Cette thèse aborde la question de la fiabilité du temps de transport. L’étude de la fiabilité du temps de transport trouve ses sources dans le fait que, dans bien des situations, le temps de transport n’est pas certain, mais aléatoire. De nombreux évènements peuvent en effet modifier le temps de transport prévu par les opérateurs ou espéré par les usagers. Par ailleurs, lors de l’évaluation socioéconomique de projets d’investissement en infrastructure de transport, il peut exister un arbitrage entre gain de temps et gain de fiabilité. Or, comme la fiabilité est encore à l’heure actuelle, difficilement intégrable dans ce type d’évaluation, ces projets d’investissement voient leur rentabilité collective sous-estimée conduisant à leurs reports. Il émerge ainsi trois problématiques majeures relatives à l’étude de la fiabilité du temps de transport : sa mesure, sa valorisation monétaire (i.e. la disposition à payer des individus pour améliorer la fiabilité du temps de transport) et enfin, sa prise en compte dans les analyses coûts-avantages. Un premier chapitre permet d’adapter les mesures usuelles de la fiabilité du temps de transport appliquées dans le cadre du transport routier, aux modes de transport collectif (fer et aérien plus particulièrement). Nous proposons également une nouvelle mesure de la fiabilité, le Delay-at-Risk (DaR) inspiré de la littérature financière. Le DaR est une transposition de la mesure de la Value-at-Risk (V aR) à l’économie des transports. Cette mesure est plus utile du point de vue des usagers pour la planification des trajets avec correspondance que les autres mesures. Le deuxième chapitre a pour principal objectif de déterminer la disposition à payer des individus pour améliorer la fiabilité du temps de transport. Nous proposons un cadre théorique inspiré de la théorie de la décision en univers risqué à partir duquel nous définissons la préférence des individus à l’égard de la fiabilité (i.e. reliabilityproneness) ainsi que la prudence. Nous développons des nouvelles mesures de la fiabilité du temps de transport, exprimées comme des primes de risque : la reliability-premium et la V OR. La reliability-premium détermine le temps de transport maximum supplémentaire qu’un individu est prêt à accepter pour supprimer l’intégralité du risque sur le temps de transport. La V OR, quant à elle, se définit comme la disposition maximale à payer d’un individu pour supprimer l’intégralité du risque sur le temps de transport. Par ailleurs, nous établissons également les conséquences sur la valeur du temps (V TTS) et de la fiabilité (V OR), de la prise en considération de l’attitude à l’égard du risque sur le temps de transport des usagers (aversion et prudence). Le dernier chapitre de cette thèse a pour objet d’intégrer la fiabilité dans les évaluations socioéconomiques de projet d’investissement et plus particulièrement dans la détermination du surplus des usagers. Nous mettonsen exergue un effet de diffusion des gains de fiabilité par rapport aux gains de temps. Ainsi, nous proposons des recommandations quant à l’arbitrage entre les projets générateurs de gain de temps et de gain de fiabilité en fonction des valeurs monétaires du temps (V TTS) et de la fiabilité (V OR). / This thesis deals with the issue of travel time reliability. The study of travel time reliability emerges from the fact that in many situations, travel time is random. Many events can change the travel time forecasted by operators or expected by users. Moreover, a tradeoff may exist between time and reliability benefits when evaluating socio economic appraisal of transport infrastructure. However, since reliability is still difficult to integrate in this type of evaluation, investment projects’ collective profitability is underestimated and often postponed. Thus, three main issues of travel time reliability analysis emerge: measurement, monetary valuation and implication for cost benefit analysis. This thesis is organized in three chapters. The first chapter adapts the measure of travel time reliability typically used in the road transport context to the collective modes (rail and air, in particular). We also develop a new reliability measure: the Delay-at-Risk (DaR). DaR is an implementation of the Value-at-Risk (V aR) measure into the transport economic framework. The DaR seem to be relevant and understandable information for the users, especially to plan their travel and avoid missing their connections. The main objective of the second chapter is to define the users’ willingness to pay to improve travel time reliability. We present a theoretical framework based on decision theory under risk. We introduce the concept of reliability-proneness (i.e. travel time risk aversion) and prudence. We develop new measures of travel time reliability expressed as risk premium: the reliability-premium and V OR. The reliability-premium is the maximum amount of additional travel time that an individual is willing to accept to escape all the risk of travel time. The V OR is defined as the maximum monetary amount that an individual is willing to pay to escape all the risk of travel time. Furthermore, we also establish the link with attitudes towards risks of travel time (aversion and prudence) and the impact of the value of travel time (V TTS) and the value of reliability (V OR). The final chapter of this thesis integrates reliability in investments project’s socioeconomic appraisal. More particularly, it allows to determine users’ surplus valuation. We highlight a diffusion effect of reliability benefits with regard to travel time benefits. Thus, we propose recommendations regarding the tradeoff between projects that generate time benefits compared with reliability benefits, according to the monetary values of travel time(V TTS) and reliability (V OR).

Reducing ED wait times is a top health care priority for the Ontario government and hospitals in Ontario are incentivised to meet provincial ED wait time targets. In this study, we considered the costs and benefits associated with increasing the number of acute-care beds to reduce the time an admitted patient spends boarding in the ED. A shorter hospital LOS has often been cited as a potential benefit associated with shorter ED wait times. We derived a multivariable Cox regression model to examine this association. We found no significant association between ED boarding times and the time to discharge. Using a Markov model, we estimated an increased annual operating cost of $2.1m to meet the prescribed wait time targets. We concluded that increasing acute-care beds to reduce ED wait times would require significant funding from hospitals and would have no effect on total length of stay of hospitalized patients.

The work describes problems of creating CBA. The theoretical part of the work defines the CBA, its drawbacks and strengths. An important part of it is a different view of economic orientations to the CBA. The work also deals with the current institutional situation that determines the obligation of drawing up the CBA for the selected projects seeking public support. The aim of this work is to evaluate the production of any obligation of the CBA. For this purpose, will be used as well interviews with experts.

The goal of the diploma thesis Evaluation of the effectiveness of public projects Cost Benefit Analysis is an application of obtained theoretical knowledge from analysis of costs and benefits on specific public project the construction of water supply and sewerage system in the city Kamenice. The introduction of the theoretical part begins with the definition of public sector, public finance, public project and describes methods of evaluation of public projects. In the next chapter of the theoretical part is dedicated in detail process of Cost Benefit Analysis. The practical part of thesis is about applying Cost Benefit analysis on a specific project from area of environment Kamenice: Water supply and sewerage system. On this real project will be analyzed the costs and benefits and after this analyse it will be possible to say if applicant held a methodology of CBA and if project is beneficial for public. The methods used in developing the topic of this diploma thesis is a literary review, descriptions, analysis, interviews, results of empirical investigations and an imperical synthesis of learned facts.

Social discounting aims to compare the respective future consequences of differing courses of action for human well-being, and so to help decide on policies for matters as varied as climate change, transport and criminal justice. Social discounting is widely used, though some decisions are too trivial, or too urgent, for it to be justified. Even so, its pervasive use is at variance with scepticism about its moral foundations, and about whether the comparisons that it claims to make can be made at all. Debate has, however, concentrated on how, rather than on whether, social discounting should be done and the conditions upon which it must be based seem never to have been set out systematically. This thesis aims to fill that gap, by explaining the moral and practical conditions that must be met for social discounting to be justified. The conditions are demanding. It behoves policy makers to satisfy themselves more carefully than is now done that the conditions are met in respect of the decisions where use of social discounting is proposed, and to consider alternatives where one or more conditions is not met. The thesis takes for granted that human well-being counts morally. But social discounting requires that well-being is capable of being described through an objective list of desiderata and that some aspect of well-being is measurable, at least on a cardinal scale and inter-personally, implying commensurabilities amongst some of the things comprising or contributing to well-being. Some moral theories incorporate priorities, such as property rights or the interests of poor people. Priorities range from easy to meet to very difficult. Priorities of the latter type are inconsistent with social discounting, and are the basis for theories as varied as those of Nozick and Nussbaum. This thesis suggests that the theories consistent with social discounting may collectively be called ‘moderate welfarism’. Moderate welfarism allows room for priorities and other moral considerations provided only that the monetisable aspect of social well-being is morally important. Moderate welfarism is necessary but not sufficient for social discounting to be justifiable. Practical difficulties may make it incapable of implementation. One such difficulty is the well-known epistemic problem, but the thesis sets out nine such difficulties, each implying a condition that must be met if social discounting is to be capable of practical use. The thesis concludes that the moral and practical conditions that must be met for social discounting to be justified are demanding and, more speculatively, that some of the conditions are not widely understood leading to inappropriate use of the technique by governments.

The objective of the thesis is - with the aid of cost benefit analysis - evaluate economic impacts of planned amendment to Regulation of the Government No. 148/2006 Coll. On Health Protection from Adverse Effects of Noise and Vibration, namely based on the case of specific road track. Amendment to Regulation is aimed at making existing noise limits softer (to increase them) and thus to bring about savings in investment cost connected with anti-noise measures. The thesis intends to use a single case study to find out whether benefits resulting from price reduction in the process of road construction are higher than costs in the form of decrease of welfare caused by the higher noise exposition; alternatively at what period savings in costs connected with road construction equal to decrease in welfare (savings in costs are one-off, while increase in noise exposition and related drop in welfare are long-term). Estimated changes in welfare are based on analysis of secondary sources -- first of all on the study of traffic externalities in the Czech republic conducted by contingent valuation method. The actual core of the thesis is cost benefit analysis. Attention is paid also to broader discussion on experience in providing exceptions from noise limits in the Czech Republic.

This thesis deals with the analysis of the cost of treatment of cataracts. The intention is to compare cataract surgery by phacoemulsification by ultrasonic method and by laser method and by using a cost-benefit analysis to evaluate the effective treatment from three perspectives - patient, medical equipment and insurance. To calculate the subjective benefits of the operation the patient is using the method of VF-14, which is a tool for transferring benefits to financial units.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-17T15:08:05Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) CUSTO UTILIDADE DA INSULINA GLARGINA E NPH REV 4.pdf: 871032 bytes, checksum: 61243dd09cce2d9260cb9239a873d2ca (MD5) / Made available in DSpace on 2017-07-17T15:08:06Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) CUSTO UTILIDADE DA INSULINA GLARGINA E NPH REV 4.pdf: 871032 bytes, checksum: 61243dd09cce2d9260cb9239a873d2ca (MD5) Previous issue date: 2014-10-31 / INTRODUÇÃO: O Diabetes Mellitus é um transtorno metabólico, caracterizado por hiperglicemia. É considerada condição sensível à Atenção Primária, tendo impacto por reduzir ou retardar as complicações da doença. A reposição de insulina para o diabete mellitus tipo 2 é indicada quando somente mudanças no estilo de vida associados a hipoglicemiante oral forem insuficientes para obter controle glicêmico. OBJETIVOS: Determinar o custo-utilidade da insulina glargina e insulina NPH para o tratamento de pacientes com diabetes mellitus tipo 2 atendidos no Sistema Único de Saúde do Município de Recife – PE. MÉTODOS: Foi realizada comparação da categoria custos médicos diretos de duas intervenções terapêuticas indicadas para o tratamento do diabete mellitus tipo 2. A avaliação de custo-utilidade foi realizada a partir da perspectiva do Sistema Único de Saúde. Foi considerado um horizonte analítico de 10 anos. Os dados coletados foram de fontes secundárias, de sistema de informação em saúde, dados dos relatórios emitidos nos sistemas de informatização das Farmácias do Recife e da Farmácia do Estado de Pernambuco e fontes da literatura. Para a análise de decisão, foram consideradas as hipoglicemias noturnas e não noturnas graves e não graves. RESULTADOS: O indivíduo médio, representante de Pernambuco, apresenta 8,7 anos de diagnóstico do DM2, recebem aproximadamente 14,4 frascos de insulina NPH ou Glargina ao ano, dados estes, utilizados na probabilidade de transição. Para o cenário das complicações agudas, o custo do usuário foi calculado para 2013: sem complicação em uso da insulina NPH foi de R$ 1.237,95 e para insulina Glargina R$ 4.935,42. Foi considerado 12 episódios de hipoglicemia noturna grave ao ano. A redução de risco de hipoglicemia para pacientes em uso da insulina Glargina é de 50,9% apresentando cinco episódios ao ano. A razão de custo incremental (RCEI) do presente estudo, indica um valor agregado adicionado de R$ 12.987,4892 por AVAQ ganho a cada ano de tratamento com a insulina glargina em relação a NPH. CONCLUSÕES: Houve redução de episódio de hipoglicemia noturna grave da insulina glargina comparado com a insulina NPH. Os dados apresentados não permite afirmar qual da intervenção é mais efetiva, apenas mostra que a insulina glargina tem um maior custo-utilidade e um custo médico direto maior. Os custos incrementais e os benefícios alcançados em anos de vidas ganhos produziu uma Razão de R$ 12.987,4892 ao ano para a insulina glargina. Diante das incertezas acerca da efetividade das insulinas analisadas, faz-se necessário a realização de estudos aprofundados entre estas intervenções terapêuticas. / INTRODUCTION: Diabetes mellitus is a metabolic disorder characterized by hyperglycemia. It is considered sensitive to Primary Health Care, considering its impacting to reduce or delay complications of the disease. Replacement of insulin for diabetes mellitus type 2 is indicated only when changes in lifestyle associated with oral hypoglycemic agents are insufficient to obtain glycemic control. OBJECTIVES: To determine the cost-utility of insulin glargine and NPH insulin for the treatment of patients with type 2 diabetes mellitus treated at the Unified Health System of the Municipality of Recife - Pernambuco. METHODS: We compared the direct medical costs of category two therapeutic interventions indicated for the treatment of diabetes mellitus type 2 was performed Assessment of cost-utility analysis was performed from the perspective of the Health System was considered an analytic horizon of 10 years.. The data were collected from secondary sources of health information system data reports issued in the computerization of Pharmacies and Pharmacy Recife Pernambuco State and literature sources systems. For decision analysis, were considered nocturnal hypoglycemia and nocturnal not serious and not serious. RESULTS AND DISCUSSION: The average individual, representative of Pernambuco, has 8.7 years of diagnosis of T2DM, receive approximately 14.4 vials of NPH or glargine per year, these data are used in the transition probability. For the setting of acute complications, the user cost was calculated for 2013: Uncomplicated in use NPH insulin was R$ 1,237.95 and R$ 4,935.42 insulin glargine. Was considered 12 episodes of severe nocturnal hypoglycemia per year. The reduced risk of hypoglycemia for patients on insulin glargine is 50.9% with five episodes per year. The ratio of incremental cost (ICER) of this study, indicates a value added of R$ 12,987.4892 per QALY gained every year of treatment with insulin glargine compared to NPH. CONCLUSION: There was a reduction of severe nocturnal hypoglycemia episode of insulin glargine compared with NPH insulin. The data presented allows not say which intervention is most effective, just shows that insulin glargine has a higher utility cost and a direct medical cost higher. Incremental costs and benefits achieved gains in years of life produced a ratio of R$ 12.987,4892 year to insulin glargine. Given the uncertainties about the effectiveness of insulin analyzed, it is necessary to conduct in-depth studies of these therapeutic interventions.

The application of retrofit options to existing heritage buildings has become one of the most interesting topics in construction. In Victoria, BC, Canada, only 4% of commercial or institutional heritage buildings have been upgraded to current building codes in the last 10 years. Remaining 96% buildings exist with poor energy performance characteristics and a risk to occupant safety in the event of a damaging earthquake. This study investigates the importance and benefits of simultaneous energy and seismic retrofitting of existing heritage buildings. It presents a case study for a building with identifiable heritage value, located in Victoria, BC, Canada, and analyzes five feasible options in terms of energy retrofitting and presents a solution for both seismic and energy upgrading. To this aim, the energy retrofit options are compared based on the amount of saved energy, annual heating demand and estimated costs. The seismic solution is designed based on the weakness and needs of the building, and cost-effectiveness. Finally, the best solution is selected for a building that dates back to the beginning of the 20th century. This study shows that the integration of energy and seismic retrofitting of heritage buildings provides economic benefits to owners while improving energy savings and building safety. / Graduate / 2021-08-31

As urban greening efforts continue, it is important to assess whether decisions to intensify street tree planting are meeting intended goals of improving urban canopy cover and increasing ecosystem services. Benefits of the urban forest take many forms, from ecological and economic to social and cultural, and are frequently cited in support of street tree planting. However, it is unknown to what extent factors such as species or nursery production method affect the ability of trees to successfully establish and provide ecosystem services in the urban environment. Using a system of oak trees planted along roads in South Amherst, Massachusetts during spring 2014, growth in caliper at six inches, diameter at breast height, and total tree height from fall 2014 to fall 2018 were modeled to determine whether species and/or nursery production method influenced street tree establishment and growth. Economic benefits were examined using a novel approach, whereby the breakeven point of costs and returns in ecosystem services was identified. Results indicated that both species and nursery production method influenced the success of these trees, which provided a return on investment by year 2018, in terms of both growth and benefits provided. This information is relevant to tree wardens and others tasked with street tree planning and maintenance, who must work within the confines of limited budgets in an environment that poses many challenges for trees.