This study was to examine whether the Manitoba Provincial Health Contact program for congestive heart failure is cost-effective and/or cost-benefit intervention relative to the standard treatment. The benefit-cost ratio was calculated in terms of the program cost and the cost savings from averted healthcare visits in order to determine whether the program would pay for itself. Then I conducted a cost-effectiveness study in which outcomes were measured in terms of QALYs derived from the SF-36. Bootstrap-resampled incremental cost-effectiveness ratios were computed to allow us to take into account the uncertainty related to small sample size. This intervention program generated a net saving of $28,307. The cost-effectiveness analysis suggests that the Health Lines intervention can generate an additional QALY for $26,486 and Health Line plus Monitoring for $70,266. The findings demonstrate that the Health Lines strategy for congestive heart failure holds great promise.

This study was to examine whether the Manitoba Provincial Health Contact program for congestive heart failure is cost-effective and/or cost-benefit intervention relative to the standard treatment. The benefit-cost ratio was calculated in terms of the program cost and the cost savings from averted healthcare visits in order to determine whether the program would pay for itself. Then I conducted a cost-effectiveness study in which outcomes were measured in terms of QALYs derived from the SF-36. Bootstrap-resampled incremental cost-effectiveness ratios were computed to allow us to take into account the uncertainty related to small sample size. This intervention program generated a net saving of $28,307. The cost-effectiveness analysis suggests that the Health Lines intervention can generate an additional QALY for $26,486 and Health Line plus Monitoring for $70,266. The findings demonstrate that the Health Lines strategy for congestive heart failure holds great promise.

Gasification is a thermo-chemical process which transforms biomass into valuable synthesis gas. Integrated with a biorefinery it can address the facility’s residue handling challenges and input demands. A number of feedstock, technology, oxidizer and product options are available for gasification along with combinations thereof. The objective of this work is to create a systematic method for optimizing the design of a residual biomass gasification unit. In detail, this work involves development of an optimization superstructure, creation of a biorefining scenario, process simulation, equipment sizing & costing, economic evaluation and optimization. The superstructure accommodates different feedstocks, reactor technologies, syngas cleaning options and final processing options. The criterion for optimization is annual worth. A biorefining scenario for the production of renewable diesel fuel from seed oil is developed; gasification receives the residues from this biorefinery. Availability of Soybeans, Jatropha, Chinese Tallow and woody biomass material is set by land use within a 50-mile radius. Four reactor technologies are considered, based on oxidizer type and operating pressure, along with three syngas cleaning methods and five processing options. Results show that residual gasification is profitable for large-scale biorefineries with the proper configuration. Low-pressure air gasification with filters, water-gas shift and hydrogen separation is the most advantageous combination of technology and product with an annual worth of $9.1 MM and a return on investment of 10.7 percent. Low-pressure air gasification with filters and methanol synthesis is the second most advantageous combination with an annual worth of $9.0 MM. Gasification is more economic for residue processing than combustion or disposal, and it competes well with natural gas-based methanol synthesis. However, it is less economic than steam-methane reforming of natural gas to hydrogen. Carbon dioxide credits contribute to profitability, affecting some configurations more than others. A carbon dioxide credit of $33/t makes the process competitive with conventional oil and gas development. Sensitivity analysis demonstrates a 10 percent change in hydrogen or electricity price results in a change to the optimal configuration of the unit. Accurate assessment of future commodity prices is critical to maximizing profitability.

This work studies the development of polymer membranes for the separation of hydrogen and carbon monoxide from a syngas produced by the partial oxidation of natural gas. The CO product is then used for the large scale manufacture of acetic acid by reaction with methanol. A method of economic evaluation has been developed for the process as a whole and a comparison is made between separation of the H2/CO mixture by a membrane system and the conventional method of cryogenic distillation. Costs are based on bids obtained from suppliers for several different specifications for the purity of the CO fed to the acetic acid reactor. When the purity of the CO is set at that obtained by cryogenic distillation it is shown that the membrane separator offers only a marginal cost advantage. Cost parameters for the membrane separation systems have been defined in terms of effective selectivity and cost permeability. These new parameters, obtained from an analysis of the bids, are then used in a procedure which defines the optimum degree of separation and recovery of carbon monoxide for a minimum cost of manufacture of acetic acid. It is shown that a significant cost reduction is achieved with a membrane separator at the optimum process conditions. A method of "targeting" the properties of new membranes has been developed. This involves defining the properties for new (hypothetical -yet to be developed) membranes such that their use for the hydrogen/carbon monoxide separation will produce a reduced cost of acetic acid manufacture. The use of the targeting method is illustrated in the development of new membranes for the separation of hydrogen and carbon monoxide. The selection of polymeric materials for new membranes is based on molecular design methods which predict the polymer properties from the molecular groups making up the polymer molecule. Two approaches have been used. One method develops the analogy between gas solubility in liquids and that in polymers. The UNIFAC group contribution method is then used to predict gas solubility in liquids. In the second method the polymer Permachor number, developed by Salame, has been correlated with hydrogen and carbon monoxide permeabilities. These correlations are used to predict the permeabilities of gases through polymers. Materials have been tested for hydrogen and carbon monoxide permeabilities and improvements in expected economic performance have been achieved.

Objective – To evaluate the correlation of sows removing genotype and farm conditions on the reproduction indicators. Research goals: 1. To analyse genotype and farm conditions influence to researching reproductions indicators of the sows; 2. To evaluate the influence of sows removing genotype and farm conditions on the reproduction indicators; 3. To evaluate removals reasons correlation with sows reproductions indicators. Research methods: The aim of the study was to evaluate how parameters of lifetime productivity differ for females having distinct removal reasons and was to describe the reasons for removal of sows distributed across parity categories data analysis was done with Microsoft Excel 2000 program. We have calculated research attribute medium values and bias (SE). Using general linear model we have investigated (genotype, farm and condeming reasons) fact influens for research reproduction index. Reproduction problems and diseases represented two third of all removals. Too early sows removing is one of the determinative factor which decreasing pigs drove reproduction and farm profitability.

Background Pulmonary diseases are the leading causes of mortality globally amongst children under five years of age. Economic evaluations (EEs) guide decision-makers on which health care intervention to adopt to reduce paediatric pulmonary disease burden. Methods We systematically reviewed EEs for paediatric pulmonary diseases published globally between 2010 and 2020. We searched PubMed, Web of Science, MEDLINE, Paediatric Economic Database Evaluation (PEDE), and the Cochrane library. EEs included were specific to paediatric pulmonary diseases in a hospital setting and of children aged from zero to six years old. We extracted data items guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. We collected qualitative and quantitative data which we analysed in Microsoft Excel and R Software. Results 22 studies met the inclusion criteria. Seven of the articles were cost-effectiveness analyses, five cost-utility analyses, two cost-minimisation analyses, and eight cost analyses. Fourteen studies were conducted in high-income countries, eight in low-middle-income countries (LMICs). Ten studies were on asthma, nine on pneumonia, two on asthma and pneumonia, and one on tuberculosis. Quality assessment of the articles revealed some methodological inconsistencies across the articles. Conclusion Fewer EEs were conducted in LMICs, yet children from these countries are disproportionately affected by pulmonary diseases. Developing standardised methods for EEs and conducting more EEs and for paediatric pulmonary diseases in LMICs could allow for more evidence-based decision-making.

Each year approximately 7,500 low-income Virginia families are enrolled in the Expanded Food and Nutrition Education Program (EFNEP), administered through the Virginia Cooperative Extension (VCE). Chronic disease and health conditions cost society an estimated $250 billion each year in medical charges and lost productivity. It has been assumed that the numerous diet and food-related changes made by EFNEP participants will lead to a reduction in the risk of chronic disease among homemakers, and perhaps, other family members. Thus, the improved diets and behaviors resulting from EFNEP participation may result in substantial future savings in healthcare costs among participants. This study explores the possibility of potential economic benefits for the Virginia EFNEP participants. In 1996, the Virginia Cooperative Extension was awarded a grant from the Cooperative State, Research, Education, and Extension Service, United States Department of Agriculture (CSREES, USDA) to conduct a cost-benefit study of EFNEP in Virginia. Though computation of the cost-benefit ratio for the Virginia adult EFNEP includes both direct and indirect benefits, this study addressed only the assessment of the direct tangible benefits based on the savings from economic costs of avoided diseases. Existing EFNEP data for the 1996 fiscal year was used to identify optimal nutritional behaviors that can delay or prevent the onset of certain chronic diseases and health conditions. The economic costs of diseases were identified from scientific literature and translated as potential benefits. The administration costs of EFNEP were also compiled. The total direct tangible benefit for the diseases and conditions identified was estimated to be $17,770,722. Along with the indirect tangible benefits ($321,462), the total tangible benefits for the Virginia EFNEP was calculated to be $18,092,184. The direct tangible costs associated with the Virginia EFNEP in 1996 was $1,922,204. The benefit-cost ratio for the Virginia EFNEP for the 1996 fiscal year for the subset of the population practicing the optimal nutritional behaviors is calculated at $9.41/$1.00 (a $9.41 return for every $1 invested in EFNEP in Virginia). Also, a benefit of $2.45 to $1.00 was calculated when only 25% of those participants practicing optimal nutritional behaviors were assumed retain these behaviors through life. For a program of the magnitude of EFNEP, these results are very gratifying. / Ph. D.

The aim of this thesis is to explore methods to incorporate external effects on decision making of public health programmes in a UK setting, using smoking cessation as an example. The National Institute for Health and Clinical Excellence (NICE) methodological guidance for evaluating public health programmes is missing the incorporation of external effects. Therefore there is a need for considering their incorporation in such evaluations and to assess what are the appropiate methods to do so. Smoking cessation is an example where epidemiological evidence of external effects exists but has not generally been incorporated into economic evaluation. This thesis therefore focused in measuring the impact, in terms of costs and QALYs lost, of the incorporation of passive smoking, smoking during pregnancy and transmission of smoking behavior into economic evaluation of smoking cessation programmes previously developed to inform policy. A static Markov model is used to incorporate passive smoking and smoking during pregnancy, whereas transmisison of smoking behaviour is incorporated through a dynamic model. The findings show that some external effects can be incorporated without a system dynamic model, when this does occur, a static Markov model may be used to account for external effects in economic evaluation. Sometimes, to incorporate external effects, the model needs a change of population. Because smoking cessation interventions are generally highly cost-effective, the incorporation of external effects does not appear to change policy decisions, but there is a clear impact on the magnitude of the ICER. Passive smoking and smoking during pregnancy have higher impact in terms of costs and QALYs lost than transmission of smoking behaviour. Our discussion considers the validity of the methods used; how much the decision making process would be affected considering or not external effects on economic evaluation of smoking cessation interventions; and other valuation approaches for external effects, such as contingent valuation.

The focus of this thesis is economic evaluations of programs and interventions regarding children and adolescents with mental health issues, victimization, and intellectual disabilities (ID). The first paper examines a potential link between mental health issues among adolescent and the class-size of the school class they are enrolled in. The class-size and schools’ financial resources is often at the center of policy debates. Our results suggest that there is no evidence that larger classes have negative impact on the mental health for adolescents in a Swedish context. The second paper investigate the societal willingness to pay (WTP) to reduce bullying in Swedish schools. The results suggest that the tax payers WTP is about 5 SEK and the societal is about 600 000 SEK per reduced bullying victim. This value of WTP could be used as a measure to evaluate different investments in anti-bullying programs and efforts to reduce the bullying in schools. The third paper estimates the cost-effectiveness of one recently introduced antibullying program, the Finnish KiVa program, one of the few evidence based programs in the world. Based on a decision-analytic model, the results indicate that the KiVa program is a cost-effective program that has a cost per reduced victim well below the WTP as estimated in the second paper as documented above. The fourth paper evaluates, from the municipality perspective, the effects of investing in a SE program compared to “business as usual” in order to increase the likelihood for gaining regular employment for the pupils with ID. The results indicate that it takes 9 years before breakeven is reached if investing in the SE program. The fifth paper conducts a decision-analytic economic evaluation of the SE program using simulations to assess the effects over the full life-course. The results suggest that from a societal perspective the program is cost-effective ten years after the investment and by then has generated a benefit of 17 000 SEK per individual.

Telemedicine offers an alternative referral strategy for fetal cardiology but is currently only used for ‘high-risk’ pregnancies. A case-study of a cost-consequences analysis comparing telemedicine to direct referral to a perinatal cardiologist is initially presented, which highlights that for high risk women for whom telemedicine was considered no cardiac anomalies were missed using either referral method. In the light of a review of the literature on the economics of telemedicine, three of the key methodological issues (of selection bias, of patient costs and using quality-adjusted life years (QALYs)) are explored to demonstrate how the case study analysis could be improved. Pregnant women were selected for referral based on their characteristics and risk factors; thus the cost and effects for the two groups may have been biased. Various methods identified in the literature are applied to the case study to reduce selection bias, but the analysis presented is unable to determine which method is best, given a number of limitations including the small sample size. The analysis is extended to include estimated total patient costs. However, when patient costs are added to the total costs of pregnancy, they did not substantially increase the overall cost. The results presented provide a guideline for future researchers and pregnant women of the likely costs during pregnancy. Given that the majority of missed cardiac anomalies were amongst low risk women, a decision analytical model is developed looking at the lifetime costs and QALYs of introducing telemedicine screening for pregnant women whose unborn babies are at a low risk of congenital heart disease. The analysis shows that offering telemedicine to all low risk women is the dominant strategy. The thesis demonstrates, within the constraints of existing data, that it would be cost-effective to provide telemedicine as part of an antenatal screening programme for all low risk women, and this would help prevent future ‘missed anomalies’.