Cost-effectiveness of bone-anchored prosthesis: the Queensland experience

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US. [1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland, in particular, have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on biomechanics aspects as well as the clinical benefits and safety of the procedure. In principle, bone-anchored prostheses should eliminate lifetime expenses associated with sockets and, consequently, potentially alleviate the financial burden of amputation for governmental organizations. Unfortunately, publications focusing on cost-effectiveness are sparse. In fact, only one study published by Haggstrom et al (2012), reported that “despite significantly fewer visits for prosthetic service the annual mean costs for osseointegrated prostheses were comparable with socket-suspended prostheses”. Consequently, governmental organizations such as Queensland Artificial Limb Services (QALS) are facing a number of challenges while adjusting financial assistance schemes that should be fair and equitable to their clients fitted with bone-anchored prostheses. Clearly, more scientific evidence extracted from governmental databases is needed to further consolidate the analyses of financial burden associated with both methods of attachment (i.e., conventional sockets prostheses, bone-anchored prostheses). The purpose of the presentation will be to share the current outcomes of a cost-analysis study lead by QALS. The specific objectives will be: • To outline methodological avenues to assess the cost-effectiveness of bone-anchored prostheses compared to conventional sockets prostheses, • To highlight the potential obstacles and limitations in cost-effectiveness analyses of bone-anchored prostheses, • To present cohort results of a cost-effectiveness (QALY vs cost) including the determination of fair Incremental cost-effectiveness Ratios (ICER) as well as cost-benefit analysis focusing on the comparing costs and key outcome indicators (e.g., QTFA, TUG, 6MWT, activities of daily living) over QALS funding cycles for both methods of attachment.

How Much Does It Cost to Provide Antiretroviral Therapy for HIV/AIDS in Africa?

Background: Many African countries are rapidly expanding HIV/AIDS treatment programs. Empirical information on the cost of delivering antiretroviral therapy (ART) for HIV/AIDS is needed for program planning and budgeting. Methods: We searched published and gray sources for estimates of the cost of providing ART in service delivery (non-research) settings in sub-Saharan Africa. Estimates were included if they were based on primary local data for input prices. Results: 17 eligible cost estimates were found. Of these, 10 were from South Africa. The cost per patient per year ranged from $396 to $2,761. It averaged approximately $850/patient/year in countries outside South Africa and $1,700/patient/year in South Africa. The most recent estimates for South Africa averaged $1,200/patient/year. Specific cost items included in the average cost per patient per year varied, making comparison across studies problematic. All estimates included the cost of antiretroviral drugs and laboratory tests, but many excluded the cost of inpatient care, treatment of opportunistic infections, and/or clinic infrastructure. Antiretroviral drugs comprised an average of one third of the cost of treatment in South Africa and one half to three quarters of the cost in other countries. Conclusions: There is very little empirical information available about the cost of providing antiretroviral therapy in non-research settings in Africa. Methods for estimating costs are inconsistent, and many estimates combine data drawn from disparate sources. Cost analysis should become a routine part of operational research on the treatment rollout in Africa.

On the Cost of Supporting Multihoming and Mobility

As the Internet has evolved and grown, an increasing number of nodes (hosts or autonomous systems) have become multihomed, i.e., a node is connected to more than one network. Mobility can be viewed as a special case of multihoming—as a node moves, it unsubscribes from one network and subscribes to another, which is akin to one interface becoming inactive and another active. The current Internet architecture has been facing significant challenges in effectively dealing with multihoming (and consequently mobility). The Recursive INternet Architecture (RINA) [1] was recently proposed as a clean-slate solution to the current problems of the Internet. In this paper, we perform an average-case cost analysis to compare the multihoming / mobility support of RINA, against that of other approaches such as LISP and MobileIP. We also validate our analysis using trace-driven simulation.

Cost of innovation in the pharmaceutical industry.

The research and development costs of 93 randomly selected new chemical entities (NCEs) were obtained from a survey of 12 U.S.-owned pharmaceutical firms. These data were used to estimate the pre-tax average cost of new drug development. The costs of abandoned NCEs were linked to the costs of NCEs that obtained marketing approval. For base case parameter values, the estimated out-of-pocket cost per approved NCE is $114 million (1987 dollars). Capitalizing out-of-pocket costs to the point of marketing approval at a 9% discount rate yielded an average cost estimate of $231 million (1987 dollars).

Creating replicas of scultural heritage through 3D reconstruction and low cost 3D printer in Education

The process of making replicas of heritage has traditionally been developed by public agencies, corporations and museums and is not commonly used in schools. Currently there are technologies that allow creating cheap replicas. The new 3D reconstruction software, based on photographs and low cost 3D printers allow to make replicas at a cost much lower than traditional. This article describes the process of creating replicas of the sculpture Goslar Warrior of artist Henry Moore, located in Santa Cruz de Tenerife. To make this process, first, a digital model have been created using Autodesk Recap 360, Autodesk 123D Catch and Autodesk Meshmixer MarkerBot MakerWare applications. Physical replication, has been reproduced in polylactic acid (PLA) by MakerBot Replicator 2 3D printer. In addition, a cost analysis using, in one hand, the printer mentioned, and in the other hand, 3D printing services both online and local, is included. Finally, there has been a specific action with 141 students and 12 high school teachers, who filled a questionnary about the use of sculptural replicas in education.

Life-Cycle Energy Analysis of a Modular/Off-Site Building School

This paper is concerned with assessing the building’s the energy efficiency and qualities of a modular design for the education industry, in order assess the long economic benefits. The research includes a life-cycle energy and cost analysis of the school building design, predicting the impact on the operational cost of the building as a result of the addition of photovoltaic panels. The paper also includes a comparative study between the ECO Modular Solutions building, and a current standard prefabricated school building, quantifying the savings in CO2 emissions and savings in cost.

D3.1 Benefits Analysis of the Initial Operational Cruiser-Feeder Concept

The REsearch on a CRuiser Enabled Air Transport Environment (RECREATE) project is considers the introduction and airworthiness of cruiser-feeder operations for civil aircraft. Cruiser-feeder operations are investigated as a promising pioneering idea for the air transport of the future. The soundness of the concept of cruiser-feeder operations for civil aircraft can be understood, taking air-to-air refueling operations as an example. For this example, a comprehensive estimate of the benefits can be made, which shows a fuel burn reduction potential and a CO2 emission reduction of 31% for a typical 6000 nautical miles flight with a payload of 250 passengers. This reduction potential is known to be large by any standard. The top level objective of the RECREATE project is to demonstrate on a preliminary design level that cruiser-feeder operations (as a concept to reduce fuel burn and CO2 emission levels) can be shown to comply with the airworthiness requirements for civil aircraft. The underlying Scientific and Technological (S&T) objectives are to determine and study airworthy operational concepts for cruiser-feeder operations, and to derive and quantify benefits in terms of CO2 emission reduction but also other benefits.

Work Package (WP) 3 has the objective to substantiate the assumed benefits of the cruiser/feeder operations through refined analysis and simulation. In this report, initial benefits evaluation of the initial RECREATE cruiser/feeder concepts is presented. The benefits analysis is conducted in delta mode, i.e. comparison is made with a baseline system. Since comparing different aircraft and air transport systems is never a trivial task, appropriate measures and metrics are defined and selected first. Non-dimensional parameters are defined and values for the baseline system derived.

The impact of cruiser/feeder operations such as air-to-air refueling are studied with respect to fuel-burn (or carbon-dioxide), noise and congestion. For this purpose, traffic simulations have been conducted.
Cruiser/feeder operations will have an impact on dispatch reliability as well. An initial assessment of the effect on dispatch reliability has been made and is reported.

Finally, a considerable effort has been made to create the infrastructure for economic delta analysis of the cruiser/feeder concept of operation. First results of the cost analysis have been obtained.

Improved Road Design for Future Maintenance - Analysis of Road Barrier Repair Costs

The cost of a road construction over its service life is a function of the design, quality of construction, maintenance strategies and maintenance operations. Unfortunately, designers often neglect a very important aspect which is the possibility to perform future maintenance activities. The focus is mainly on other aspects such as investment costs, traffic safety, aesthetic appearance, regional development and environmental effects. This licentiate thesis is a part of a Ph.D. project entitled “Road Design for lower maintenance costs” that aims to examine how the life-cycle costs can be optimized by selection of appropriate geometrical designs for the roads and their components. The result is expected to give a basis for a new method used in the road planning and design process using life-cycle cost analysis with particular emphasis on road maintenance. The project started with a review of literature with the intention to study conditions causing increased needs for road maintenance, the efforts made by the road authorities to satisfy those needs and the improvement potential by consideration of maintenance aspects during planning and design. An investigation was carried out to identify the problems which obstruct due consideration of maintenance aspects during the road planning and design process. This investigation focused mainly on the road planning and design process at the Swedish Road Administration. However, the road planning and design process in Denmark, Finland and Norway were also roughly evaluated to gain a broader knowledge about the research subject. The investigation was carried out in two phases: data collection and data analysis. Data was collected by semi-structured interviews with expert actors involved in planning, design and maintenance and by a review of design-related documents. Data analyses were carried out using a method called “Change Analysis”. This investigation revealed a complex combination of problems which result in inadequate consideration of maintenance aspects. Several urgent needs for changes to eliminate these problems were identified. Another study was carried out to develop a model for calculation of the repair costs for damages of different road barrier types and to analyse how factors such as road type, speed limits, barrier types, barrier placement, type of road section, alignment and seasonal effects affect the barrier damages and the associated repair costs. This study was carried out using a method called the “Case Study Research Method”. Data was collected from 1087 barrier repairs in two regional offices of the Swedish Road Administration, the Central Region and the Western Region. A table was established for both regions containing the repair cost per vehicle kilometre for different combinations of barrier types, road types and speed limits. This table can be used by the designers in the calculation of the life-cycle costs for different road barrier types.

Estimated lifetimes of road pavements in Sweden using time-to-event analysis

Maintenance planning of road pavement requires reliable estimates of roads’ lifetimes. In determining the lifetime of a road, this study combines maintenance activities and road condition measurements. The scope of the paper is to estimate lifetimes of road pavements in Sweden with time to event analysis. The model used includes effects of pavement type, road type, bearing capacity, road width, speed limit, stone size and climate zone, where the model is stratified according to traffic load. Among the nine analyzed pavement types, stone mastic had the longest expected lifetime, 32 percent longer than asphalt concrete. Among road types, ordinary roads with cable barriers had 30 percent shorter lifetime than ordinary roads. Increased speed lowered the lifetime, while increased stone size (up to 20 mm) and increased road width lengthened the lifetime. The results are of importance for life cycle cost analysis and road management.

Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil

CONTEXTO E OBJETIVO: Gestações complicadas pelo diabetes estão associadas com aumento de complicações maternas e neonatais. Os custos hospitalares aumentam de acordo com a assistência prestada. O objetivo foi calcular o custo-benefício e a taxa de rentabilidade social da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes ou com hiperglicemia leve. DESENHO do ESTUDO: Estudo prospectivo, observacional, quantitativo, realizado em hospital universitário, sendo incluídas todas as gestantes com diabetes pregestacional e gestacional ou com hiperglicemia leve que não desenvolveram intercorrências clínicas na gestação e que tiveram parto no Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (HC-FMB-Unesp). MÉTODOS: Trinta gestantes tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta e insulina foram abordadas com hospitalizações curtas e frequentes. Foram obtidos custos diretos (pessoal, material e exames) e indiretos (despesas gerais) a partir de dados contidos no prontuário e no sistema de custo por absorção do hospital e posteriormente calculado o custo-benefício. RESULTADOS: O sucesso do tratamento das gestantes diabéticas evitou o gasto de US$ 1.517,97 e US$ 1.127,43 para pacientes hospitalizadas e ambulatoriais, respectivamente. O custo-benefício da atenção hospitalizada foi US$ 143.719,16 e ambulatorial, US$ 253.267,22, com rentabilidade social 1,87 e 5,35 respectivamente. CONCLUSÃO: A análise árvore de decisão confirma que o sucesso dos tratamentos elimina custos no hospital. A relação custo-benefício indicou que o tratamento ambulatorial é economicamente mais vantajoso do que a hospitalização. A rentabilidade social de ambos os tratamentos foi maior que 1, indicando que ambos os tipos de atendimento à gestante diabética têm benefício positivo.

CPITN: time and cost estimates for periodontal prevention and treatment procedures.

The aim of this study was to estimate the necessary time and cost for periodontal prevention and treatment in a working population from sugar and alcohol refineries in Araraquara, SP, Brazil. A stratified sample of 528 employees aged 18-64 from administrative, industrial and agricultural staffs was examined by one examiner, previously trained, according to the community periodontal index of treatment needs (CPITN). The time required for procedures and the cost was extrapolated to the total worker population. The results showed that the estimated time required for periodontal prevention/treatment was 4527 hours. Of this time, 1783 hours were required for oral hygiene instruction, 2531 for scaling, 151 for surgery and 62 for maintenance. The cost would be US $17,655 for hiring a dentist for 8 hours/day to provide oral hygiene instruction, scaling, surgery and maintenance. However, the cost would be US $9,028 for hiring a dentist for 4 hours/day to provide surgery and maintenance and a dental hygienist for 8 hours/day to provide scaling and oral hygiene instruction. Taking into account epidemiologic, technical and economic aspects, the decision relating to manpower should be this second option.

Analysis of the effect of wash water reduction on bleached pulp characteristics

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The Economics of Threatened Species Conservation: A Review and Analysis

Stabilizing human population size and reducing human-caused impacts on the environment are keys to conserving threatened species (TS). Earth's human population is ~ 7 billion and increasing by ~ 76 million per year. This equates to a human birth-death ratio of 2.35 annually. The 2007 Red List prepared by the International Union for Conservation of Nature and Natural Resources (IUCN) categorized 16,306 species of vertebrates, invertebrates, plants, and other organisms (e.g., lichens, algae) as TS. This is ~ 1 percent of the 1,589,161 species described by IUCN or ~ 0.0033 percent of the believed 5,000,000 total species. Of the IUCN’s described species, vertebrates comprised relatively the most TS listings within respective taxonomic categories (5,742 of 59,811), while invertebrates (2,108 of 1,203,175), plants (8,447 of 297,326), and other species (9 of 28,849) accounted for minor class percentages. Conservation economics comprises microeconomic and macroeconomic principles involving interactions among ecological, environmental, and natural resource economics. A sustainable-growth (steady-state) economy has been posited as instrumental to preserving biological diversity and slowing extinctions in the wild, but few nations endorse this approach. Expanding growth principles characterize most nations' economic policies. To date, statutory fine, captive breeding cost, contingent valuation analysis, hedonic pricing, and travel cost methods are used to value TS in economic research and models. Improved valuation methods of TS are needed for benefit-cost analysis (BCA) of conservation plans. This Chapter provides a review and analysis of: (1) the IUCN status of species, (2) economic principles inherent to sustainable versus growth economies, and (3) methodological issues which hinder effective BCAs of TS conservation.

A comparative analysis of outpatient costs in HIV treatment programs

OBJECTIVE: To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems. METHODS: A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars. RESULTS: Annual cost of HIV outpatient treatment for the Brazilian national public program was US$ 2,572.92 in 2006 in São Paulo, ranging from US$ 1,726.19 for patients with CD4 cell count > 500 to US$ 3,693.28 for patients with 51 < CD4 cell count < 200. Antiretrovirals (ARVs) represented approximately 62.0% of annual HIV outpatient costs. Comparing among different health systems during the same period, HIV outpatient treatment presented higher costs in countries where HIV treatment is provided by the private sector. CONCLUSION: The main cost drivers of HIV outpatient treatment in different health systems were: ARVs, other medications, health professional services, and diagnostic exams. Nevertheless, the magnitude of cost drivers varied among HIV outpatient treatment programs due to health system efficiency. The data presented may be a valuable tool for public policy evaluation of HIV treatment programs worldwide.

Cost-effectiveness of universal prophylaxis in pregnancy with prior group B streptococci colonization.

OBJECTIVE: To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy. STUDY DESIGN: A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis. RESULTS: When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8,805 versus $12,710). CONCLUSION: Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.