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Objective: The primary objective of this study was to estimate the long-term cost-effectiveness of stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the United States using new anticoagulant therapies - dabigatran 150 mg, apixaban 5 mg, and rivaroxaban 20 mg - as well as the standard treatment, warfarin. Methods: A Markov decision-analysis model was constructed using data from clinical trials that evaluated the new oral anticoagulants relative to warfarin (apixaban 5 mg & ARISTOTLE, dabigatran 150 mg & RE-LY, and rivaroxaban 20 mg & ROCKET-AF) to compare the lifetime cost and quality-adjusted life expectancy. The Markov model target population was a hypothetical cohort of 70-year old patients with nonvalvular atrial fibrillation, an increased risk for stroke (CHADS₂ ≥ 1, or equivalent), a renal creatinine clearance (CrCl) of 50 or above, and no contraindication to anticoagulant therapy. Using pair-wise comparisons of each therapy, analyses were conducted to evaluate incremental cost-effectiveness ratios (ICERs), net monetary benefits (NMBs), lifetime costs, life-years, and quality-adjusted life-years (QALYs). Results: In the base case, warfarin had the lowest cost of $71,857 (95% confidence interval [CI]: $68,730, $77,452), followed by rivaroxaban 20 mg ($74,023; 95% CI: $70,943, $77,307), dabigatran 150 mg ($78,584; 95% CI: $75,277, $81,968), and apixaban 5 mg ($81,180; 95% CI: $78,642, $83,756). Apixaban 5 mg also yielded the highest QALY estimate, 8.63 (95% CI: 8.52, 8.72), followed by dabigatran 150 mg (8.55; 95% CI: 8.43, 8.67), rivaroxaban 20 mg (8.42; 95% CI: 8.31, 8.54), and warfarin (8.17; 95% CI: 8.1, 8.24). In a Monte Carlo probabilistic sensitivity analysis, apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg, and warfarin were cost effective in 45%, 37%, 19%, 0%, respectively, of the simulations using a willingness-to pay threshold of $50,000 per QALY gained. From the one-way sensitivity analyses, new anticoagulant (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) costs and probabilities associated with intracranial hemorrhage and stroke for patients receiving rivaroxaban 20 mg were identified as significant influential variables impacting model results. Conclusion: In patients with NVAF and an increased risk of stroke prophylaxis, apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg may all be cost-effective alternatives to warfarin depending on pricing in the United States and neurologic events for rivaroxaban 20 mg.

The primary aim was to compare the effectiveness of smoking cessation interventions of different intensities in a clinical dental and a telephone setting in Sweden. Methods: A total of 300 smokers were randomized to High or Low Intensity Treatment (HIT or LIT) at the Public Dental Service, County Council of Västmanland. Effectiveness (abstinence rate) was measured after 1yr (paper I) and 5-8yrs (paper III). A cost-effectiveness analysis was conducted, based on intervention costs, number of abstinent participants after 1yr, and a Markov modelling of future costs and health (in QALYs) consequences (paper II). In paper IV, 586 callers to the Swedish National Tobacco Quitline (SNTQ) were randomized to high-intensity proactive or low-intensity reactive service, and effectiveness was measured after 1 yr. Effectiveness measures were self-reported point prevalence, 6-month continuous abstinence, and sustained abstinence. Results: Absolute quit rates were 7% higher with HIT than with LIT on all measures and increased by 8% from 1yr to 5-8yrs. Point prevalence was 23% vs. 16% (p=.11) after 1yr and 31% vs. 24% (p=.16) after 5-8yrs. Six-month continuous abstinence was 18% vs. 9% (p =.02) after 1yr and 26% vs.19% (p=.18) after 5-8yrs. Sustained abstinence was 12% vs. 5% (p =.03) after 5-8yrs. Nicotine dependence was a strong predictor for abstinence at 1yr and achieved abstinence at 1yr was a strong predictor for abstinence at long-term follow-up. The cost-effectiveness analysis showed that both HIT and LIT were cost-effective, and LIT was even cost-saving compared with doing nothing. HIT was more costly and more effective than LIT, and the cost of each extra QALY gained by HIT was 100,000SEK, which is considered very cost-effective in Sweden. Proactice and reactive services were equally effective at the SNTQ. Point prevalence was 27% and 6-month continuous abstinence was 21% after 1yr. Being smoke-free at baseline was the strongest predictor for abstinence at 1yr. Conclusion: Support at high as well as low intensity in a clinical dental setting in Sweden and at the SNTQ was effective in achieving smoking cessation. Both high- and low-intensity interventions were very cost-effective in a clinical dental setting.

We are at a point in the history of higher education in South Africa when radical changes are occurring in instructional delivery system models. Of increasing significance is a mixed mode of traditional and distance delivery (i.e. Telematic Learning Systems at the PU for CHE). In this changing environment, language lecturers, the persons responsible for developing language modules within various Telematic programmes, remain a key element in the teaching and learning process. However, these lecturers are suddenly expected to make appropriate decisions in terms of distance education technology classification, evaluation, and consequent selection without the necessary knowledge and/or capacity to make effective technological decisions. The purpose of this article is to assist "Lone Ranger" language lecturers, in making pedagogically sound decisions when classifying, evaluating and selecting distance education technologies by: (a) considering technology selection as part of the instructional design process, (b) referring to some reasons for using technology for language learning, (c) focusing on criteria for classifying and evaluating distance education technologies, and by (d) reviewing selected studies in order to indicate the application possibilities of technologies for language teaching and learning. / Thesis (M.A. (English))--Potchefstroom University for Christian Higher Education, 2002

This research reviews and evaluates the FedExâ s Premium Service Program currently being used by DLA customers. The research will examine some of the benefits and costs of this co-locating of DOD warehousing and shipping operation managed by a commercial express transportation carrier. The research will view the possible benefits gained through commercial inventory and transportation practices by partnering a third party logistics service with the Defense Transportation System. DLA and FedEx have formed a partnership called DLA Premium Service. Premium Service is the only DoD warehousing operation that is co-located with and managed by a commercial express transportation carrier at FedEx main transportation hub. Premium Service System allows users to position materials in the Memphis facility for expedited delivery to the required destinations worldwide. All items are guaranteed, under contract, to be delivered to their continental U.S. (CONUS) destination within 24 hours and within 48 hours to outside of CONUS (OCONUS) to the major airports serviced by FedEx. Items will be delivered to the OCONUS final destination 24 hours of release from customs holding area at the airport. The service provides advance notification to streamline customs requirements of all OCONUS shipments.

M.Tech. (Industrial Engineering) / Please refer to full text to view abstract

Master of Science / Department of Electrical and Computer Engineering / Anil Pahwa / In Afghanistan, electricity is mostly generated by hydroelectric, diesel and natural gas generators. A significant amount of electricity also is imported from neighboring countries. Accessibility of electricity is mostly limited to the capital and main towns. The government of Afghanistan and other development organizations, such as The United States Agency for International Development (USAID) and Deutsche Gesellschaft für Internationale Zusammenarbeit (German Agency for International Cooperation “GIZ”), are striving to develop accessibility of electricity to remote communities by supporting the local population of people to enhance living conditions. Although some of these remote communities are served by local diesel fuel generators for just a couple of hours during the night, still most communities do not have access to electricity and they are using wood and kerosene as major sources of energy in cooking, heating and lighting. For those remote communities who are served by local diesel fuel generators, the cost of electricity is much higher than from the national grid. On the other hand, grid extensions are too expensive and, in some cases, impossible for such communities because of the geographical features of Afghanistan. Afghanistan is a mountainous country which receives a significant amount of snow during the winter and once it melts the water runs into rivers, lakes and streams. Therefore mostly it does not face any shortage of running water during the year. Also Afghanistan has plentiful wind and solar energy. Therefore, small hydro-power, wind turbine and solar energy are attractive renewable energy sources for remote communities. The development of such a hybrid power system is a complex process and technical expertise is essential in design and construction phases. The main challenges are the high cost of civil works and equipment, technical expertise for design and construction and encouragement of local people for the support of the project. This report will give an insight into design, cost-effectiveness and feasibility of the system using HOMER in order to encourage private investors and local community people to take advantage of this potential available in Afghanistan and be convinced of the sustainability for investments in micro-hydropower, wind and solar.

When measuring Information Systems (IS) success, it is important to know the type of IS being measured, the systems objectives, and the unit of analysis. As organizations invest in technology to help achieve strategic goals, they need to be able to measure IS success. Measuring the effectiveness of IS from an organizational perspective is the effect it has on achieving organizational goals. The effectiveness of information systems is a measure of net benefits. This empirical study investigated IS success in terms of the DeLone and McLean IS success model variable, net benefits. In order to measure IS success, the context of the investigation and the unit of analysis are as important as what is being measured. This investigation, in the context of a building automation system (BAS), evaluated the net benefits success measurement with the organization as the unit of analysis. Two hypothesis testing studies were conducted. The first study was a predictive investigation, which researched the relationship among the independent variables, kilowatt hours, kilowatt demand, and the dependent variable, the cost of energy. A multiple regression analysis was conducted to understand to what extent the independent variables could predict the dependent variable. The second study was a correlational investigation. This study was conducted to ascertain whether a building automation system affects the cost of energy. A Point Biserial Correlation Coefficient test was conducted to understand the relationship between the cost of energy and stores with a building automation system and those without. A t-test was conducted to understand the level of significance. The results of the analysis showed that the relationship between the cost of energy and a BAS is statistically significant and that the variables kilowatt hours and kilowatt demand are statistically significant as predictors of the cost of energy.

The U.S. Army Corps of Engineers is a federal agency with a mission to develop water resource projects to benefit the nation. Some of its large scale projects have been built to benefit cities, but through unintended consequences have caused economic and environmental damages. For example, its control of Mississippi River flooding has protected the City of New Orleans, but contributed to land loss in coastal Louisiana, and by some accounts, made the population more susceptible to hurricane damage. The agency has now embarked on a mission to restore some of the damaged environmental areas. This dissertation evaluates whether policies and practices used by the agency to evaluate and select plans to implement is logically flawed and could produce suboptimal project selection. The primary issue is the practice of including only implementation costs in the analysis while excluding other positive and negative economic impacts. A case study is performed using the method to evaluate a traditional economic development project for which optimal project selection has already been determined using widely accepted benefit-cost practices. The results show that the Corps' environmental project evaluation method would cause rejection of the most efficient plan. The loss of welfare that would result from using this technique is measured by comparing the welfare gain of the optimal project to the welfare gain of the suboptimal projects which could be selected using the flawed methodology. In addition, the dissertation evaluates whether suboptimal results could be produced using two other current Corps policies: selecting projects based on production efficiency, and the exclusion of environmental benefits from the discounting process. For the first policy, a simple counter example shows how clearly inferior choices may come from including only supply considerations in investment choices. For the second policy, it is demonstrated mathematically that refraining from discounting benefits while discounting costs causes a bias towards selection of plans that take longer to build, are delayed in their implantation, or a combination of the two.

Le législateur français a intégré le critère d’efficience dans la détermination du prix du médicament remboursable en 2012. L’efficience des médicaments doit être documentée pour les produits susceptibles d’apporter un bénéfice thérapeutique important et d’avoir un impact significatif sur les dépenses d’assurance maladie. Elle vise à mesurer le coût du gain marginal en santé produit par une intervention, par rapport au coût et à l’efficacité d’une autre intervention substituable. La thèse se situe dans une perspective d’analyse empirique des relations de délégation à l’œuvre dans la régulation du médicament, en vue de son accès au remboursement et de la fixation de son prix en France. Elle se fonde sur une analyse de trois applications de l’évaluation de l’efficience reflétant un approfondissement progressif de l’évaluation économique de l’intervention de santé dans trois contextes institutionnels distincts. Leur comparaison permet d’identifier les enjeux soulevés par la mise en œuvre de la régulation, les facteurs de son efficacité et les risques associés au regard du cadre théorique de la théorie des incitations en se posant successivement les questions suivantes : 1) L’information produite par le calcul économique expose-t-elle le décideur à un risque de manipulation de l’outil ? 2) L’apport du calcul économique est-il amélioré dans un processus d’évaluation contraint? 3) Des approches complémentaires peuvent-elles enrichir l’évaluation économique et en améliorer l’usage en révélant d’autres déterminants de la décision en santé? Les travaux de la thèse mettent en évidence l’apport du critère d’efficience pour améliorer l’information du décideur. Le risque, réel, de capture de régulation peut être limité par un processus d’évaluation plus transparent et par une explicitation des enjeux de la décision et des objectifs de la régulation. / In 2012, cost-effectiveness has been formally introduced in the French legislation as a criterion to determine the price of prescription drugs. Cost-effectiveness is requested to claim for reimbursement of drugs expected to provide a therapeutic benefit and to have a significant impact on Social Insurance budget. Cost-effectiveness estimates the incremental cost and effectiveness produced by an intervention in comparison to other interventions that could have been used. The thesis is an empirical analysis of delegation relationships in the regulation of reimbursed drugs in France. The thesis analyses three different applications of cost-effectiveness evaluation to highlight the issues surrounding the use of economic calculation and the risks that are associated with it through three questions: 1) does the cost-effectiveness evaluation expose the regulator to regulation capture? 2) Is the contribution of the cost-effectiveness evaluation enhanced in a regulatory framed process? 3) Could complementary evaluations enrich cost-effectiveness evaluation and favour its usage via the clarification of the issues surrounding the decision? The thesis documents the benefit provided by the introduction of the cost-effectiveness criteria. The actual risk of regulation capture could be limited through a more transparent process of evaluation and through a clarification of the objectives of the regulation.