Solar heat pump systems (SHPs) are systems that combine solar energy and heat pumps. SHPs have been investigated for several decades and have been proven to increase the share of renewable energy and reduce electric energy demand in residential heating applications. Many solar thermal heat pump systems have become market-available in recent years; however these systems are still not widely employed in the residential sector. This is due mainly to the high initial costs (investment and installation costs) of solar thermal heat pump systems, which limits their cost-effectiveness. Enhancing cost-effectiveness of solar thermal heat pump systems is necessary for a more effective and broader market penetration. In this thesis, solar thermal and photovoltaic systems combined with heat pumps for heating applications are treated. The overall aims of the thesis are to: 1) investigate techno-economics of SHPs and 2) investigate possible solutions for improving system performance of a reference solar thermal and heat pump system for residential heating applications. In the first part of the thesis, the influence of climatic boundary conditions on economic performance of SHPs has been investigated by means of: a) an economic comparison of SHPs found in the relevant literature and b) system simulations of the reference solar thermal heat pump system. In the second part of the thesis, potential solutions for improving system performance of the reference solar thermal heat pump system with limited change in system’ costs are investigated. A systematic approach was used for investigating cost-effectiveness of the system improvements in the reference system. Based on results of the cost-effectiveness analysis, some of the investigated system improvements were chosen for being included in the design of a novel solar thermal and air source heat pump system concept. The novel system was designed for a house standard with relatively high operating temperatures (55°C/45°C) in the space heating distribution system and for high space heating demand (123 kWh/m2·year). Finally, the thesis ends with a cost-effectiveness analysis of the novel system. / <p>QC 20170918</p> / MacSheep / iNSPiRe

Ischemic stroke is the most common cause of handicap in adults and the third most common cause of death in Sweden. Internal carotid artery atherosclerosis is an important cause and accounts for 20% of ischemic strokes. Screening for carotid atherosclerosis has been debated over the past two decades. The aims of this thesis were (I) to study the prevalence of and risk factors associated with carotid artery atherosclerosis among 65 year old men, (II) to evaluate a simplified ultrasound protocol (the grayscale/mosaic method) for the exclusion of significant carotid artery stenosis for screening purpose, (III) to evaluate the required effect of primary preventive therapy in reducing risk of stroke among patients with asymptomatic carotid disease in order for screening to be cost-effective and (IV) to study natural history of carotid atherosclerosis and outcome five years after screening in 65-year old men. The prevalence of atherosclerotic plaques was high (25%), while the prevalence of &gt;50% stenosis was relatively low (2.0%). Smoking, hypertension, diabetes mellitus and coronary artery disease were independent risk factors and individuals with several risk factors had a higher prevalence of stenosis. Most of those at risk were not on any preventive medication. A simplified grayscale/mosaic method was found to have a high negative predictive value for significant carotid stenosis. The minimum stroke risk reduction effect required for preventive intervention to be cost effective was 22%. Carotid atherosclerotic plaque and stenosis 50-79% has a relatively benign development during five years if treated with BMT and risk factor adjustment. Very few progressed to symptomatic disease. More severe stenosis (80-99%) had higher rate of neurological events, and may benefit from additional intervention. In conclusion, prevalence of silent atherosclerotic disease in carotid arteries was common among 65-year-old men. Most of those at risk had no secondary prevention. There is a simple DUS method that could be used for screening purpose. Screening for carotid disease is only cost-effective if the preventive strategy lowers the risk of stroke by 22%. Men with plaques and moderate stenosis have a good prognosis, but among those with severe stenosis there is a need for further intervention. / Screening for asymptomatic carotid atherosclerosis

Abstract Each year approximately 11,000 induced abortions are performed in Finland, the majority of these women being younger than 25 years of age. Medical abortion with the antiprogestin mifepristone and the prostaglandin analogue misoprostol is increasingly being used instead of surgical method (dilatation of cervix and uterine evacuation with instruments). Similarly, miscarriages can be treated with medical or surgical management. Still, clinical outcomes of the medical treatment of miscarriage are not well established, and various different regimens exist. The aim of this study was to investigate the frequency and risk factors of repeat abortions and immediate post-abortal complications, focusing especially on the impact of the method of abortion. National health registries were used as a data source. Another part of the study was aimed at comparing the efficacy, acceptability and cost-effectiveness of the medical and surgical treatment of miscarriage. In national cohort, the risk of repeat abortion was associated with sociodemographic characteristics (parity, previous abortion, low socioeconomic status, being unmarried but cohabiting or single), but not with the method of abortion. The risk of repeat termination of pregnancy decreased with age, among women living in rural area, and when intrauterine devices or sterilization were planned for future contraception. The overall incidence of adverse events was 4-fold greater in the medical compared to the surgical abortion cohort. Hemorrhage and incomplete abortion were more common following medical abortion, but the incidence of infections did not differ. Medical and surgical treatment of miscarriage were compared in a randomized setting; the efficacy of the treatment did not differ. Medically treated patients were less satisfied with the treatment and had experienced more pain. In the cost analysis, the primary costs of the surgical treatment were higher, but more unexpected events and complications increased the secondary costs in the medical group. In summary, medical abortion offered a good alternative to surgical method without increasing the risk of repeat abortions, but with an increased risk of short-term adverse events. The medical method was efficient in treating miscarriages, and the majority of women were satisfied with the treatment. Neither of the methods was economically superior in treating miscarriage.

Background: Despite proven efficacy, Manual Vacuum Aspiration (MVA) use for incomplete abortions is low in the Swaziland setting, including Raleigh Fitkin Memorial (RFM) Hospital. Uncertainty in the costs implications of introducing MVA to replace Dilatation and Curettage (D&C) is the major hindrance to change. This study aimed to evaluate the cost-effectiveness of introducing MVA as an evacuation method for first trimester incomplete miscarriages as well as assess the implications of the introduction of MVA to the entire post-abortion care budget at RFM Hospital. Methods: The methods comprised cost-effectiveness and budget impact analyses from a healthcare perspective based on a theoretical cohort. Clinical outcomes data for procedures were obtained from relevant literature. Costs were collated from prospective suppliers and then compared for the two treatment modalities. Future numbers of annual evacuations were extrapolated from previous annual figures. First trimester miscarriages were in turn extrapolated from proportions found in previous studies. Total budgets were calculated under the current scenario, as well as if MVA had to be introduced. Results: With initial capital costs of ZAR11 093.00, introduction of MVA for first trimester incomplete abortions will cut post-abortion care costs by 34.7%. MVA would cost ZAR819.86 per procedure while D&C costs ZAR1 255.40 per procedure. An estimated 26 MVA procedures done instead of D&C will compensate for the initial capital investment. Introduction of MVA into the post-abortion care programme will save the hospital about ZAR516 115.30 annually, with at least similar clinical outcomes compared to D&C. Conclusions: MVA should be considered as the first option in first trimester post abortion care. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted

D.Ing. (Engineering Management) / Promotion of ICT usage in developing countries, even under rigorous government initia- tives and policies, is a discouraging undertaking and a very di cult one. One of the many challenges government of developing countries is facing in the promotion of ICT adoption is how to incorporate a subsidy rate discount into a price model as expressed in the following sentiments: Until now, USAASA has used very little of the money in the USAF. It must justify its spending plans each year before it is given access to any of Information on how price a ects the number of users was generated by asking users on how much the spent on internet usage. The sensitivity of users was determined by asking users how many hours they spent on the internet. Analysis of the information gathered showed that there was a substantial amount of money in USAASA and ZICTA co ers which was not utilized. Furthermore users expressed desire to have their prices subsidized. In rural areas internet prices were more expensive, on comparative terms, than those in the urban areas. Analysis of data or results concerning the price and the number of users showed that there was a positive relationship between the number of users and the price of the internet service. The relationship showed that a low price attracted a lot of users, while a high price attracted few users or none at all. The mathematical analysis of the pricing model proved that at a certain subsidy discount rate and price sensitivity, the model was able to reach equilibrium while maximizing the ISP's revenue. In conclusion the price of internet services for the information \have nots" depend on the price sensitivity and the level of subsidy given by the government. the funds". \Universal access of ICT services with particular reference to rural areas is an issue that has been on the agenda of most countries in the whole world today. You are aware that while some countries are currently e ectively extending services to rural areas using various means, others have found this challenging and have ended up with unutilized funds in the banks". Subsidies, though seen as the means of promoting social and economic agendas in developing countries, can create the tragedies associated with public resources usage or something-for-nothing resources. Given a subsidy discount rate or a low price, consumers usually anticipate a net bene t derived from free resources due to subsidy. Anticipation of net a bene t from such resources may generate a damaging rush from consumers to exploit the resource, which may result in the tragedy of the commons. On the contrary, when no subsidy is given, consumers face no di erential between the perceived utility and the price of the resource creating a no social and pecuniary bene t to users, as such very few consumers or users will utilize the resource. The contribution this research develops is as follows: To show the extent of ICT usage patterns in developing countries.To determine why ICT usage in developing countries is low even under rigorous government initiatives and policies. To determine how price a ects the number of users using the internet resource. To incorporate a subsidy discount rate in a price model for unserved or rural areas of developing countries. To proposes a subsidy driven pricing framework that helps both the internet service providers and users to maximize their utilities and prevent the tragedies associated with resource use i.e. the tragedy of the commons and the tragedy of the anti- commons. To apply a non-cooperative game theoretic model to investigate the con ict between ISPs and consumers or consumers in a heterogeneous communities i.e. the infor- mation \haves" and \have-nots". We de ne utility-based decision rules for both providers and users under varying prices and subsidy requirements. We provide a decision model under a non-cooperative, incomplete-information game environment. To investigates the properties of the NE (under di erent optimization rules) and to study whether there exists an optimal solution to the game. The basic hypothesis that this research addresses is: A pricing model, with correct subsidy discount rate allows for better resource usage (preventing the tragedy of the commons and anti-commons) and makes the attainment of the objective of \ICT access for all" more likely. The methodology used for collecting statistical data was a combination of qualitative and quantitative research methods. The purpose of research was to collect data that would later be used to propose a pricing framework for heterogeneous communities. The strategy was to use three important variables in the subsidy driven pricing model to validate the hypothesis i.e. subsidy discount rate, the relationship between price and the number of users and the sensitivity (elasticity of demand) of users towards price. Incorporation of subsidy discount rate into the pricing model was driven by the fact that institutional frameworks such as universal service and access agency of South Africa (USAASA) and the Zambia information and communications tech- nology authority (ZICTA) were sitting with unutilized universal service and access fund (USAF). Additionally, users of internet services in underserviced areas of the two countries advocated for subsidized prices towards internet provision.

Master of Public Health - MPH / The World Health Organisation estimates that more than 50% of medicines are inappropriately used globally. The situation is worst in developing countries such as Nigeria, where irrational prescribing practices account for wastage of resources, catastrophic medicines costs and poor access to health services. In 2005, the Social Health Insurance Programme was launched as a financially sustainable model to achieve cost effective and affordable health care services including medicines. This study investigated prescribing practices and availability of medicines in the Social Health Insurance Programme in accredited public sector secondary hospitals in the Federal Capital Territory, Nigeria.Methodology:The study is a descriptive, cross-sectional and retrospective survey of prescriptions of insured outpatients in the Federal Capital Territory, Nigeria. Four hospitals were selected by stratification of thirteen (13) public secondary hospitals in the territory into urban/peri-urban areas, followed by random selection of two hospitals from each stratum.A total of seven hundred and twenty (720) retrospective prescription encounters of insured outpatients were systematically selected from encounters between July 2009 and June 2010 at the selected facilities. Data on prescribing practices and the extent to which prescribed medicines were provided were assessed with the use of modified WHO/INRUD indicators. Descriptive statistics were generated with Epi-info (version 3.4.3) and SPSS (version 17.0)Results: Out of the seven hundred and twenty (720) prescriptions that were assessed analgesics/NSAID, antibiotics, antimalarials and haematinics/vitamins collectively accounted for 67.4% of the medicines prescribed.A comparison of the results with WHO/Derived reference values showed that average number of medicines prescribed per prescription (3.5 ±1, p<0.001) and the rate of antibiotic prescribing (53.7%, p=0.009) were higher than the WHO recommended ranges of (1.6-1.8) and (20.0- 25.4%) respectively.The use of generic names in prescribing (50.9%, p<0.0009) and medicines prescribed from the Essential Medicine List (74.2%, p=0.05) were considerably lower than the standard (100%) However, the rate of injection prescribing (12.49%, p=0.4) was within the recommended range (10.1–17.0%).The study also found that 85.1%, (p=0.001) of prescribed medicines were dispensed, while 93.4% (p=0.256) of essential medicines were dispensed which was lower than the recommended standard (100%). Overall, only 58%,(p<0.0001) of patients had all prescribed medicines completely dispensed and this was significantly lower than the desired standard (100%.) in social health insurance programmes.Conclusions:The findings of this study show trends toward irrational prescribing practices as characterized by poly-pharmacy, overuse of antibiotics, sub-optimal generic prescribing, as well as poor adherence to the use of NHIS-Essential Medicine List. There was sub-optimal provision of prescribed medicines. These are potential threats to the scheme‟s goal of universal access to health care in the year 2015. Pragmatic multi-component interventions are recommended to promote rational prescribing and improve equity in access to essential medicines.

After many years of research have been developed, and then in January 2013 approved by the European Medicines Agency new multicomponent vaccine against meningococcal disease Group B Bexsero from Novartis. Meningococcal disease, because of its rapid progression and tragic consequences, a very dangerous disease. The aim of my thesis was to try to quantify the impact on the costs and benefits of the introduction of vaccination for the most vulnerable groups, namely children after birth to 4 years of age, by comparing the hypothetical vaccinated and unvaccinated cohorts. The work itself has not demonstrated at today's prices and epidemiological data Bexsero vaccines, cost efficiency. However, at a reduced cost or increased incidence of cases appear to vaccination Bexsero as well utilized resources.

This diploma thesis is focused on cost analysis of cataract treatment.The aim of the diploma thesis is to evaluate the effectiveness and efficiency of cataract surgery and treatment in terms of the costs and benefits of treatment in two possible ways from the perspective of the patient and the health care facility.

Please read the abstract in the section 00front of this document / Dissertation (MSc ( Electronic Engineering))--University of Pretoria, 2005. / Electrical, Electronic and Computer Engineering / unrestricted

Submitted in fulfillment of the requirements for the Degree in Master in Technology: Marketing, Technikon Natal, 2003. / Managed care is defined by Chetty (1999: 1) as "the practice of evidence based medicine with an approach to managing both the quality and cost of medical care". Managed care was introduced into South Africa in the last decade due to increasing cost of healthcare. All forms of managed care represent attempts to control costs by modifying the behaviour of general practitioners. / M