Due to the interdisciplinary nature of eco-labelling, the sense of the phenomenon itself is lost when studied in isolation. With this consideration, a balance of research between practical and theoretical approaches, between environmental sociology, environmental economics, international trade relations, consumer society, sustainability and marketing theory was explored. Eco-labelling has far-reaching ramifications in society, not just in the commercial relationship between producer and consumer, but in socio-cultural norms and values. It combines economic and social forces via the marketplace. The research of this paper focuses on 1) the socio-cultural aspects of eco-labelling, 2) the economic incentive which drives eco-labelling and 3) the global institutional structures which influence the eco-labelling dimension. Chapter 1 provides an overview of eco-labelling and introduces ecological modernization, the theoretical foundation of this paper. Chapter 2 is a summary of interviews which were conducted with eco-labelling managers around the world. Chapter 3 analyses the economic impact of eco-labelling, the effects on international trade and the environment, and how eco-labelling affects consumers and producers. Chapter 4 deals with the social context of eco-labelling, and the social paradigms of consumer society and sustainability, merging in the case of ecological modernization. Chapter 5 looks at opportunities and challenges to eco-labelling, and concrete recommendations with respect to the design of eco-labelling programmes are made. Eco-labelling is the only tool which functions within the conflicting social forces of consumer society and sustainability. As a market-based instrument for environmental management that functions within the producer - consumer relationship, eco-labelling can be seen as the ecological marketisation of consumer society. Best practices in eco-labelling rely on accepting the fundamental market principles combined with social trends. (author´s abstract)

The study evaluated the cost-effectiveness of community based Nurse Case Management (NCM) utilizing existing hospital information systems data. Program outcomes of intensive NCM were compared with those of existing hospital programs for a group at high risk for readmission. Thirty-one elderly patients were assigned to one of three groups. A retrospective pretest-posttest design was used and multivariate analyses were performed. Outcomes were measured at six month intervals before and after NCM. The intensive NCM group had a higher length of stay and inpatient costs than the other two groups. Direct costs of NCM were estimated at $1.55 per active case per day. The study found that cost-effectiveness of NCM cannot be determined accurately unless health risk assessments are quantified, NCM is clearly translated into categories of intervention, and direct costs of NCM are measured consistently. These factors must be integrated into routine hospital information system reports.

ACE inhibitors have been widely used in the treatment of certain diseases of the cardiovascular system, the major use being hypertension, since all ACE inhibitors are prescribed for its treatment. ACE inhibitors is also used in the treatment of congestive heart failure. The angiotensin-converting enzyme (ACE) converts angiotensin 1 into angiotensin I1 and also stimulates the production of aldosterone (a hormone produced in the adrenal glands that influences salt and water retention by the kidneys, increasing blood volume and blood pressure). The cost benefit, cost-effectiveness and cost utility of ACE inhibitors have not been established. The objective of the study was to review and analyse the cost of ACE inhibitors by using a medical aid claims database. Data for the study population consisted of all prescriptions containing one or more ACE inhibitor combinations and were extracted from the central database of Interpharm datasystems for a period of one year, from 1 January 2001 to 31 December 2001. A total of 1 475 532 prescriptions containing a total of 2 953 244 ACE inhibitor items represented the study population. Through the analysis of the general medicine utilisation patterns that were obtained from the medicine claims database, it became evident that ACE inhibitor utilisation contributes considerably to the total prevalence and cost of all the medicine items available on the database. It constituted a total prevalence of 4,62% (n =1 475 532) of all the prescriptions and a total prevalence of 2,31% (n =2 953 244) for all the medicine items in the prescriptions with a cost of 3,65% (n =R379 91 1 472,OO). It was concluded that in the analysis of ACE inhibitors according to the innovator/generic classification, the majority of ACE inhibitors prescribed during the twelve-month period were for the innovator product, with a prevalence of 82,56% (n =68 162) and a cost of 89,11% (n =R13 863 080, 90). The utilisation of the generic ACE inhibitors, with a prevalence of 17,44% (n =68 162) and at a cost of 10,89% (n =R13 863 080, 90), was under-utilised. If the total number of prescriptions containing innovator ACE inhibitors could be generically substituted, (37,54%) R5 204 392,68 in cost expenditure could be saved over a twelve-month period. However, the fact that not all the innovator ACE inhibitors have generic equivalents available must be taken into account. If only the prescriptions containing ACE inhibitor items that have generic equivalents were to be substituted with their generic equivalents, R899 751.29(6.5%) would be saved. This was found by adding all the costs saved by substituting innovator drugs with their generics. Consequently, it can be concluded that the extensive use of the innovator ACE inhibitors could mean an exceptional increase in the cost expenditure associated with ACE inhibitor therapy. In completion of the study, recommendations were formulated as an aim to optimise the utilisation of ACE inhibitor generic equivalents. / Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2004.

Many countries, including Nepal, have been affected with highly pathogenic avian influenza (HPAI) outbreaks. There have been human mortalities in some countries and large numbers of poultry either died or were culled due to HPAI. The overall objective of this thesis was to improve our understanding of the epidemiology and economics of avian influenza (AI), and particularly HPAI, in Nepal. We determined the seroprevalence of and risk factors for AI virus antibodies presence in ducks in Kathmandu, Nepal. The estimated true prevalence of AI viruses (AIV) antibodies was 27.2% [95% Confidence Interval (CI): 24.6- 29.5]. Age of the ducks was identified as the only risk factor for AIV seropositivity. Ducks older than one year were more likely to be seropositive compared to ducks less than six months of age [Odds Ratio= 2.17 (95% CI: 1.07- 4.39)]. This study provided baseline information about seroprevalence of AIVs in Kathmandu that will benefit further research to differentiate the subtypes of AIVs circulating in Kathmandu. We also evaluated alternatives to the current control program (CCP) for HPAI in Nepal. The considered alternatives were: (i) absence of control measures (ACM) and (ii) vaccinating 60% of the domestic poultry flock twice per year. Cost-benefit analysis approach was used to evaluate the economic feasibility of the programs. In terms of the benefit-cost ratio, our findings indicated that there is a return of 1.96 dollars for every dollar spent in the CCP compared to ACM. The net present value of the CCP versus ACM was US$ 989,918. The vaccination program yielded a return of 2.41 dollars for every dollar spent when compared to the CCP. The net present value of vaccination versus implementing the CCP was US$ 13,745,454. These results support a continued investment into the CCP rather than ceasing to implement government regulated control measures and suggest that vaccination may be an even better control alternative. In summary, our studies have highlighted the value of epidemiologic and economic analysis in research of AI. Our results are expected to lead to an improved understanding and awareness of AI in Nepal and to formulation of better control strategies.

ACE inhibitors have been widely used in the treatment of certain diseases of the cardiovascular system, the major use being hypertension, since all ACE inhibitors are prescribed for its treatment. ACE inhibitors is also used in the treatment of congestive heart failure. The angiotensin-converting enzyme (ACE) converts angiotensin 1 into angiotensin I1 and also stimulates the production of aldosterone (a hormone produced in the adrenal glands that influences salt and water retention by the kidneys, increasing blood volume and blood pressure). The cost benefit, cost-effectiveness and cost utility of ACE inhibitors have not been established. The objective of the study was to review and analyse the cost of ACE inhibitors by using a medical aid claims database. Data for the study population consisted of all prescriptions containing one or more ACE inhibitor combinations and were extracted from the central database of Interpharm datasystems for a period of one year, from 1 January 2001 to 31 December 2001. A total of 1 475 532 prescriptions containing a total of 2 953 244 ACE inhibitor items represented the study population. Through the analysis of the general medicine utilisation patterns that were obtained from the medicine claims database, it became evident that ACE inhibitor utilisation contributes considerably to the total prevalence and cost of all the medicine items available on the database. It constituted a total prevalence of 4,62% (n =1 475 532) of all the prescriptions and a total prevalence of 2,31% (n =2 953 244) for all the medicine items in the prescriptions with a cost of 3,65% (n =R379 91 1 472,OO). It was concluded that in the analysis of ACE inhibitors according to the innovator/generic classification, the majority of ACE inhibitors prescribed during the twelve-month period were for the innovator product, with a prevalence of 82,56% (n =68 162) and a cost of 89,11% (n =R13 863 080, 90). The utilisation of the generic ACE inhibitors, with a prevalence of 17,44% (n =68 162) and at a cost of 10,89% (n =R13 863 080, 90), was under-utilised. If the total number of prescriptions containing innovator ACE inhibitors could be generically substituted, (37,54%) R5 204 392,68 in cost expenditure could be saved over a twelve-month period. However, the fact that not all the innovator ACE inhibitors have generic equivalents available must be taken into account. If only the prescriptions containing ACE inhibitor items that have generic equivalents were to be substituted with their generic equivalents, R899 751.29(6.5%) would be saved. This was found by adding all the costs saved by substituting innovator drugs with their generics. Consequently, it can be concluded that the extensive use of the innovator ACE inhibitors could mean an exceptional increase in the cost expenditure associated with ACE inhibitor therapy. In completion of the study, recommendations were formulated as an aim to optimise the utilisation of ACE inhibitor generic equivalents. / Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2004.

Children under the age of 18 are the largest age group of people who live in poverty in America. This paper focuses on early intervention programs and how they can help ameliorate the negative effects of poverty. Previous research has demonstrated the negative effects of poverty, such as lower academic performance and achievement and more behavioral problems. Various risk factors for poverty, such as single parents, low maternal education, and lack of resources, and their role in the design of early intervention programs will be explained. The Perry Preschool Project (PPP), Head Start, the Chicago Child-Parent Center (CPC) Program, and the Carolina Abecedarian Project and their effects on child outcomes will be analyzed. Cost-benefit analyses for each early intervention program, as well as future considerations for public policy, will be discussed in this paper.

Risk management is composed of three major elements viz., hazard identification, risk estimation and risk evaluation. The aim of hazard identification and risk estimation is to identify the outcomes from risk, the magnitude of the associated con&quences from risk, and the estimation of the probabilities of these outcomes. Previous work focused on hazard identification and risk estimation and identified the relatively high risks associated with playing professional football. By adhering to the risk management process, the aim of this thesis was to determine the significance of these high risks to football clubs and their players. A theoretical framework was designed to evaluate the influence of player injury on the financial and playing performance of professional football clubs. This framework was also used to assess, through use of cost benefit analysis, the practicalities of investing in suitable injury prevention strategies, to reduce the risks to football clubs and their players. Former professional footballers were surveyed to investigate the long-term medical and socioeconomic consequences associated with the high risks of playing professional football. The results identified the high financial costs associated with player injury on professional football clubs. Although the high risks of player injury have a relatively minor effect on teamperformance of the Premier League clubs, this effect still has a relatively major influence on the financial performance of the club. In contrast, the influence of player injury to teamperformance was relatively major for Division I and Division 2 clubs, but this had a relatively minor effect on financial performance. The application of cost benefit analysis to the investment of specialist personnel to reduce the risks of injury demonstrated that the proposals were practicable for Premier League and Division I clubs only. In addition, it was also demonstrated that the high risks associated with playing professional football have a significant influence on the long-term well-being of foriner players. One-third of former players had been medically diagnosed osteoarthritic in a lower limb joint. The majority of players also perceived that injury had a negative influence on their present and future welfare. The results demonstrate that the consequences associated with the relatively high acute injury risk also have a significant effect on the financial and playing performance of football clubs and the future welfare of their players.

A more rapid and widespread use and implementation of technology in construction often fails since its benefits and limitations remain somewhat unclear. Project control is one of the most variable and time consuming task of construction project managers and superintendents, and yet continues to be mostly a manual task. Controlling tasks such as tracking and updating project schedules can be assisted through remotely operating technology such as hi-resolution cameras that can provide construction management and other users with imaging feeds of job site activities. Although construction cameras have been around for many years the costs, benefits, and barriers of their use have not been investigated nor quantified in detail. Subsequently, definitions and understanding vary widely, making it difficult for decision makers at the organizational level to decide on the investment in camera technology. This thesis reviews the status of hi-resolution cameras and their present use in construction. Results of a multi-phased survey to industry professionals were collected in order to identify benefits and barriers and develop a cost-benefit model that can be used for implementation technology in construction.

Statement of Problem In the past few years, there has been increased interest in the intravenous administration of antibiotics in the home. The catalyst for this interest has been the need to contain costs and decrease surgical waiting lists in hospitals. However, the scientific evidence for cost containment for home parenteral programs is scant, conflicting and confusing. This study is the first to undertake an economic model based on a cost-benefit framework encompassing both direct and the often-ignored indirect costs. It also examines patient self-administered home parenteral antibiotic therapy (HPAT) within an economic, clinical and humanistic outcomes (ECHO) structure as a source of model inputs. The modelling approach overcomes the analytical and statistical difficulties associated with these early discharge programs due to the small and diverse nature of the populations. Methods and Procedures This study uses data from the Alternate Site Infusion Service (ASIS) at Princess Alexandra Hospital, Brisbane, Australia to populate some fields in the economic model. This service is based on the patient self-administration model and provides early hospital discharge to medically stable patients who require medium to long-term intravenous antibiotics for the treatment of infectious disease. The economic model is described as a probabilistic, second-order, Monte Carlo simulation based on cost-benefit design and constructed from realistic incremental differences in costs and benefits. The multi-dimensional probabilistic sensitivity analysis is used to account for uncertainty present in some of the model inputs. Risk analysis software known as “@Risk” Version 4.5.5 Professional is used to construct the simulation model. The cost and benefit framework, and ultimately inputs, are constructed from primary data emanating from the databases of the ASIS unit, Princess Alexandra Hospital in Brisbane for the period 2001 to 2002, secondary data based on literature reviews, and expert opinion. Societal perspective is chosen to encompass areas such as loss or gain of productivity and carer burden. Clinical outcome is investigated by examining the ASIS database regarding the treatment outcome of HPAT patients. The incidence and mortality rates of nosocomial intravascular bacteraemia (NIB) for hospital and HPAT patients are based on the literature review and included as inputs in the model. Carer burden is determined by the identified carers of ASIS patients with the completion of the mailed Caregiving Distress Scale (CDS) and the Impact of Caring Scale (ICS) instruments. A labour questionnaire was designed to collect data on paid employment, students returning to education and individuals returning to normal daily activities (including forgone leisure activities). The Australian Bureau of Statistics’ (ABS) Australian Standard Classification of Occupations (ASCO) and the ABS gender-specific average weekly wages for nine major work groups are used to estimate productivity of patients and their carers. The value of a hospital bed day was modelled to estimate the value of hospitalisation at the end of a hospital length of stay to avoid using an average bed day cost. The change in the utilisation of nursing, medical and pharmacy human resources due to HPAT is also modelled to avoid using average estimates. A sensitivity analysis is conducted on the value of a hospital bed day to measure the impact on the net benefit. Results The @Risk economic model was undertaken with 10,000 iterations to capture the variability of the net benefit. The value of a hospital bed day appears to have the greatest impact on the net benefit of ASIS with the probability of NIB and incidence of death from NIB in hospital also contributing. The correlation of CDS and the ICS demonstrates a linear relationship, and a total of 93% of carers indicate that they would repeat their participation as a carer. However, most relationships between variables are not statistically significant, or clinically unimportant. Carer burden is suggested to be low in home parenteral antibiotic patients despite the ASIS unit adopting the patient self-administered form of service delivery. However, the number of patients identifying a carer is low and, therefore, there is difficulty in the collection of a suitable sized data set. HPAT failed in 10% of home patients and was fairly comparable with other studies based on the patient self-administered model of service delivery. A total of 58% of HPAT patients (total patients = 123 and 3,939 bed days) returned to work or normal activities with an estimated productivity gain of $190,045 for the economic model of 3,964 bed days. Lost productivity for carers emanating from the survey research was estimated to be $118,121 for the economic model of 3,964 bed days. A mean cost difference of $19,584 between the hospital and home NIB, based on literature probability rates, was estimated indicating a benefit to the HPAT with regard to NIB. Overall, the @Risk model for the ASIS patients representing 3,964 bed days calculated a mean net benefit of $2,450,163 for the HPAT program. A 50% reduction in a hospital bed day value to $253 still resulted in a mean net benefit of $1,447,273 – and a zero net benefit resulted when the value of a hospital bed day reached $112. This suggests that the HPAT program, based on a patient self-administered model of service delivery, represents a viable option for healthcare delivery.

Alcohol is a complex good which is ingrained within the social fabric of Australian culture. This is even more apparent within rural communities which are considered to have higher levels of risky alcohol consumption. While alcohol provides pleasure to many, it has devastating effects for others. Not only are individuals themselves affected, but also their families and the community at large. This thesis considers a number of the economic aspects associated with alcohol consumption in rural Australia. This thesis was completed in conjunction with a larger ongoing project: Alcohol Action in Rural Communities (AARC), which is a cost-benefit analysis of community-wide interventions to reduce alcohol-related harm in rural Australia. Given the study involves 20 rural communities in New South Wales, Australia; much of the analysis is centred around data collected from these communities. This thesis examines the amount and patterns of alcohol consumption, some of the associated harms, the value of reducing these harms, plus professionals’ and the public’s opinions on interventions, viewed as an optimal solution to reduce alcohol-related harm for the communities within this study. First, those factors which affect individuals’ decisions regarding how much alcohol to consume are examined through econometric modelling of the demand for alcohol. Moreover, a theoretical model is derived whereby individuals choose both the intensity and frequency of alcohol consumption in order to maximise their utility. This is then used to examine those factors that affect the relationship between intensity and frequency of alcohol consumption for individuals within the 20 communities of the study. Secondly, the impact that this alcohol consumption has in terms of the effect on morbidity, crime and traffic accidents within these 20 communities is analysed. The relationship between selfreported quality of life using the EQ5D (a quality of life instrument) and self-reported risky alcohol use are examined using ordered Probit and Tobit models. Also, the relationship between community levels of risky drinking and crime and traffic accidents that occur in alcohol-related times is analysed, controlling for the underlying level of crime in the community by using the rate of incidents that occur in non-alcohol-related times. It is found that rural communities in Australia are experiencing a sizeable amount of potentially avoidable harm due to risky alcohol use. Thirdly, the value of reducing alcohol-related harm in these communities, in terms of the amount households are willing to pay for these reductions, is estimated using contingent valuation methods. Individuals’ willingness to pay for a percentage reduction in alcohol-related harm is estimated using both a postal questionnaire for the 20 communities, plus a face-to-face questionnaire conducted in two of these communities. The face-to-face questionnaire is also used to conduct a double-bounded dichotomous choice experiment, to investigate the willingness of households to pay for a reduction in a number of different types of alcohol-related harm. Finally, the views on the optimal policy options to reduce alcohol-related harm for rural communities in Australia are examined for both professionals and the general public. A sample of drug and alcohol (D&A) professionals were asked to allocate a budget of $100,000 to a number of interventions in order to reduce alcohol-related harm in a hypothetical rural community. The D&A professionals most commonly selected interventions include training general practitioners (GPs), targeting high-risk groups, developing a harm-reduction code of practice, expanding social work services and the training of emergency department staff. Additionally, individuals from the general public were asked via a postal questionnaire to allocate a percentage of total funds to eight intervention areas in order to reduce alcohol-related harm in their communities. The top three intervention areas given the most funding, on average, by the public were school-based interventions, educational messages in the media, and greater police enforcement. There is no doubt that alcohol consumption causes a substantial amount of harm for rural communities within Australia. This thesis has provided information to inform the development of interventions tailored to specific communities and has derived estimates which can be used to help evaluate the cost-benefit of these interventions. There is still additional research to be done in order to obtain more accurate estimates of the exact effect alcohol has on rural communities and thus comprehensively evaluate which interventions are likely to be the most cost-effective in reducing this harm.