Study objectives and significance Generally, patients go to hospitals or clinical offices for seeking health care service. However, some studies reveal that old patient or those who have disability would get hurt and expose in some dangerous situation, such as falls and infection. As the reasons, the rehabilitation delivery model, which sends the service to patients¡¦ community, is needed. The community delivering-rehabilitation model that this study focuses on integrates hospital center and retirement home. This study is to compare the community delivering-rehabilitation model and general delivery model that patients go to hospital for rehabilitation service. Data and methods In one-year study duration from Nov. 1, 2002 to Oct. 31, 2003, the Barthel Index score from two delivery models were collected every 3 months. On the other hand, patients¡¦ rehabilitation costs were collected once 3 months, too. The study unit is individual unit. Cost-effectiveness analysis (CEA) was used here to be a standard comparing tool. CEA was computed by dividing the cost that patient spent in 3 months into the Barthel Index score which patient improved his functional status. Independent variables include environmental factors and structural factors The Environment factors include rehabilitation delivery model and the patient-therapist ratio. Structural factors include chain-affiliation status, instrumental volume and status. The General Estimating Equation was used here for comparing longitudinal dependent data. Results The study reveals that environmental factors and structural factors affect the performance of rehabilitation units. Environmental factors positively affect the rehabilitation effect. Structural factors negatively affect the rehabilitation effect. On the other hand, Environmental factors positively affect the rehabilitation efficiency. Structural factors negatively affect the rehabilitation efficiency. Conclusion and the project¡¦s relevance to public health The community delivering-rehabilitation model has better rehabilitation effect, but on the aspect of efficiency, is not as good as general delivery model. However, the community delivering-rehabilitation model has good accessibility to patient. It also concerns patient safety. If the model can improve its efficiency, the promotion of health can be further implied in community delivering-rehabilitation model.

Thesis(Ph.D.)--Case Western Reserve University, 2010 / Title from PDF (viewed on 2010-01-28) Department of Epidemiology and Biostatistics Includes abstract Includes bibliographical references and appendices Available online via the OhioLINK ETD Center

Thesis (M.S. in Operations Research)--Naval Postgraduate School, September 1990. / Thesis Advisor(s): Halwachs, Thomas E. Second Reader: Sovereign, Michael G. "September 2009." Description based on title screen viewed on December 17, 2009. DTIC Descriptor(s): Computer programs, cost effectiveness, economics, parameters, compatibility, public opinion, costs, availability, laboratories, operations research, microcomputers, economic analysis, reduction. DTIC Identifier(s): Economic analysis, personal computers, present value, cash flow diagram, discount rate, system effectiveness analysis, system performance, sensitivity analysis, sensitive, insensitive, life cycle costs. Author(s) subject terms: Present Value (P.V.), Cash flow diagram, Life-Cycle-Cost (L.C.C.), Discount rate, system-effectiveness analysis, system performance, break-even analysis, sensitivity analysis, sensitive, insensitive. Includes bibliographical references (p. 72-73). Also available in print.

This thesis employed methods used in health care decision making to evaluate strategies for prevention and treatment of febrile neutropenia (FN) in non-Hodgkin lymphoma (NHL) patients. The objectives of this thesis were to quantify the cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against FN in NHL patients, to develop an algorithm for converting health-related quality of life data collected in non-Hodgkin lymphoma patients into preference-based health utility values, and to evaluate NHL patients’ preferences for outpatient treatment of FN. The cost-effectiveness analysis demonstrated that neither filgrastim, nor pegfilgrastim are cost-effective, with respective incremental cost-effectiveness ratios [95% confidence interval] of $4,599,000/QALY [$597,045, dominated] and $6,272,000/QALY [$730,692, dominated], well above the normally accepted threshold of $50,000/QALY. The algorithm for deriving health utility values was based on a regression model that used health utility values obtained from the EQ-5D instrument as the outcome variable and the four subscales of the Functional Assessment of Cancer Therapy – General (FACT-G) questionnaire as the predictor variables. The model final model included three of the FACT-G subscales, and had an R-squared value of 0.502 and a mean squared error of 0.013. A discrete choice experiment was used to examine patients’ preferences for out patient treatment of FN, and demonstrated that out-of-pocket costs, unpaid caregiver time required daily, and probability of return to hospital are all significant attributes when considering outpatient therapy for FN. Adjusted odds ratios [95% confidence intervals] of accepting outpatient treatment for FN were 0.84 [0.75 to 0.95] for each $10 increase in out-of-pocket cost; 0.82 [0.68 to 0.99] for each 1 hour increase in daily unpaid caregiver time; and 0.53 [0.50 to 0.57] for each 5% increase in probability of return to hospital. These results provide important information for clinicians and health care decision makers involved in implementing programs for NHL patients with FN.

This thesis employed methods used in health care decision making to evaluate strategies for prevention and treatment of febrile neutropenia (FN) in non-Hodgkin lymphoma (NHL) patients. The objectives of this thesis were to quantify the cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against FN in NHL patients, to develop an algorithm for converting health-related quality of life data collected in non-Hodgkin lymphoma patients into preference-based health utility values, and to evaluate NHL patients’ preferences for outpatient treatment of FN. The cost-effectiveness analysis demonstrated that neither filgrastim, nor pegfilgrastim are cost-effective, with respective incremental cost-effectiveness ratios [95% confidence interval] of $4,599,000/QALY [$597,045, dominated] and $6,272,000/QALY [$730,692, dominated], well above the normally accepted threshold of $50,000/QALY. The algorithm for deriving health utility values was based on a regression model that used health utility values obtained from the EQ-5D instrument as the outcome variable and the four subscales of the Functional Assessment of Cancer Therapy – General (FACT-G) questionnaire as the predictor variables. The model final model included three of the FACT-G subscales, and had an R-squared value of 0.502 and a mean squared error of 0.013. A discrete choice experiment was used to examine patients’ preferences for out patient treatment of FN, and demonstrated that out-of-pocket costs, unpaid caregiver time required daily, and probability of return to hospital are all significant attributes when considering outpatient therapy for FN. Adjusted odds ratios [95% confidence intervals] of accepting outpatient treatment for FN were 0.84 [0.75 to 0.95] for each $10 increase in out-of-pocket cost; 0.82 [0.68 to 0.99] for each 1 hour increase in daily unpaid caregiver time; and 0.53 [0.50 to 0.57] for each 5% increase in probability of return to hospital. These results provide important information for clinicians and health care decision makers involved in implementing programs for NHL patients with FN.

Due to the loss and degradation of wetland habitat it has become accepted that active management of remaining habitat is needed to provide sufficient resources for migrating and wintering waterfowl. Numerous studies have documented increased seed production and waterfowl use on actively managed wetlands; however, no studies have evaluated the cost of active management or compared the cost effectiveness of actively and passively managed wetlands. I surveyed a random sample of restored wetlands in southern Illinois in 2005 and 2006 to compare the cost effectiveness of actively and passively managed wetlands. Actively managed wetlands had a greater percent cover of common waterfowl foods, Echinochloa spp. and Panicum spp., but also tended to have a greater percent cover of Xanthium strumarium, a common nuisance species. Actively managed wetlands also had greater waterfowl densities in 2005 and 2006. Duck energy-days were calculated from fall 2005 and fall 2006 seed biomass data and used as an effectiveness measure in the cost effectiveness analysis. In 2005, actively managed wetlands tended to provide more "duck energy-days" than passively managed wetlands, however, no difference was observed in 2006. Actively managed wetlands cost nearly 7 times more to restore per hectare, and nearly 3 times more to manage per hectare, than passively managed wetlands. My results suggest that although actively managed wetlands have the potential to provide more foraging resources for waterfowl, the cost effectiveness of actively and passively managed wetlands is similar. Choosing passive management as the typical restoration option would allow for more acres restored and may therefore be more beneficial to waterfowl, as well as other wildlife groups. When managers are faced with fixed budgets, management effectiveness could be enhanced if costs were considered in addition to the benefits of each management alternative.

Class of 2017 Abstract / Objectives: To determine the cost-effectiveness of proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors with high-intensity statins compared to high-intensity statins alone for the treatment of heterozygous familial hypercholesterolemia (HeFH). Methods: A Markov model was built through TreeAge Pro to model two groups: patients taking PCSK9 inhibitors with high-intensity statins or high-intensity statins alone. For each group, there were five health states that patients could be in: well, unstable angina, myocardial infarction, ischemic stroke, or death. The data used in the model were extracted from published clinical trials evaluating PCSK9 inhibitors and statins. Results: For the primary analysis, the overall cost and effectiveness was $31,390.93 and 23.01 for the statin alone group and $362,798.50 and 24.32 for the PCSK9 with statin group, respectively. The incremental cost, incremental QALY, and incremental cost-effectiveness ratio (ICER) was $331,407.60, 1.31 QALYs, and $252,833.60/QALY, respectively. Conclusions: Since the calculated ICER was higher than the pre-established threshold of $150,000, the results from our primary analysis suggest that treatment of patients with HeFH with a PCSK9 inhibitor and a high-intensity statin is not cost effective, compared to treatment with a high-intensity statin alone. However, when certain parameters (cost of PSCK9 and mortality rate) were adjusted in the secondary analyses, these agents appear to be cost-effective.

Environmental concern and the possibility of energy shortages have drawn attention to means for recovering material and energy resources from waste products. The focus of this thesis is on the application of cost-benefit analysis as a methodological technique for evaluating the economics of resource recovery: namely used lubrication oil. The study initially focuses on the general concern of the economics of resource recovery. This is undertaken primarily by a review of existing literature. An investigation of cost-benefit analysis as advanced by Pearce, Pearce and Dasgupta, Canadian Treasury Board Secretariat, Winch, Nath, Anderson, and Settle, to name a few, reveal a comprehensive and systematic framework for the evaluation of public investment alternatives. Items for inclusion in the analysis are all costs and benefits to every member of, a defined society whose welfare would be affected by the project if implemented. Many goods and services do not enter into the market system, causing difficulty in deriving monetary values for some of the components, especially environmental concerns. For example, the case study reveals two areas: 1) benefit of pollution abatement stemming from resource recovery of used lubrication oil, and 2) costs associated with the improper disposal of the waste products from the recycling process of used lubrication oil. An attempt is made to apply the cost-benefit framework to the case of lubrication oil recycling in the province of British Columbia. Adequate quantitative data were not available, particularly on the social costs and benefits, to fully employ the cost-benefit technique, therefore restricting the analysis in that only an identification of costs and benefits was prepared. When quantification of costs and benefits is not possible, a detailed description of the unquantifiable items indicates to the decision maker the extent of the components. Included in this study is a presentation of the environmental impacts of used oil disposal. The limitations of the cost-benefit analysis as an evaluation technique arise because of limited information and data needed to evaluate, in monetary terms, environmental improvement. Future research could involve a "simulation" of the market to determine a plausible shadow price that gives an indication of what the market price of the item would have been if it had been normally traded. A determination of the price that consumers would be willing to pay for the benefits of pollution control with the knowledge that some pollution would be produced by the recycling activity would aid the analyst in placing values on the costs and benefits. / Applied Science, Faculty of / Community and Regional Planning (SCARP), School of / Graduate

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