In this thesis, two methods are proposed in order to rank units: Target-direction-set value efficiency analysis (TDSVEA) and mixed integer programming (MIP) technique. Besides its ranking ability based on preferences of a decision maker (DM), TDSVEA, which modifies the targeted projection approach of Value Efficiency Analysis (VEA) and Data Envelopment Analysis (DEA), provides important information to analyzer: targets and distances of units from these targets, proposed input allocations in order to project these targets, the lack of harmony between the DM and the manager of the unit etc. In MIP technique, units select weights of the criteria from a feasible weight space in order to outperform maximum number of other units. Units are then ranked according to their outperforming ability. Mixed integer programs in this technique are simplified by domination and weight-domination relations. This simplification procedure is further simplified using transitivity between relations. Both TDSVEA and MIP technique are applied to rank research universities and these rankings are compared to those of other ranking techniques.

為了加入世界貿易組織，台灣早已自80年代逐步進行金融自由化的工作：早在1983年政府就擴大存放款利差，1984年允許銀行根據其個別情況制定基本放款利率並放寬本國銀行設立分行的家數與條件。然而金融自由化最重大的里程碑則是在1989年7月財政部修訂銀行法，開放新銀行設立並解除利率管制，自此之後台灣才真正成為金融自由化的國家。 本研究針對1986年到2002年的本國銀行，採用資料包絡分析法計算效率值，旨在探討台灣銀行業在開放新銀行設立前後的效率與生產力變動情形。不同於其他研究僅以年度為基礎來計算相對效率值，本研究使用「大邊界」的觀念建構出單一效率邊界，更能顯示出在一致的比較基礎上效率變動的趨勢。本研究的主要結果如下： 1.銀行業全體與開放前既存之舊銀行，在開放前的效率值均顯著大於開放後。至於開放後新舊銀行效率的比較，新銀行的整體技術效率與規模效率較高，舊銀行則在純技術效率上領先新銀行，但檢定結果僅有規模效率一項為顯著。 2.金控子銀行的效率值較非金控子銀行為高，顯示金控公司會挑選表現好的銀行作為合作夥伴。 3.在生產力分析部分，舊銀行開放後的總生產力仍小於開放前，儘管舊銀行在開放後的各項經營效率變動較開放前高，但因技術的大幅衰退以致整體生產力仍呈現衰退現象。顯示舊銀行雖然在效率上有所改善，但對於營運上的創新仍太過保守。 4.在Tobit迴歸分析的部分，股東權益報酬率、資產規模、流動準備率和效率值的關係為正向；分行家數、可控制費用、催收款比率和效率值的關係則為負向。 關鍵詞：銀行業、效率分析、資料包絡分析法、解除管制 / In order to join World Trade Organization, Taiwan has been gradually liberating its banking industry since 1980s. In 1983 Taiwan augmented the interest difference between loans and savings in banking industry. In 1984 Taiwan allowed a bank to set its own basic interest rate of loans base on business difference and reduced the restriction of setting up the new branches. The biggest leap was in 1989, Taiwan passed the new banking law which deregulated the banking industry. The new law opened the market for the new entrants and abandoned the interest regulation. The purpose of this research is to examine the efficiency and productivity changes before and after deregulation of Taiwan’s banking industry. This research applies Data Envelopment Analysis (DEA) approach to measure efficiency scores. The data include most of the domestic banks in Taiwan from 1986 to 2002. Unlike other research use yearly basis to measure relative efficiency difference, this research constructs a single efficiency frontier, grand frontier, to measure the trends of efficiency changes. The major findings of this research as follows. 1. The statistical results of the full sample exhibit that the efficiency measures before deregulation are statistically significant greater than that of after deregulation. Although the new entrants exhibit higher efficiency scores in total technical efficiency and scale efficiency than incumbents after deregulation, however, only scale efficiency indicates statistically significant level. Incumbents exhibit a higher pure technical efficiency than the new entrants after deregulation. 2. Banks that joined the financial holding company exhibit higher efficient scores than those of do not join the financial holding company. 3. The total factor productivity denotes a regress after deregulation. The major factor of productivity regress is due to technology decrease. However, the efficiency change of incumbent banks exhibits a significant increase after deregulation. The finding suggests that although the incumbent banks have significant improvements in efficiency, they are still too conservative in innovations. 4. The Tobit regression suggests that return on equity (ROE), total assets, and current-reserve ratio have a positive effect on efficiency measures; however, the number of branches, controllable expenses, and bad debt ratio have a negative effect on efficiency measures. Keywords: Bank industry, Efficiency analysis, Data envelopment analysis, Deregulation

摘要 1980年代至90年代初期，東亞各國成為全球經濟重要的發展區域之一，泰國、馬來西亞、印尼、菲律賓等繼亞洲四小龍之後成為亞洲地區成長迅速的新興開發中國家。然而，自1995年起，東南亞各國經濟開始出現衰退現象，1997年7月泰國更出現泰銖貶值，匯價劇跌，造成泰國股市的崩盤，傳染性的匯率貶值壓力延伸至菲律賓、馬來西亞、印尼與新加坡，甚至連東北亞的韓國，日本、台灣與香港也受波及，使得整個東亞地區幾乎都遭受到金融風暴的衝擊。 因此本研究針對1984至2002年的東亞國家，採用資料包絡分析法探討亞洲金融風暴對東亞各國效率的影響，利用Malmquist指數計算分析生產力變動的來源，以研究東亞各國在歷經金融風暴後如何調整其生產力及效率。 本研究依東亞各國受金融風暴影響的程度分為金融風暴國以及非金融風暴國兩大群組，實證結果顯示，東亞地區國家之整體技術效率值以及純技術效率值於金融風暴發生後有提升的現象，相較於金融風暴國於風暴前後之整體技術效率值以及生產力變動有顯著差異，非金融風暴國則未發生此一現象。本研究利用國內固定資本形成毛額作為投入要素與實質國內生產毛額作為產出項所構成的效率前緣曲線圖，分析解釋前述現象，發現金融風暴國在風暴前確實有投資過剩的問題，風暴後金融風暴國效率的提升來自於調整其生產規模、減少不當投資。 此外，本研究發現中國大陸的生產力在金融風暴後有逐年衰退的趨勢，其主要原因是來自於規模變動的不利影響，意味著中國大陸在展現高度經濟成長的同時，似乎已產生供給過剩的現象，是否會為日後的經濟發展帶來隱憂，甚至成為二次亞洲金融風暴的起源，值得注意。 / Abstract From the1980s to early 1990s, East Asia became one of the most important areas in developing the global economy. Thailand, Malaysia, Indonesia, and Philippine’s economy grew up fast and became the newly developing country following the Four little Dragons in Asia. However, since 1995, the economy of various countries in Southeast Asia began to decline. In July 1997 Thailand’s Thai Baht and exchange rate depreciated dramatically and crash of the Thai stock market. Then the Tai Baht currency depreciation rapidly spread to Philippine, Malaysia, Indonesia and Singapore; even South Korea, Japan, Taiwan and Hong Kong were involved in the crisis. As a result, the whole East Asia nearly all suffered this financial storm. Today, most of Asian countries are recovered from the Asia crisis. In order to analyze how East Asian countries to overcome the Asian financial crisis and adjust their productivity and efficiency, this study uses a panel data of 15 East Asian countries through 1984 to 2002 to apply data envelopment analysis (DEA) to assess the effects of the Asia financial crisis and measure the Malmquist productivity index to analyze the sources of the change in efficiency. The study breaks down the East Asian countries into two groups, Asian-crisis countries and non-Asian-crisis countries, depending on the extent to which they were affected by the Asian financial crisis. The major findings of this paper are as follows. The full samples denote that after crisis era the overall technical efficiency and the pure technical efficiency are higher than that of before crisis era. The further analysis demonstrates that such phenomenon only can be found in Asian-crisis group. This study constructs a two dimensions efficiency frontier curve graph by using gross fixed capital formation and gross domestic product as input and output proxy to analyze the efficiency change to help to explain the above phenomenon. The frontier efficiency curves find that the Asian-crisis countries indeed have over investment problem before the crisis, and the improvement of efficiencies after crisis is due to successful downsizing, such as reducing production scale and improper investments. In addition, this study illustrates that the productivity change in China has a tendency of declining over the last couple of years. The main reason comes from the unfavorable change in scale efficiency. The high economic growth accompanies over supply in China which reveals the similar phenomenon in Asia-crisis countries before the crisis. Therefore, it is worth to take a notice that whether the growth phenomenon in China becomes the source of the second Asian financial crisis in the future.

Bike share system (BSS) has received increasing attention in research for its potential economic and environmental benefits. However, some research has pointed out the negative sustainability impacts of BSS from rebalancing activity, due to its greenhouse gas (GHG) emissions and additional vehicle travels. Additionally, bike and station manufacturing also bring considerable emissions to the system. Therefore, it is important to analyze the current rebalancing efficiency and sustainability of BSSs, and to assist the BSS operators in optimizing the BSS design. Existing studies lack tools to estimate the real-world rebalancing activities and vehicle usage for system sustainability evaluation and improvements. To address this gap, this research first proposed a framework to estimate rebalancing activities and applied a clustering-based method to estimate the rebalancing vehicle use. Applying the framework to the BSSs in Chicago, Boston, and Los Angeles, this study estimated the rebalancing operation and compared the rebalancing efficiencies among the three systems. The analysis results show that 1) only a small proportion of stations and bikes were involved in the daily rebalancing activities; 2) most rebalancing activities were operated during the daytime, while the overnight rebalancing was limited; 3) the system scale, trip demand, and station types are critical for the rebalancing efficiency; and 4) reducing the rebalancing activities at self-rebalance stations could help to improve the rebalancing efficiency and benefits system sustainability. Additionally, the sustainability performance (e.g., carbon emissions) of BSS is not only decided by the rebalance, but also the manufacturing of bikes and stations. It is important to consider all these factors when optimizing a BSS. The existing literature on system improvement for the BSSs lacks an integrated view, and a well-designed integrated model for current BSS improvement is needed. The second part of this thesis built a simulation-based optimization model and generated 2400 scenarios for evaluation. This model aims to minimize the expansion investment, rebalancing mileage, and maximize the system demand and service rate. A Weight Sum Model is applied to solve the multi-criteria decision analysis. The model results show that the best system improvement is to build a new station with a small capacity and initial bikes. The investment and location impacts are discussed to find the tradeoff among expansion strategies. A sensitivity analysis is conducted to evaluate how different weight combinations (refer to different preferences in decision making) impact the preferred station configuration (docks and bikes) and new station locations.

I denna studie undersöks värdet av diagnostik vid sällsynta sjukdomar hos unga individer. Då området är mångfacetterat studeras två fall med olika karaktär. Det första fallet undersöker värdet av screening för den sällsynta sjukdomen fenylketonuri (PKU) bland nyfödda, denna screening har utförts sedan 1960-talet. Det andra fallet fokuserar på en mer modern teknologisk utveckling och utvärderar värdet av införandet av helgenomsekvensering (WGS) som genetiskt test vid sökandet efter sällsynta sjukdomar.  Båda fallen använder sig av kostnadseffektivitetsanalys som metod där kostnader respektive hälsoeffekter estimeras för de utvärderade insatserna. Fallen skiljer sig åt med avseende på tillgängliga dataunderlag vilket innebär att tillvägagångssättet för att skatta kostnaderna och hälsoeffekterna är olika i de båda fallen. I fallet med PKU-screening används Markovmodellering där data från olika källor syntetiseras i en simuleringsmodell. I fallet med WGS-testning används i större utsträckning ett insamlat empiriskt datamaterial som utgörs av faktiskt uppmätta sjukvårdskostnader.  Resultaten i båda fallen indikerar att de diagnostiska metoderna har en rimlig kostnad i förhållande till hälsoeffekterna. Fall ett åskådliggör att dagens screening för PKU genererar ökade hälsoeffekter till lägre kostnader i jämförelse med att inte screena för PKU. För en kohort på 100 000 nyfödda barn blir den sammanlagda hälsoeffekten en ökning med 73 QALYs och screeningen medför samtidigt en besparing på 53 376 602 kr, sett över ett livstidsperspektiv. Fall två visar att WGS som första genetiskt test i genomsnitt minskar sjukvårdskostnaderna med 15 903 kr per individ jämfört med nuvarande vård och ökar samtidigt chansen till diagnos med 9,5 procentenheter (45,7%). Resultaten bör tolkas med viss försiktighet då de är förknippade med osäkerheter, men kan samtidigt användas som en del av det underlag beslutsfattare behöver för att fatta beslut om hur hälso- och sjukvårdens resurser ska prioriteras. / This study examines the value of diagnostics in rare diseases in young individuals. As the field is varied, two cases with different character are studied. The first case examines the value of screening for the rare disease phenylketonuria (PKU) among newborns, this screening has been performed since the 1960s. The second case focuses on a more modern technological development and evaluates the value of the introduction of whole genome sequencing (WGS) as a genetic test in the search for rare diseases.  Both cases utilize the method of cost-effectiveness analysis where costs and health effects are estimated for the evaluated measures. The cases differ regarding available data, which means that the approach to estimating costs and health effects is different in the two cases. In the case of PKU- screening, Markov modeling is used where data from different sources are synthesized in a simulation model. In the case of WGS-testing, an empirical data material is used to a greater extent, which is based on actually measured healthcare costs.  The results in both cases indicate that the diagnostic methods have a reasonable cost in relation to the health effects. Case one illustrates that today's screening for PKU generates increased health effects at lower costs compared to not screening for PKU. For a cohort of 100 000 newborns, the total health effect will be an increase of 73 QALYs and the screening will also result in cost- savings of SEK 53 376 602, seen from a lifetime perspective. Case two shows that WGS used as an initial genetic test on average reduces healthcare costs by SEK 15 903 per individual compared with current care and at the same time increases the chance of diagnosis by 9.5 percentage points (45.7%). The results should be interpreted with some caution as they are associated with some uncertainties, but can still be used as part of the basis on which decision-makers need to make decisions on how health care resources should be prioritized.

Decisions on measures reducing environmental damage or improving environmental impact are usually constrained by financial limitations. Eco-efficiency analysis has emerged as a practical decision support tool by integrating environmental and economic performance. Environmental impact, as well as economic revenues and expenses, are usually distributed over a certain time scale. The temporal distribution of economic data is frequently assessed by discounting while discounting of environmental impact is rather uncommon. The scope of this paper is to reveal if this assumed inconsistency is common in eco-efficiency assessment literature, what reasons and interrelations with indicators exist and what solutions are proposed. Therefore, a systematic literature review is conducted and 35 publications are assessed. Theoretical eco-efficiency definitions and applied eco-efficiency indicators, as well as applied environmental and economic assessment methods, are compared here, but it is revealed that none of the empirical literature findings applied or discussed environmental discounting. It was, however, found in methodical literature. It is concluded that the theoretical foundation for the application of discounting on environmental impact is still insufficient and that even the theoretical foundation of economic discounting in studies is often poor. Further research and, eventually, a practical framework for environmental discounting would be beneficial for better-founded, more “eco-efficient” decisions.

Em um cenário global de indisponibilidade hídrica, até regiões sem histórico de escassez de recursos hídricos vêm sendo impactadas pela ausência de chuvas e circunstâncias de adversidade climática. Com perspectivas cada vez menos favoráveis quanto ao abastecimento hídrico, têm-se difundido progressivamente, no Brasil e no mundo, alternativas de tratamento de efluentes aquosos industriais visando seu reúso na própria indústria, diminuindo a necessidade de captação de água em corpos hídricos. Os processos de separação com membrana (PSM\'s) têm tido destaque, sobretudo para reúso em caldeiras e torres de resfriamento. Em um PSM, no entanto, os íons removidos da corrente de alimentação durante o processo de dessalinização concentram-se no compartimento de rejeito das membranas (concentrado). Consequentemente, os sais de baixa solubilidade comumente ultrapassam sua saturação e excedem seus limites metaestáveis, passando a oferecer risco de deposição sobre as membranas. As deposições salinas, chamadas incrustações (ou scaling) prejudicam o processo de dessalinização: reduzem a taxa de recuperação de água, aumentam o consumo energético e danificam membranas e tubulações. Uma vez que o sulfato de bário (BaSO4) é um dos sais com maior potencial incrustante em efluentes industriais, e cujas incrustações apresentam maiores resistências às práticas convencionais de limpeza, estudou-se métodos preventivos de incrustação de BaSO4 por remoção de íons bário de fase líquida a montante de um PSM. A depleção de bário de solução foi analisada mediante: (i) precipitação de BaSO4 por meio de dessupersaturação (com adição de sementes) e efeito do íon comum (excesso de sulfato) e (ii) precipitação de CaCO3 por abrandamento com incorporação do íon Ba2+ no precipitado. Desenvolveu-se, inicialmente, um estudo conceitual da precipitação de BaSO4 por modelagem termodinâmica, aplicada ao tratamento de um efluente padrão de refinaria de petróleo supersaturado em BaSO4. As simulações termodinâmicas apontam que o pre-tratamento de efluentes por dessupersaturação, com opção de adicionar sulfato (via adição externa ou reciclo) são promissores para aumentar o rendimento de PSM\'s. Em estudos experimentais com efluente sintético de refinaria de petróleo, foi obtida a cinética de precipitação do BaSO4 para o ajuste de um modelo de precipitação de BaSO4. Observou-se que o tempo de indução do BaSO4 foi reduzido à medida que se aumentou o excesso de sulfato (em relação ao bário presente) ou à medida que se adicionou sementes de BaSO4. Após um período curto de precipitação (alguns minutos), a solução permanecia supersaturada por longos períodos (horas), com razões de supersaturação residuais dentro da faixa de 1,1 a 3,0. Esses valores foram associados com uma dependência de quarta ordem da taxa de crescimento do cristal com a taxa de supersaturação. Verificou-se que a carga de sementes de BaSO4 é diretamente proporcional à depleção de supersaturação, que sementes heterogêneas (CaCO3, CaSO4.2H2O) são ineficazes para a precipitação do BaSO4 e que os íons cálcio inibem a precipitação de BaSO4. A precipitação de CaCO3 (em mix de vaterita e calcita) por abrandamento em efluente sintético foi eficaz para remover bário da solução. O mecanismo que controla o processo foi identificado como sendo a substituição isomórfica do íon cálcio pelo íon bário no retículo cristalino do carbonato de cálcio. Consequentemente, a remoção de bário da solução é favorecida quando se aumenta a quantidade de carbonato de cálcio precipitado e quando o coeficiente de distribuição aparente em vateita e calcita (DBa, que indica a quantidade de bário incorporada ao sólido) é elevado. Valores altos de pH e de concentração de cálcio elevam a precipitação de CaCO3 e, portanto, maximizam a remoção de bário. O coeficiente de distribuição aparente do bário mostra-se independente do pH inicial (na faixa de 9,5 a 11,7) e aumenta com a concentração de cálcio. Ele também aumenta com a quantidade de sementes de calcita, o que pode ser consequência de uma maior incorporação de bário em camadas que crescem sobre substratos puros de CaCO3 ou ainda, pode ser devido à manifestação de mecanismos de adsortivos com o aumento de lugares ativos disponíveis para incorporação de bário. Em experimentos com efluente real, ao contrário do observado com soluções sintéticas, a remoção de bário por dessupersaturação foi realizada com eficiência mesmo em presença do íon cálcio, devido provavelmente a sua complexação com aditivos orgânicos. Em precipitação de calcita, fatores que aumentam a supersaturação inicial, como adição de carbonato e aumento do pH, elevaram a precipitação de CaCO3, o que maximizou a remoção de bário. Tais fatores, no entanto, reduziram valores de DBa em calcita, possivelmente devido à diminuição na sorção de íons que estimulam a incorporação do bário. Dosagens de sulfato (insuficientes para precipitar BaSO4) reduziram a quantidade de calcita precipitada, diminuindo a remoção de bário e, inesperadamente, elevando DBa em calcita. Por fim uma análise de ecoeficiência foi feita em um estudo de reúso de água com zero de descarte líquido em refinaria de petróleo aplicando as técnicas de precipitação estudadas. A implantação de etapas de precipitação e de unidades maiores de osmose inversa (OI) acarretaram em reduções no consumo de energia no tratamento térmico do concentrado da OI, diminuindo proporcionalmente a emissão de gases de efeito estufa, consumo de água e degradação ecotoxicológica de água doce. Além disso, verificou-se redução de capital de investimento (dada à aquisição de equipamentos de evaporação menores) e redução nos custos energéticos operacionais. / In a global scenario of water unavailability, even regions with no records of water scarcity have been impacted by the absence of rainfall and climatic adversity. With increasingly unfavorable perspectives on water supply, alternatives to water treatment for industrial reuse have been progressively diffused in Brazil and around the world, reducing the need for water withdraw in water bodies. The membrane separation processes (PSM) have been emphasized in the tertiary treatment of industrial effluents, providing improvement in water quality for reuse in boilers or cooling towers. In a PSM, however, the salts removed from the feed stream during the desalination process are concentrated in the brine stream (concentrate). At this stage, the low solubility salts commonly exceed their saturation in the system, and surpasses their metastable limits, offering risk of deposition on the membranes. Salt deposits, called scaling, jeopardize the desalination process: they reduce the rate of water recovery, increase energy consumption and damage membranes and pipes. Since BaSO4 is one of the salts with the greatest scaling potential in the industry, and which the fouling presents the greatest resistance to conventional cleaning practices, preventive methods of BaSO4 scaling were studied by removal of barium ions from the liquid phase upstream a PSM. The barium depletion from solution was analyzed during the processes of: (i) precipitation of BaSO4 by means of desupersaturation (with addition of seeds) and common ion effect (excess of sulfate) and (ii) chemical precipitation of CaCO3 (softening) with incorporation of the Ba2+ ion in the precipitated crystal. A conceptual study of the BaSO4 precipitation was first developed by thermodynamic modeling, applied to the treatment of a standard oil refinery effluent supersaturated in BaSO4. The thermodynamic simulations show that effluents pretreatment by desupersaturation, with the option of adding sulfate (via external addition or recycle), are promising to increase the yield of PSM\'s. In experimental studies with synthetic oil refinery effluent, BaSO4 precipitation kinetics were obtained in order to adjust a BaSO4 precipitation model. The BaSO4 induction time was reduced as the excess sulfate (relative to the barium present) was increased and/or as BaSO4 seeds were added. After a short period of precipitation (a few minutes), the solution remained supersaturated for long periods (hours), with residual supersaturation ratios within the range of 1.1 to 3.0. These values were associated with a fourth order dependence of the crystal growth rate with the supersaturation rate. It was found that BaSO4 seed loading is directly proportional to the supersaturation depletion, heterogeneous seeds (CaCO3, CaSO4.2H2O) are ineffective for BaSO4 precipitation and that calcium ions inhibit BaSO4 precipitation. The precipitation of CaCO3 (as a mix of vaterite and calcite) by softening in synthetic effluent was effective to remove barium from solution. Isomorphic substitution of calcium by barium ion in the crystalline lattice of calcium carbonate was identified as the controlling mechanism of sorption process. Consequently, removal of barium from the solution is favored when the amount of precipitated calcium carbonate is increased and when the apparent distribution coefficient (DBa, which indicates the amount of barium incorporated into the solid) is raised. High values of pH and calcium concentration raise the precipitation of CaCO3 and, therefore, maximize the barium removal. The apparent barium distribution coefficient is independent of the initial pH (in the range of 9.5 to 11.7) and increases with calcium concentration. It also increases with the amount of calcite seeds, which may be consequence of higher barium incorporation in growing layers on CaCO3 pure substrates, or may be due to manifestation of adsorption mechanisms by the increase on available active places for barium incorporation. In experiments with real effluent, unlikely the synthetic solutions, the removal of barium by desupersaturation was performed efficiently even in the presence of calcium ion, probably due to its complexation with organic additives. In calcite precipitation, factors that increase initial supersaturation, such as carbonate addition and pH increase, elevates CaCO3 precipitation, which maximized the barium removal. These factors, however, reduced DBa in calcite, possibly due to a decrease on sorption process of ions which may stimulate barium incorporation. Sulphate dosages (insoluble to precipitate BaSO4) reduced the amount of precipitated calcite, decreasing barium removal and unespectly reducing the DBa in calcite. Finally, an eco-efficiency analysis was carried out in a water reuse study with zero liquid discharge in an oil refinery, applying the precipitation techniques studied. The implementation of precipitation stages and larger units of OI resulted in reductions in energy consumption in the thermal treatment of OI concentrate, reducing proportionally the emission of greenhouse gases, water consumption and ecotoxicological degradation of fresh water. In addition, there was reduction of investment costs (given the purchase of smaller evaporation equipment) and reduction in the operational energy costs.

INTRODUÇÃO: O presente trabalho teve como objetivo elaborar análise custoefetividade do esquema de quimiorradioterapia com cisplatina (estratégia 2) comparado ao tratamento radioterápico (estratégia 1) para pacientes portadores de CECCP localmente avançado não elegíveis para tratamento cirúrgico. MÉTODOS: levantamos dados prospectivos de 33 pacientes na estratégia 2 e dados retrospectivos de 29 pacientes tratados no HC-FMUSP e Hospital A.C. Camargo, (estratégia 1). Consideramos a tabela de reembolso do Sistema Único de Saúde (perspectiva SUS) e custos do HC-FMUSP com honorários profissionais, medicamentos, demais insumos e depreciação de equipamentos (perspectiva Institucional). A medida de efetividade foi 1 ano de vida ganho, livre de progressão da doença (SLPD). Calculamos a Razão Incremental Custo Efetividade (RICE). RESULTADOS: 31% dos pacientes da estratégia 1 e 58% na estratégia 2) tiveram 1 ano de SLPD. Na perspectiva SUS o custo total por paciente na estratégia 1 foi de R$ 2.798,52 e R$ 4.938,11 na estratégia 2. Na perspectiva institucional os custos foram R$ 26.798,52 e R$ 5.040,79, respectivamente. A RICE na perspectiva SUS foi de R$ 7.924,00 reais por ano de vida ganho e R$ 8.912,71 na perspectiva institucional. CONCLUSÃO: nas duas perspectivas a estratégia 2 se mostrou custo-efetiva, sendo o custo incremental considerado aceitável, segundo diretrizes do Banco Mundial. / INTRODUCTION: The present study aims to conduct a cost-effectiveness analysis comparing chemoradiotherapy with cisplatine and radiotherapy alone, to treat inoperative advanced head and neck cancer. METHODS: we collected data from 29 patients in a prospective study on chemoradiotherapy with cisplatin, conducted at Hospital das Clínicas HC-FMUSP,(strategy 2). For strategy 1, we collected retrospective data of 33 patients treated with radiotherapy at HC-FMUSP and Hospital A.C. Camargo. We considered only direct costs (personnel, drugs, material and equipment depreciation). We considered, the National Health Service (SUS) reimbursement parameters as the National Security System perspective, and HC-FMUSP costs as the institutional perspectives. We measured effectiveness as one year of diseasefree life gained. We collected costs and effectiveness data and calculated the cost-effectiveness incremental ratio ICER, which expresses additional costs per life year gained, in strategy 2, compared to strategy 1 RESULTS: 31.0% of the patients treated in strategy 1 lived more than 12 months, without disease progression, compared to 58.0% of the patients in strategy 2. According to SUS perspective, the total cost per patient in strategy 1) is R$ 2.798,52 and R$ 4.938,11 in strategy 2. Considering the institutional perspective, total costs are R$ 2.634,36, and R$ 5.040,79 respectively. In SUS perspective, the ICER ratio of strategy 2 compared to 1 is R$ 7.924,00 per lifes year gained. In the institutional perspective, ICER is R$ 8.912,71. We conducted a one way sensitivity analysis to verify our calculations. CONCLUSION: Chemoradioterapy with cisplatin proved more cost-effective than radiotherapy. Using the World Bank guidelines, wich considers the countries GDP per capita an acceptable cost per additional year of life (R$ 12.491,00 in 2006), the incremental cost of both is acceptable.

Στη διατριβή αυτή έχει αναπτυχθεί ένας νέος συνδυασμός της Ανάλυσης Κύκλου Ζωής (ΑΚΖ) και της Ανάλυσης Οικολογικής Απόδοσης, που εφαρμόζεται για την αξιολόγηση της περιβαλλοντικής και ενεργειακής απόδοσης και της απόδοσης κόστους ενός πρότυπου ηλεκτροχρωμικού παραθύρου, η οποία έχει σκοπό να χρησιμοποιηθεί ως διάταξη εξοικονόμησης ενέργειας σε κτήρια. Ο κύριος στόχος είναι να επισημάνουμε πώς η συγκεκριμένη μέθοδος συμπληρώνει τις δύο μεθόδους, ενσωματώνοντας τα ιδιαίτερα πλεονεκτήματά τους σε ένα πληρέστερο και πιο ισχυρό διαγνωστικό εργαλείο. Η αποδοτικότητα της μεθόδου αποδεικνύεται με εφαρμογή σε έναν ηλεκτροχρωμικό υαλοπίνακα (K-Glass/WO3/πολυμερής ηλεκτρολύτης/V2O5/K-Glass), διαστάσεων 40cmx40cm. Αξιολογείται ολόκληρος ο κύκλος ζωής του εφαρμόζοντας τη μέθοδο της ΑΚΖ (ISO 14040). Για να μετρηθεί και να καταγραφεί η οικολογική απόδοση, χρησιμοποιούνται δείκτες περιβαλλοντικής απόδοσης, οι οποίοι βασίζονται σε ισοζύγια υλικών και ενέργειας και ορίστηκαν λαμβάνοντας υπόψη διάφορες παραμέτρους, (σενάριο ελέγχου, προσδοκώμενος χρόνος ζωής, κλιματικές συνθήκες, κόστος αγοράς). Ο συνδυασμός των αποτελεσμάτων οδηγεί σε σημαντικά συμπεράσματα για τον συνδυασμό ιδιοτήτων και τις πιθανές βελτιώσεις, που μπορεί να χρησιμοποιηθούν στη λήψη αποφάσεων για το σχεδιασμό και την ανάπτυξη του προϊόντος και για την επιλογή της βέλτιστης περίπτωσης μεταξύ διαφόρων υαλοπινάκων για ειδικές κλιματικές συνθήκες. Τέλος, μια τέτοια μεθοδολογία μπορεί να χρησιμοποιηθεί για την καθιέρωση ενεργειακής σήμανσης, ή ενεργειακής ταξινόμησης των παραθύρων, ενώ επιπλέον είναι σύμφωνη με την Ευρωπαϊκή Οδηγία (2002/91/EC) για την ενεργειακή απόδοση των κτηρίων, που απαιτεί πιστοποιητικά ενεργειακής απόδοσης για υφιστάμενα και νέα κτήρια. / In this study, a novel combination of the Life Cycle Assessment (LCA) and the Eco-efficiency analysis has been developed and implemented to evaluate the environmental, energy and cost efficiency potential of an electrochromic (EC) window prototype that aims to be used as an energy saving component in the building. The main objective is to mark out how the proposed method complements the traditional techniques, namely LCA and Eco-efficiency integrating their individual advantages into a more complete and a further more powerful diagnostic tool. The efficiency of the method is demonstrated with implementation to a 40cm x 40cm EC glazing (K-Glass/WO3/polymer electrolyte/V2O5/K-Glass). The whole life cycle of the EC glazing is evaluated by implementing the method of LCA (ISO 14040). In order to measure and report the ecological efficiency, environmental performance indicators were used, based on material and energy balances. The indicators were suitably defined taking into consideration various parameters (control scenario, expected lifetime, climatic type, purchase cost). Significant conclusions can be drawn for the development and the potential applications of the device compared to other commercial fenestration products. The combination of the results leads to significant conclusions for the balance of its properties and possible improvements that can be utilized in decision making for the product design and development and for the selection of an optimum case among various fenestration products for specific areas/climates. Finally, such a methodology can be utilized to establish a system for energy labeling or energy rating of windows and it is in accordance with the European Directive (2002/91/EC) on the energy performance of buildings, which calls for energy performance certificates to be available for new and existing buildings.

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