scholarly journals Does scale matter?Cost-effectiveness of agricultural nutrient abatement when target level varies

2008 ◽  
Vol 14 (3) ◽  
pp. 277 ◽  
Author(s):  
A. IHO
Keyword(s):  
Cost Effectiveness ◽  
Water Status ◽  
Cost Effective ◽  
River Basin Management ◽  
Nutrient Loss ◽  
Target Level ◽  
River Basin Management Plans ◽  
Management Plans ◽  
Alternative Measures ◽  
The Cost

Agriculture is facing stringent requirements for nutrient loss reductions. These reductions should be done cost-effectively. For instance, the European Water Framework Directive (WFD) emphasizes cost-effectiveness in reaching good water status in European river basins by 2015. River Basin Management Plans specify the eventual reduction targets, which will differ between the basins. These differences have implications on cost-effectiveness assessments: changing the level of total abatement changes the relative shares of measures in the cost-effective allocation. In this paper we develop a model which determines the cost-effective allocation of three alternative measures to reduce phosphorus loss from fields. The model allows for comparisons with cost and reductions of all possible allocations. We show that, even for homogenous regions, the cost-effective allocation of measures is strongly dependent on the target level, and that using the allocation from one reduction level as a guideline for other levels violates cost-effectiveness seriously. On the grounds of these results we give recommendations for cost-effectiveness assessments in the context of the WFD.;

scholarly journals A Hybrid Multicriteria 0/1 Programming Methodology for Prioritizing the Measures of River Basin Management Plans

Proceedings ◽  
2018 ◽  
Vol 2 (11) ◽  
pp. 624
Author(s):  
Mike Spiliotis ◽  
Charalampos Skoulikaris
Keyword(s):  
River Basin ◽  
Financial Constraints ◽  
River Basin Management ◽  
Basin Management ◽  
Programming Methodology ◽  
River Basin Management Plans ◽  
Management Plans ◽  
Water Quality Status ◽  
The Cost ◽  
Quality Status

The Programmes of Measures (PoMs) are included in the River Basin Management Plans (RBMPs). They comprise the outputs on the analysis of pressures, impacts and status of the water bodies, by designating those actions that need to be employed for the amelioration of the water quality status. In this research a methodology based on the coupling of hybrid multicriteria methods, namely outranking, in which 6 criteria and 37 alternatives are integrated, with a 0/1 linear programming in which the cost of the measures is induced as a constraint, is proposed for the prioritization of the supplementary PoMs that are included in the RBMP of Central Macedonia, Greece. The results of the research demonstrated the usefulness of the methodology when financial constraints do not permit the implementation of the whole set of measures.

Economic analysis in the process of the preparation of river basin management plans in Slovenia: the Drava River Basin pilot study

2009 ◽  
Vol 59 (2) ◽  
pp. 353-358
Author(s):  
J. Dodič ◽  
A. Bizjak
Keyword(s):  
River Basin ◽  
Water Status ◽  
Waste Water Treatment ◽  
River Basin Management ◽  
Basin Management ◽  
River Basin Management Plans ◽  
Eu Directive ◽  
Management Plans ◽  
Drava River ◽  
The Eu

According to the EU Directive 2000/60/EC (Water Framework Directive, hereinafter called: WFD), several steps have to be worked out on the way towards the good water status. For this goal, some of the main elements of the river basin management plans are the programme of measures. The programme of measures has to include basic and supplementary measures. In addition, it has to check the implementation of European Directives into the national law and has to estimate the effects of these rules on the quality of the water bodies. If these regulations are not sufficient to reach the good status of water, supplementary measures have to be applied. The paper gives an overview of how basic and supplementary measures for wastewater treatment were considered in the Drava River Basin. The main stress is given to the implementation of the EU Directive 91/271/EEC (the Urban Waste Water Treatment Directive, hereinafter called: UWWTD), as part of the basic measures as defined in Annex VI of WFD and its results in the Drava River Basin.

scholarly journals Implementing a Statewide Deficit Analysis for Inland Surface Waters According to the Water Framework Directive—An Exemplary Application on Phosphorus Pollution in Schleswig-Holstein (Northern Germany)

Water ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1365 ◽  
Author(s):  
Phuong Ta ◽  
Björn Tetzlaff ◽  
Michael Trepel ◽  
Frank Wendland
Keyword(s):  
Water Framework Directive ◽  
Water Status ◽  
Ecological Status ◽  
Essential Element ◽  
River Basin Management ◽  
Emission Model ◽  
Phosphorus Pollution ◽  
River Basin Management Plans ◽  
Management Plans ◽  
Good Ecological Status

Deficit analysis—which principally deals with the question “how big are the gaps between current water status and good ecological status?”—has become an essential element of the river basin management plans prescribed by the European Water Framework Directive (WFD). In a research project on behalf of the Ministry of Energy, Agriculture, the Environment, Nature and Digitalization Schleswig-Holstein (MELUND), a deficit analysis based on distributed results from the water balance and phosphorus emission model system GROWA-MEPhos at high spatial resolution was performed. The aim was, inter alia, to identify absolute and relative required reduction in total phosphorus at any river segment or lake within the state territory as well as to highlight significant emission sources. The results of the deficit analysis were successfully validated and show an exceedance of the phosphorus target concentrations in 60% of the analyzed subcatchments. Statewide, 269 tons of phosphorus needs to be reduced yearly, which corresponds to approximately 31% of the total emission. Detailed data as well as maps generated by the deficit analysis benefit the planning and implementation of regionally efficient measures, which are indispensable with regard to meeting the environmental quality objectives set by the WFD.

MODERN HYDROGRAPHIC AND WATER MANAGEMENT ZONING OF UKRAINE’S TERRITORY – IMPLEMENTATION OF THE WFD-2000/60/EC

2020 ◽  
Author(s):  
V.K. Khilchevskyi ◽  
Keyword(s):  
Water Management ◽  
Water Resources ◽  
River Basins ◽  
River Basin Management ◽  
The Black Sea ◽  
Main Function ◽  
River Basin Management Plans ◽  
Management Plans ◽  
The Crimea ◽  
Sea Coast

In contrast to the hydrological and hydrochemical zoning, hydrographic and water management zoning of Ukraine (2016) was created on a basin basis, taking into account the boundaries of river basins, and not physiographic zoning. The main function of hydrographic and water management zoning is water management. Primary is hydrographic zoning, and water management - based on it. The description of modern hydrographic zoning of the territory of Ukraine, approved in 2016 by the Verkhovna Rada of Ukraine and included in the Water Code of Ukraine is given. Hydrographic zoning is carried out for the development and implementation of river basin management plans. On the territory of Ukraine nine areas of river basins are allocated: Dnipro; Dnister; Danube; Southern Bug; Don; Vistula; rivers of the Crimea; rivers of the Black Sea coast; rivers of the Azov Sea coast 13 sub-basins are allocated in four river basins district. The water management zoning is described - the division of hydrographic units into water management areas, which is carried out for the development of water management balances. In the regions of the river basins in the territory of Ukraine allocated 132 water management areas, 59 of which are located in the Dnipro basin. About 9,000 bodies of surface water allocated for monitoring in Ukraine. Approved zoning is the implementation of the provisions of the EU Water Framework Directive 2000/60 / EC in the management of water resources in Ukraine. Modern hydrographic and water management zoning of the territory of Ukraine approximates the management of water resources of the state to European requirements.

scholarly journals Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 707
Author(s):  
Afifah Machlaurin ◽  
Franklin Christiaan Karel Dolk ◽  
Didik Setiawan ◽  
Tjipke Sytse van der Werf ◽  
Maarten J. Postma
Keyword(s):  
Cost Effectiveness ◽  
Univariate Analysis ◽  
Cost Effective ◽  
Epidemiological Data ◽  
Control Programme ◽  
Detection Rates ◽  
Middle Income ◽  
Bcg Vaccination ◽  
Life Years ◽  
The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

scholarly journals Cost Effectiveness of Transbronchial Needle Aspiration

1999 ◽  
Vol 6 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Jennifer A Crocket ◽  
Eric YL Wong ◽  
Dale C Lien ◽  
Khanh Gia Nguyen ◽  
Michelle R Chaput ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Benign Disease ◽  
University Hospital ◽  
High Yield ◽  
Transbronchial Needle Aspiration ◽  
Computed Tomographic ◽  
The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran

2020 ◽  
Vol 33 (4/5) ◽  
pp. 323-331
Author(s):  
Mohsen pakdaman ◽  
Raheleh akbari ◽  
Hamid reza Dehghan ◽  
Asra Asgharzadeh ◽  
Mahdieh Namayandeh
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Regular Insulin ◽  
Diabetes Control ◽  
Diabetic Patients ◽  
Insulin Analogs ◽  
Content Type ◽  
Patients With Diabetes ◽  
The Government ◽  
The Cost

PurposeFor years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.Design/methodology/approachIn this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.FindingsQALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.Originality/valueThis study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

scholarly journals Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis

1996 ◽  
Vol 3 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Afaf Girgis ◽  
Philip Clarke ◽  
Robert C Burton ◽  
Rob W Sanson—Fisher
Keyword(s):  
Cost Effectiveness ◽  
Screening Programme ◽  
Cost Effective ◽  
Economic Assessment ◽  
Screening Tests ◽  
Family Practitioners ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Primary Health Care Physicians ◽  
Melanoma Screening

Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated. Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.

Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

2021 ◽  
pp. 019459982110268
Author(s):  
Joseph R. Acevedo ◽  
Ashley C. Hsu ◽  
Jeffrey C. Yu ◽  
Dale H. Rice ◽  
Daniel I. Kwon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Submandibular Gland ◽  
Average Cost ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Probability Of Success ◽  
Markov Decision Model ◽  
The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

scholarly journals Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Obinna Ikechukwu Ekwunife ◽  
Chinelo Janefrances Ofomata ◽  
Charles Ebuka Okafor ◽  
Maureen Ugonwa Anetoh ◽  
Stephen Okorafor Kalu ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Service Delivery ◽  
Motivational Interviewing ◽  
Cost Effective ◽  
Economic Incentives ◽  
Additional Patient ◽  
Incentive Scheme ◽  
The Cost ◽  
The Impact

Abstract Background In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. Result The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. Conclusion The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

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