David Capistrano Filho (CPDCF), situada no município do Rio de Janeiro. Os objetivos específicos deste estudo são: estimar o tipo e a quantidade dos recursos consumidos na execução do cuidado ao ciclo gravídico puerperal de acordo com o protocolo assistencial da CPDCF; analisar os custos diretos relacionados ao protocolo assistencial da CPDCF; comparar os custos avaliados no período da pesquisa ao orçamento municipal destinado a assistência das gestantes de baixo risco no mesmo período. O método utilizado foi a Avaliação de Economia em Saúde, a perspectiva adotada foi o Sistema Único de Saúde (SUS) como órgão gestor, foram avaliados os prontuário das gestantes que realizaram o pré-natal na CPDCF no ano de 2010, excluindo destes as que não pariram na unidade, computando um total de 161 prontuários. Na análise foi realizada a descrição dos custos diretos envolvidos na assistência ao ciclo gravídico puerperal, para isso, foram relacionados e contados os recursos utilizados, definidos como unidades de custo, para a assistência na CPDCF durante o pré-natal, trabalho de parto/parto e pós-parto, e posteriormente esses recursos foram valorados de acordo com as tabelas do Sistema de Gerência da Tabela de Procedimentos (SIGTAP), Medicamentos, Próteses e Materiais Especiais do Sistema Único de Saúde/Ministério da Saúde do Banco de Preços em Saúde (BPS) e da Secretaria Municipal de Saúde Defesa Civil/Rio de Janeiro (SMSDC/RJ). Os resultados apontaram que o custo do pré-natal por gestante foi de R$ 271,91, com prevalência de custos para os exames realizados no pré-natal. Em relação ao trabalho de parto e parto, os custos foram de R$ 352,50 por gestante, neste item os maiores custos foram com os recursos humanos. A pesquisa demonstrou que a CPDCF apresentou menor valor que o orçamento municipal destinado para o parto de acordo com a tabela do SIGTAP (R$ 443,40 a R$ 475,16). Apesar desses dados, e de acordo com o relato das diretoras, a CPDCF é ociosa, e esta influência pode ser negativa para os custos do parto. Em relação ao pós-parto foi avaliado o custo por binômio com uma média de custo de R$ 269,94, os maiores custos de pós-parto foram com os recursos humanos. O custo geral da assistência na CPDCF foi de R$ 894,36 por gestante, desse valor, 39,42% correspondeu aos custos com o parto, 30,40% correspondeu ao custo com o pré-natal e 30,18% com a assistência pós-natal. Para afirmar a eficiência e eficácia das ações na CPDCF, é preciso a realização de uma avaliação de economia em saúde completa; o trabalho de parto/parto foram os que mais representaram os custos; o custo do parto é menor que o valor orçado para o parto de baixo risco, mas medidas de ação sobre a ociosidade são necessárias, pois esta pode influenciar nos custos do parto.

Custo-efetividade da prova tuberculínica versus QuantiFERON-TB Gold-In-Tube no diagnóstico e tratamento da infecção latente tuberculosa em profissionais de saúde da Atenção Básica no Brasil.

Os profissionais da área da saúde formam um dos grupos mais vulneráveis à infecção pelo Mycobacterium tuberculosis (Mtb). Segundo estimativas da Organização Mundial de Saúde (OMS), 8,8 milhões de pessoas estavam infectadas pelo Mtb e ocorreram 1,4 milhão de óbitos por tuberculose (TB) em 2010. A identificação de pessoas com Infecção Latente Tuberculosa (ILTB) é considerada pela OMS como uma prioridade no controle da doença, especialmente em países em desenvolvimento em que a incidência da doença ativa tem apresentado redução. O objetivo do presente trabalho foi avaliar, no Brasil, o custo-efetividade dos testes Prova Tuberculínica (PT) e Quantiferon TB Gold-In-Tube (QTF-GIT) no diagnóstico e tratamento da ILTB em profissionais de saúde atuantes na atenção básica, sob a perspectiva do Sistema Único de Saúde (SUS), comparando cinco estratégias que incluem o QTF-GIT, distintos pontos de corte para a PT e uso sequencial dos dois testes; e analisar o impacto do tabagismo sobre o risco de ILTB entre os profissionais de saúde, destacando-se a categoria da Enfermagem. Foi realizada uma avaliação econômica completa do tipo custo-efetividade, conduzida considerando uma coorte hipotética de 10.000 profissionais de saúde atuantes na atenção básica, com horizonte temporal restrito a um ano. Um modelo analítico de decisão, caracterizado por uma árvore de probabilidades de eventos, foi desenvolvido utilizando o software TreeAge ProTM 2013 para simular os resultados clínicos e impactos econômicos em saúde da nova tecnologia diagnóstica (QTF-GIT) versus a PT tradicional. Esse modelo simulou cinco estratégias diagnósticas para detecção e tratamento da ILTB: (a) PT, usando ponto de corte de 5mm; (b) PT, usando ponto de corte de 10 mm; (c) teste QTF-GIT; (d) PT, com ponto de corte de 5mm, seguida de teste QTF-GIT quando PT positiva; (e) PT, com ponto de corte de 10mm, seguida de teste QTF-GIT quando PT positiva. Foi realizada análise de sensibilidade determinística univariada. Na determinação dos fatores associados à ILTB, foi elaborado um modelo de regressão logística múltipla com seleção hierarquizada, utilizando o software Stata. A estratégia mais custo-efetiva foi a PT no ponto de corte ≥10mm, considerando como medida de desfecho tanto o número de indivíduos corretamente classificados pelos testes assim como o número de casos de TB evitados. A utilização isolada do QTF-GIT revelou-se a estratégia de menor eficiência, com RCEI= R$ 343,24 por profissional corretamente classificado pelo teste. Encontrou-se risco à ILTB significantemente maior para sexo masculino [OR=1,89; IC 95%:1,11-3,20], idade ≥ 41 anos [OR=1,56; IC 95%: 1.09-2,22], contato próximo com familiar com TB [OR=1,55; IC 95%: 1.02-2,36], status do tabagismo fumante [OR=1,75; IC 95%: 1.03-2,98] e categoria profissional da Enfermagem [OR=1,44; IC 95%: 1.02-2,03]. Concluiu-se que a PT no ponto de corte de 10mm é a estratégia diagnóstica mais custo-efetiva para ILTB entre os profissionais de saúde na atenção básica e que a ILTB está associada ao hábito do tabagismo e à categoria profissional de Enfermagem.

A hybrid power system for remote areas in Jordan

This paper presents a techno-economic assessment for a unique Isolated Hybrid Power System (IHPS) design for remote areas isolated from the grid which also has the capability of being operated as a smart μ-grid. The share of renewable energy sources in resource poor developing countries is low. In these countries an increase in the share of alternative energy (wind, water and sun) delivered with inexpensive operationally robust generation and delivery systems is seen to the way forward. In our design also incorporates a novel storage system to increase the effectiveness of the Isolated IHPSs previously reported in the literature. The configuration reported is a system consisting of, the wind and sun powered generation complemented with batteries, fuel cell unit and a diesel generator. The modelling design and simulations were based on Simulations conducted using MATLAB/SIMULINK, and HOMER Energy Planning and Design software tools. The design and simulation of a new storage approach incorporating Hydrogen Peroxide (H2O2) fuel cell (increasing the efficiency of the fuel cell from 35% to 65%) and a single board computer (Raspberry Pi) used for the energy management and control the system are the novel features of our design. The novel control strategy implemented also includes a synchronization capability that facilitates IHPS to IHPS or IHPS to Main-Grid connection. In the paper after briefly but comprehensively detailing the design and simulations we will present the results on which we conclude that smart independent systems that can utilize indigenous renewable energy with a capability of being able to synchronize with the grid or each other are the most optimal way of electrifying resource poor developing countries in a sustainable way with minimum impact on the environment and also achieve reductions in Green House Gases.

Evaluación económica de las decisiones sobre fertilidad del suelo mediante el uso de modelos dinámicos

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The role of economics in ecosystem based management: The case of the EU Marine Strategy Framework Directive, First lessons learnt and way forward

The EU Marine Strategy Framework Directive (MSFD) sets out a plan of action relating to marine environmental policy and in particular to achieving ‘good environmental status’ (GES) in European marine waters by 2020. Article 8.1 (c) of the Directive calls for ‘an economic and social analysis of the use of those waters and of the cost of degradation of the marine environment’. The MSFD is ‘informed’ by the Ecosystem Approach to management, with GES interpreted in terms of ecosystem functioning and services provision. Implementation of the Ecosystem Approach is expected to be by adaptive management policy and practice. The initial socio-economic assessment was made by maritime EU Member States between 2011 and 2012, with future updates to be made on a regular basis. For the majority of Member States, this assessment has led to an exercise combining an analysis of maritime activities both at national and coastal zone scales, and an analysis of the non-market value of marine waters. In this paper we examine the approaches taken in more detail, outline the main challenges facing the Member States in assessing the economic value of achieving GES as outlined in the Directive and make recommendations for the theoretically sound and practically useful completion of the required follow-up economic assessments specified in the MSFD.