Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

Objectives: In contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany. Methods: To assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a “World with ClosureFast” with a “World without ClosureFast” over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic). Results: In the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters. Conclusions: Results of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance.

How ecotourism works at the community-level : the case of whale-watching in the Azores

Whale-watching is one of the fastest growing tourism industries worldwide, often viewed as a sustainable, non-consumptive strategy for the benefits of cetacean conservation and the coastal communities, alternative to and incompatible with whaling. Yet, there is paucity of research on how things actually work out at the community-level. Drawing on the research literature and my own ethnographic fieldwork, this article bridges a knowledge gap in this field while examining an Azorean context where tourism has brought a re-commodification of the whale for the community (observing wildlife as opposed to harpooning it) in the last 20 years. The analysis is focused on four main community-level implications: governance of common maritime resources, and tourism's contribution to economic sustainability, cultural identity and social relations. It is shown that whale-watching, as any other form of community-based ecotourism, is not a panacea that always promotes biodiversity conservation and economic and sociocultural sustainability for the host communities. Moreover, expanding on the theorisation of emerging institutional fields by Lawrence and Phillips, the political, historical, economic and sociocultural context of the community involved is a key factor for understanding local agency and the local specific features of new fields.

A proposed impact assessment method for genetically modified plants (AS-GMP Method).

An essential step in the development of products based on biotechnology is an assessment of their potential economic impacts and safety, including an evaluation of the potential impact of transgenic crops and practices related to their cultivation on the environment and human or animal health. The purpose of this paper is to provide an assessment method to evaluate the impact of biotechnologies that uses quantifiable parameters and allows a comparative analysis between conventional technology and technologies using GMOs. This paper introduces amethod to performan impact analysis associatedwith the commercial release and use of genetically modified plants, the Assessment SystemGMPMethod. The assessment is performed through indicators that are arranged according to their dimension criterion likewise: environmental, economic, social, capability and institutional approach. To perform an accurate evaluation of the GMP specific indicators related to genetic modification are grouped in common fields: genetic insert features, GMplant features, gene flow, food/feed field, introduction of the GMP, unexpected occurrences and specific indicators. The novelty is the possibility to include specific parameters to the biotechnology under assessment. In this case by case analysis the factors ofmoderation and the indexes are parameterized to perform an available assessment.

Modeling object identification and tracking errors on image-based safety assessment of earthmoving operations

Object identification and tracking have become critical for automated on-site construction safety assessment. The primary objective of this paper is to present the development of a testbed to analyze the impact of object identification and tracking errors caused by data collection devices and algorithms used for safety assessment. The testbed models workspaces for earthmoving operations and simulates safety-related violations, including speed limit violations, access violations to dangerous areas, and close proximity violations between heavy machinery. Three different cases were analyzed based on actual earthmoving operations conducted at a limestone quarry. Using the testbed, the impacts of device and algorithm errors were investigated for safety planning purposes.

Recognising the capacities of dynamic reconfiguration for the QoS assurance of running systems in concurrent and parallel environments

Recognizing the impact of reconfiguration on the QoS of running systems is especially necessary for choosing an appropriate approach to dealing with dynamic evolution of mission-critical or non-stop business systems. The rationale is that the impaired QoS caused by inappropriate use of dynamic approaches is unacceptable for such running systems. To predict in advance the impact, the challenge is two-fold. First, a unified benchmark is necessary to expose QoS problems of existing dynamic approaches. Second, an abstract representation is necessary to provide a basis for modeling and comparing the QoS of existing and new dynamic reconfiguration approaches. Our previous work [8] has successfully evaluated the QoS assurance capabilities of existing dynamic approaches and provided guidance of appropriate use of particular approaches. This paper reinvestigates our evaluations, extending them into concurrent and parallel environments by abstracting hardware and software conditions to design an evaluation context. We report the new evaluation results and conclude with updated impact analysis and guidance.

Transfer pricing and multinational financial institutions : the case for replacing arm’s length price with a unitary approach

The international tax system, designed a century ago, has not kept pace with the modern multinational entity rendering it ineffective in taxing many modern businesses according to economic activity. One of those modern multinational entities is the multinational financial institution (MNFI). The recent global financial crisis provides a particularly relevant and significant example of the failure of the current system on a global scale. The modern MNFI is increasingly undertaking more globalised and complex trading operations. A primary reason for the globalisation of financial institutions is that they typically ‘follow-the-customer’ into jurisdictions where international capital and international investors are required. The International Monetary Fund (IMF) recently reported that from 1995-2009, foreign bank presence in developing countries grew by 122 per cent. The same study indicates that foreign banks have a 20 per cent market share in OECD countries and 50 per cent in emerging markets and developing countries. Hence, most significant is that fact that MNFIs are increasingly undertaking an intermediary role in developing economies where they are financing core business activities such as mining and tourism. IMF analysis also suggests that in the future, foreign bank expansion will be greatest in emerging economies. The difficulties for developing countries in applying current international tax rules, especially the current traditional transfer pricing regime, are particularly acute in relation to MNFIs, which are the biggest users of tax havens and offshore finance. This paper investigates whether a unitary taxation approach which reflects economic reality would more easily and effectively ensure that the profits of MNFIs are taxed in the jurisdictions which give rise to those profits. It has previously been argued that the uniqueness of MNFIs results in a failure of the current system to accurately allocate profits and that unitary tax as an alternative could provide a sounder allocation model for international tax purposes. This paper goes a step further, and examines the practicalities of the implementation of unitary taxation for MNFIs in terms of the key components of such a regime, along with their their implications. This paper adopts a two-step approach in considering the implications of unitary taxation as a means of improved corporate tax coordination which requires international acceptance and agreement. First, the definitional issues of the unitary MNFI are examined and second, an appropriate allocation formula for this sector is investigated. To achieve this, the paper asks first, how the financial sector should be defined for the purposes of unitary taxation and what should constitute a unitary business for that sector and second, what is the ‘best practice’ model of an allocation formula for the purposes of the apportionment of the profits of the unitary business of a financial institution.

Revised benefits and costs of eradicating the red imported fire ant

The paper revisits estimates of cost/benefit for eradication in Australia provided in 2001 which were based largely on information about a US ecosystem. The study had two major components; spread modelling using a cellular automation model provided by Joe Scanlan and an impact analysis undertaken by the remaining authors. The revised figures provided in this study increased the damage estimate from $2.8 billion to $45 billion and the benefit-cost ratio of eradication efforts improved from 25:1 to 390:1.

Custo-efetividade do tratamento da infecção pelo vírus da hepatite C em candidatos a transplante renal submetidos à diálise

O estudo tem como objetivo geral avaliar a razão de custo-utilidade do tratamento da infecção pelo vírus da hepatite C (VHC) em pacientes dialisados, candidatos a transplante renal, tendo como esquemas terapêuticos alternativos o interferon-_ em monoterapia; o interferon peguilado em monoterapia; o interferon-_ em terapia combinada com ribavirina e o interferon peguilado em terapia combinada com ribavirina, comparando-os com o nãotratamento. A perspectiva do estudo foi a do Sistema Único de Saúde(SUS), que também serviu de base para estimar o impacto orçamentário da estratégia de tratamento mais custo efetiva. Para o alcance dos objetivos, foi construído um modelo de Makov para simulação de custos e resultados de cada estratégia avaliada. Para subsidiar o modelo, foi realizada uma revisão de literatura, a fim de definir os estados de saúde relacionados à infecção pelo vírus da hepatite C em transplantados e a probabilidade de transição entre os estados. Medidas de utilidade foram derivadas de consultas a especialistas. Os custos foram derivados da tabela de procedimentos do SUS. Os resultados do estudo demonstraram que o tratamento da infecção pelo VHC antes do transplante renal é mais custo-efetivo que o não tratamento, apontando o interferon-a como a melhor opção. O impacto orçamentário para adoção dessa estratégia pelo SUS corresponde a 0,3% do valor despendido pelo SUS com terapia renal substitutiva ao longo do ano de 2007.

Racionalidade e otimização regulatórias: um estudo a partir da teoria das falhas de regulação

A presente dissertação procura investigar o incremento da racionalidade regulatória (ou otimização regulatória) a partir da teoria das falhas de regulação. Hoje, já parece existir um consenso teórico e prático de que a regulação e seu aparato institucional as agências reguladoras constituem fenômeno irreversível. Nesse contexto, as perguntas que se colocam são as seguintes: no plano dos resultados, o Estado Regulador tem alcançado as finalidades a que se propôs? Em caso negativo, que tipo de obstáculos o tem impedido? E mais: que providências devem ser adotadas para superá-los? Responder a tais indagações depende do reconhecimento de que não apenas os mercados são imperfeitos; também a intervenção estatal na economia gera riscos e efeitos negativos. Estudar seus tipos, suas fontes e a maneira como operam é o ponto de partida para se otimizar a regulação. O trabalho propõe uma sistematização das espécies de falhas regulatórias, baseada na proposta de Cass Sunstein, mas adaptada à realidade brasileira. A exposição é precedida de explicações introdutórias sobre o conceito de regulação; as razões para se regular; e características da regulação no Estado Democrático de Direito. Tais características conformam um ideal de racionalidade regulatória, o qual é comprometido pela instauração das falhas de regulação. Reconhecer a existência dos defeitos regulatórios e conhecê-los é já um primeiro passo para se melhorar a regulação. Mas há outros encaminhamentos deveras importantes para a prevenção e correção de falhas regulatórias. Dentre eles, destaca-se um conjunto de reformas institucionais em sentido amplo e estrito, as quais envolvem o sistema de controle pelos Poderes Legislativo, Executivo e Judiciário, e mecanismos procedimentais como a análise de impacto regulatório e a elaboração de agendas regulatórias.

Simplified Formulae for the Estimation of Offshore Wind Turbines Clutter on Marine Radars

The potential impact that offshore wind farms may cause on nearby marine radars should be considered before the wind farm is installed. Strong radar echoes from the turbines may degrade radars' detection capability in the area around the wind farm. Although conventional computational methods provide accurate results of scattering by wind turbines, they are not directly implementable in software tools that can be used to conduct the impact studies. This paper proposes a simple model to assess the clutter that wind turbines may generate on marine radars. This method can be easily implemented in the system modeling software tools for the impact analysis of a wind farm in a real scenario.

Custo-efetividade da Terapia Tripla para pacientes adultos portadores do genótipo 1 da hepatite C crônica.

As ações de prevenção, diagnóstico e tratamento da hepatite C crônica integram as agendas das políticas de saúde do Brasil e do mundo, pois se trata de uma doença com grande número de acometidos, com alto custo tratamento e que ocasiona graves desfechos e incapacidade, o que acaba por onerar seu custo social. Os protocolos clínicos e diretrizes terapêuticas demonstram os esforços de inúmeras entidades no combate da hepatite C, pois informam aos profissionais de saúde, pacientes e familiares e cidadãos em geral, qual seria a melhor forma, comprovada cientificamente, de se proceder frente a uma infecção desta natureza. Realizouse uma análise de custoefetividade, sob a perspectiva do SUS, das estratégias: tratamento e retratamento com a terapia dupla, tratamento com a terapia dupla e retratamento com a terapia tripla e tratamento com a terapia tripla. Através de modelo de simulação baseado em cadeias Markov foi criada uma coorte hipotética de 1000 indivíduos adultos, acima de 40 anos, de ambos os sexos, sem distinção declasse socioeconômica, com diagnóstico confirmado para hepatite C crônica, monoinfectados pelo genótipo 1 do VHC e com ausência de comorbidades. A simulação foi iniciada com todos os indivíduos portando a forma mais branda da doença, tida como a classificação histológica F0 ou F1 segundo a escala Metavir. Os resultados demonstram que as duas opções, ou seja, a terapia dupla/tripla e a terapia tripla estão abaixo do limiar de aceitabilidade para incorporação de tecnologia proposto pela OMS (2012) que é de 72.195 (R$/QALY) (IBGE, 2013; WHO, 2012). Ambas são custoefetivas, visto que o ICER da terapia dupla/tripla em relação alinha de base foi de 7.186,3 (R$/QALY) e o da terapia tripla foi de 59.053,8 (R$/QALY). Entretanto o custo incremental de terapia tripla em relação à dupla/tripla foi de 31.029 e a efetividade incremental foi de 0,52. Em geral, quando as intervenções analisadas encontramse abaixo do limiar, sugerese a adoção do esquema de maior efetividade. A terapia tripla, apesar de ter apresentado uma efetividade um pouco acima da terapia dupla/tripla, apresentou custo muito superior. Assim, como seria coerente a adoção de uma ou da outra para utilização no SUS, visto que este sistema apresenta recursos limitados, indicase a realização de um estudo de impacto orçamentário para obterse mais um dado de embasamento da decisão e assim poder apoiar o protocolo brasileiro existente ou sugerir a confecção de novo documento.

Economic valuation of natural resources: a handbook for coastal resource policymakers

Professionals who are responsible for coastal environmental and natural resource planning and management have a need to become conversant with new concepts designed to provide quantitative measures of the environmental benefits of natural resources. These amenities range from beaches to wetlands to clean water and other assets that normally are not bought and sold in everyday markets. At all levels of government — from federal agencies to townships and counties — decisionmakers are being asked to account for the costs and benefits of proposed actions. To non-specialists, the tools of professional economists are often poorly understood and sometimes inappropriate for the problem at hand. This handbook is intended to bridge this gap. The most widely used organizing tool for dealing with natural and environmental resource choices is benefit-cost analysis — it offers a convenient way to carefully identify and array, quantitatively if possible, the major costs, benefits, and consequences of a proposed policy or regulation. The major strength of benefit-cost analysis is not necessarily the predicted outcome, which depends upon assumptions and techniques, but the process itself, which forces an approach to decision-making that is based largely on rigorous and quantitative reasoning. However, a major shortfall of benefit-cost analysis has been the difficulty of quantifying both benefits and costs of actions that impact environmental assets not normally, nor even regularly, bought and sold in markets. Failure to account for these assets, to omit them from the benefit-cost equation, could seriously bias decisionmaking, often to the detriment of the environment. Economists and other social scientists have put a great deal of effort into addressing this shortcoming by developing techniques to quantify these non-market benefits. The major focus of this handbook is on introducing and illustrating concepts of environmental valuation, among them Travel Cost models and Contingent Valuation. These concepts, combined with advances in natural sciences that allow us to better understand how changes in the natural environment influence human behavior, aim to address some of the more serious shortcomings in the application of economic analysis to natural resource and environmental management and policy analysis. Because the handbook is intended for non-economists, it addresses basic concepts of economic value such as willingness-to-pay and other tools often used in decision making such as costeffectiveness analysis, economic impact analysis, and sustainable development. A number of regionally oriented case studies are included to illustrate the practical application of these concepts and techniques.

Marine eutrophication review. Part 1: Quantifying the effects of nitrogen enrichment on phytoplankton in coastal ecosystems; Part 2: Bibliography with abstracts

Professionals who are responsible for coastal environmental and natural resource planning and management have a need to become conversant with new concepts designed to provide quantitative measures of the environmental benefits of natural resources. These amenities range from beaches to wetlands to clean water and other assets that normally are not bought and sold in everyday markets. At all levels of government — from federal agencies to townships and counties — decisionmakers are being asked to account for the costs and benefits of proposed actions. To non-specialists, the tools of professional economists are often poorly understood and sometimes inappropriate for the problem at hand. This handbook is intended to bridge this gap. The most widely used organizing tool for dealing with natural and environmental resource choices is benefit-cost analysis — it offers a convenient way to carefully identify and array, quantitatively if possible, the major costs, benefits, and consequences of a proposed policy or regulation. The major strength of benefit-cost analysis is not necessarily the predicted outcome, which depends upon assumptions and techniques, but the process itself, which forces an approach to decision-making that is based largely on rigorous and quantitative reasoning. However, a major shortfall of benefit-cost analysis has been the difficulty of quantifying both benefits and costs of actions that impact environmental assets not normally, nor even regularly, bought and sold in markets. Failure to account for these assets, to omit them from the benefit-cost equation, could seriously bias decisionmaking, often to the detriment of the environment. Economists and other social scientists have put a great deal of effort into addressing this shortcoming by developing techniques to quantify these non-market benefits. The major focus of this handbook is on introducing and illustrating concepts of environmental valuation, among them Travel Cost models and Contingent Valuation. These concepts, combined with advances in natural sciences that allow us to better understand how changes in the natural environment influence human behavior, aim to address some of the more serious shortcomings in the application of economic analysis to natural resource and environmental management and policy analysis. Because the handbook is intended for non-economists, it addresses basic concepts of economic value such as willingness-to-pay and other tools often used in decision making such as costeffectiveness analysis, economic impact analysis, and sustainable development. A number of regionally oriented case studies are included to illustrate the practical application of these concepts and techniques.

Digital elevation models and GIS for watershed modelling and flood prediction-A case study of Accra Ghana

Geographical Information Systems (GIS) and Digital Elevation Models (DEM) can be used to perform many geospatial and hydrological modelling including drainage and watershed delineation, flood prediction and physical development studies of urban and rural settlements. This paper explores the use of contour data and planimetric features extracted from topographic maps to derive digital elevation models (DEMs) for watershed delineation and flood impact analysis (for emergency preparedness) of part of Accra, Ghana in a GIS environment. In the study two categories of DEMs were developed with 5 m contour and planimetric topographic data; bare earth DEM and built environment DEM. These derived DEMs were used as terrain inputs for performing spatial analysis and obtaining derivative products. The generated DEMs were used to delineate drainage patterns and watershed of the study area using ArcGIS desktop and its ArcHydro extension tool from Environmental Systems Research Institute (ESRI). A vector-based approach was used to derive inundation areas at various flood levels. The DEM of built-up areas was used as inputs for determining properties which will be inundated in a flood event and subsequently generating flood inundation maps. The resulting inundation maps show that about 80% areas which have perennially experienced extensive flooding in the city falls within the predicted flood extent. This approach can therefore provide a simplified means of predicting the extent of inundation during flood events for emergency action especially in less developed economies where sophisticated technologies and expertise are hard to come by. © 2009 Springer Netherlands.

Digital Elevation Models and GIS for watershed modelling and flood prediction - A case study of Accra Ghana

Geographical Information Systems (GIS) and Digital Elevation Models (DEM) can be used to perform many geospatial and hydrological modelling including drainage and watershed delineation, flood prediction and physical development studies of urban and rural settlements. This paper explores the use of contour data and planimetric features extracted from topographic maps to derive digital elevation models (DEMs) for watershed delineation and flood impact analysis (for emergency preparedness) of part of Accra, Ghana in a GIS environment. In the study two categories of DEMs were developed with 5 m contour and planimetric topographic data; bare earth DEM and built environment DEM. These derived DEMs were used as terrain inputs for performing spatial analysis and obtaining derivative products. The generated DEMs were used to delineate drainage patterns and watershed of the study area using ArcGIS desktop and its ArcHydro extension tool from Environmental Systems Research Institute (ESRI). A vector-based approach was used to derive inundation areas at various flood levels. The DEM of built-up areas was used as inputs for determining properties which will be inundated in a flood event and subsequently generating flood inundation maps. The resulting inundation maps show that about 80% areas which have perennially experienced extensive flooding in the city falls within the predicted flood extent. This approach can therefore provide a simplified means of predicting the extent of inundation during flood events for emergency action especially in less developed economies where sophisticated technologies and expertise are hard to come by. © Springer Science + Business Media B.V. 2009.