Aims: To assess effectiveness and economic benefit of the psychological treatment of anxiety disorders in order to compare them with the consumed resources of the treatment. Methods: Assessment of specific and non-specific symptoms and impairments in N=493 anxiety patients (DSM-IV) receiving cognitive behavior therapy pre, post, and one year after treatment with various measures. Additional analyses of costs of the treatment and the benefits due to reduced work disability and health care utilization after therapy (including a pilot study using a willingness-to-pay approach). The treatment setting can be characterised as clinically typical for everyday practice. Core results: a) effectiveness: Effect sizes ranged from 0.9 to 1.9. All improvements were significant and lasted until 1-year-follow-up. Rates of clinically significant therapy success ranged from 63% to 79% depending on outcome measure and success criteria. b) cost-effectiveness analysis: Cost-effectiveness-indices ranged from DM 8338.- to DM 10456.- for one successful treatment (average costs taking also the costs of unsuccessful treatments into account). c) cost-benefit-analysis: Cost reduction in the year after therapy was remarkable (inpatient costs about 25%, other cost factors 87%-100%), resulting in a benefit of DM 3026.- per patient and a cost-benefit-ratio of 1:0.58 in the first year after treatment. Assuming that the improvements are stable, the cost-benefit-ratio after five years would be estimated as 1:2.63. Discussion: The present study shows exemplarily for CBT of anxiety disorders that modern psychotherapy can produce remarkable results at reasonable costs. Furthermore, clinical-psychological treatment methods show an additional economic benefit. Clinical Psychology can benefit from focusing not only the promising developments in classification, etiology, and treatment but also taking over the cost perspective (which is relatively new in scientific evaluation of psychotherapy). (Appendix: Cost-Benefit-Calculator.htm; 8,97 KB -- Usage: Referat Informationsvermittlung/ SLUB) / Fragestellungen: Ermittlung von Effektivität und monetärem Nutzen psychologischer Behandlung von Angststörungen, die dann den für die Therapie aufgewendeten Ressourcen gegenübergestellt werden. Methoden: N=493 Patienten mit Angststörungen (DSM-IV), die eine ambulante störungsspezifische kognitive Verhaltenstherapie absolviert haben, wurden prä, post und zur 1-Jahres-Katamnese untersucht. Das Spektrum der Erhebungen umfasste störungsspezifische und störungsübergreifende Symptombelastung und Beeinträchtigungen in verschiedenen Lebensbereichen, sowie eine globale Therapieerfolgseinschätzung von Patienten und Therapeuten. In einer zweiten Studie wurden zusätzlich an einer Teilstichprobe Kosten-Nutzen-Aspekte untersucht (Einsparungen durch Reduktion von Gesundheitsleistungen und Arbeitsunfähigkeit; außerdem Pilotstudie zu willingness-to-pay-Ansatz). Das Behandlungssetting der Studie ist charakterisiert durch klinisch relevante Rahmenbedingungen und Praxisnähe. Zentrale Ergebnisse: a) Effektivität: Die Effektstärken reichten in Abhängigkeit von der Meßmethode von 0.9 bis 1.9. Die Verbesserungen waren durchgängig signifikant und blieben bis zur 1-Jahres-Katamnese stabil. Die Raten klinisch bedeutsamer Besserungen betrugen 63% - 79% in Abhängigkeit von Mess- und Auswertungsmethode. b) Kosten-Effektivitäts-Analyse: Die Kosten-Effektivitätivitäts-Indices betrugen DM 8338.- bis DM 10456.- (dieser Index gibt an, was eine erfolgreiche Behandlung durchschnittlich kostet, also unter Einbezug der nicht erfolgreichen Behandlungen in die Gesamtkosten). c) Kosten-Nutzen-Analyse: Im Jahr nach Therapie reduzierten sich die Kostenfaktoren der Störungen vor Therapie beträchtlich (stationäre Kosten um 25%, restliche Kostenfaktoren 87% - 100%). Die dadurch erzielten Einsparungen betrugen durchschnittlich DM 3026.- (Kosten-Nutzen-Verhältnis im ersten Jahr: 1 : 0.58). Unter der Annahme, dass die Auswirkungen der Therapie auch über die 1-Jahres-Katamnese hinaus stabil bleiben, kann man abschätzen, dass sich die Therapie innerhalb des zweiten Jahres amortisiert und das Kosten-Nutzen-Verhältnis nach fünf Jahren (diskontiert) 1 : 2.63 beträgt. Diskussion: Wie in dieser Arbeit anhand der kognitiven Verhaltenstherapie für Angststörungen gezeigt wird, kann moderne Psychotherapie bei vertretbarem Aufwand beachtliche Erfolge verbuchen. Klinisch-psychologische Behandlungsmethoden sind darüber hinaus auch wirtschaftlich, derart, dass sie über den reinen Behandlungserfolg hinaus zu Kosteneinsparungen beitragen könnten. Es ist erstaunlich, dass die Kosten-Perspektive der wissenschaftlichen Bewertung von Psychotherapie noch recht neu ist. Die Klinische Psychologie kann davon profitieren, diese Dimension (neben den beachtlichen Erkenntnisfortschritten in bezug auf Klassifikation, Ätiologie, Verlaufsforschung und Behandlungsverfahren) mehr herauszustellen. (Anlage: Cost-Benefit-Calculator.htm; 8,97 KB -- Nutzung: Referat Informationsvermittlung der SLUB)

This professional project estimates the upfront costs and utility savings expected from greening an approximately 1,100 square foot home built in the 1950s in the San Francisco Bay Area. Two sets of upgrades (alternative and original) were compared for costs and benefits. The alternative set (which included ceiling insulation and omitted upgrading to dual-pane windows) clearly out performed the original set. The alternative set would be expected to reduce resident utility bills by 28% annually, and to prevent approximately 2,700 lbs of carbon dioxide emissions annually. The water efficiency upgrades were the best performing group of upgrades, as they had the lowest upfront cost and shortest payback period. (These water efficiency upgrades consisted of modifying toilets, faucets, and showerhead, as well as upgrading the dishwasher and clothes washer to efficient models.) Future very low-budget greening programs, in nearly all cases, should include a full-set of water fixture modifications, weatherstripping, and clotheslines. As budgets allow, other upgrades from alternative upgrades list are recommended, such as ceiling fans, programmable thermostats, and ceiling insulation. Whenever possible, workforce development labor should be used to simultaneously reduce labor costs and multiply the social benefit of each project dollar by providing entry-level green collar jobs.

Les amputations d’un membre supérieur sont non seulement dévastatrices pour le bien-être physique, psychologique et social des patients, mais elles comportent également des répercussions financières importantes pour l’individu et le système de santé. Les allotransplantations de tissus composites vascularisés ont été proposées en tant que solution permettant de rétablir la forme et la fonction au détriment d’une immunosuppression à vie et d’un taux élevé de rejet chronique. Les prothèses myoélectriques combinent l’expertise chirurgicale avec les avancées technologiques pour réhabiliter les fonctions motrices d’un moignon amputé, mais elles demeurent limitées par un taux élevé d’abandon et des coûts importants. Dans les systèmes de santé avec des ressources limitées, les dirigeants ont la tâche complexe de partager équitablement l’allocation de ressources entre plusieurs maladies et interventions. Dans le domaine de l’économie de la santé, les analyses de type coût-bénéfice ont été développées pour répondre à ces questions. Les mesures d’utilité doivent incorporer l’impact que le traitement suscite sur l’espérance de vie et la qualité de vie. Ces utilités sont ensuite rapportées en fonction du coût, ce qui permet aux dirigeants de la santé de déterminer dans quels traitements il serait préférable d’investir les ressources. Dans cette thèse, nous proposons un modèle pour étudier les coûts-utilité des allotransplantations de la main et des prothèses myoélectriques. Pour commencer, une étude pilote a été effectuée sur les amputations du pouce traitées avec des lambeaux libres de l’orteil, ce qui nous a permis de confirmer la faisabilité des questionnaires d’utilité conçus. Par la suite, les utilités ont été mesurées dans une population d’amputés du membre supérieur, de patients réimplantés proximalement et de contrôles en santé. Les résultats démontrent que 1) les patients réimplantés rapportent la meilleure utilité avec les prothèses myoélectriques, 2) les amputés unilatéraux préfèrent significativement les prothèses myoélectriques également, et 3) aucune différence n’a été recelée entre les deux traitements chez les amputés bilatéraux. Au final, une analyse des coûts-bénéfices a été effectuée dans le contexte du système de santé canadien, démontrant que le traitement des patients amputés unilatéralement avec des prothèses myoélectriques permettrait de sauver davantage de coûts, alors que l’écart en épargnes monétaires se rétrécit pour les amputés bilatéraux traités avec une allotransplantation ou une prothèse. Avec les résultats rapportés dans cette thèse, nous pouvons proposer une mise à jour des indications de traitements pour les patients avec une amputation du membre supérieur. Basé sur l’analyse de type coût-utilité, nous concluons que les amputés unilatéraux sont de meilleurs candidats pour des prothèses myoélectriques, alors que les deux traitements sont encore adéquats pour les amputations bilatérales. / Amputations of the upper extremity are not only devastating for the patient’s physical, psychological and social well-being, but they also yield significant financial repercussions to the individual and the healthcare system. Vascularized composite allotransplantations of the upper extremity were proposed as a solution to restore form and function, albeit to the detriment of lifelong immunosuppression and high rates of chronic rejection. New-generation myoelectric prostheses combine surgical prowess with technological refinements to rehabilitate motor functions of the amputated stump, but remain plagued by high rates of abandonment and significant costs. In healthcare systems wherein resources are limited, financial regulators have the difficult task of proposing an equitable divide of resource allocations between a multitude of diseases and interventions. In the field of health economics, cost-benefit analyses were developed to assist in this decision-making process. Utility outcome measures need to encompass the impact that a treatment elicits on life expectancy and quality of life. Comparison of utilities of different interventions as a function of cost further indicates which route healthcare regulators should partake. In this thesis, we propose a model to study cost-utilities of hand allotransplantation and myoelectric prostheses. To begin, a pilot study was performed on thumb amputations treated with free toe flaps, which allowed to confirm the feasibility of the utility questionnaires that we developed. Afterwards, utilities and quality adjusted life years were measured in a population of upper extremity amputees, proximally replanted patients and healthy controls. Findings demonstrated that 1) replanted patients reported the highest utility outcomes for myoelectric prostheses, 2) unilateral amputees significantly preferred myoelectric prostheses as well, and 3) no significant preference between both interventions was obtained in patients with bilateral amputations. Finally, a cost-benefit analysis was performed in the context of the Canadian healthcare system, demonstrating that significant savings can be achieved with treatment of unilateral amputations with myoelectric prostheses, whereas the gap in cost savings between both treatment groups becomes less significant in bilateral amputees. With the findings reported in this thesis, we can propose an update of the indications for treatment in patients with upper extremity amputations. From the perspective of cost-utility analyses, we conclude that unilateral amputees are better candidates for myoelectric prostheses, and that both treatments can still be offered in cases of bilateral amputations.

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The pandemic has disrupted nearly every aspect of our lives, including tasks as fundamental as going to work. The change has brought with it both opportunities and challenges. The use of digital services to hold meetings, webinars and conferences has increased at an avalanche-like pace. Before the pandemic took hold, there was a more traditional view of work - with the general perception that work tasks should be performed in the office. As a stark contrast to this more traditional view of work, nearly 75 percent of Swedish workplaces was forced to switch to working remotely in a short time and many believe that this will lead to permanent changes in how Swedish offices are designed. There are numerous indications that most people want to continue working in offices in the future as well. On the other hand, the working life of the future is characterized by an increased demand for flexible solutions. Research exhibited that most organizational and work variables were considerably related with the outcome measures productivity and work satisfaction, while individual and household variables were significantly less corelated. For organizations, this is vastly beneficial, since organizational and work-related characteristic variables are far easier influenced by procedures and HR policies rather than individual work style and household factors. The work-from-home trial period induced by the pandemic has evidently unveiled the vast number of organizations who have the capabilities to implement remote work on a permanent basis and that employees highly regard the opportunity to do so. Conversely, it correspondingly exhibited how imperative the office is for colleague interaction as well as collaboration and how immensely this have been longed for the past year. This study exhibits that the East Link Project in Stockholm, Sweden would save 182 000 SEK annually per employee working remotely 2 days per week due to reduced real estate, absenteeism, turnover, emissions, continuity of operations, and increased productivity. Further, it exhibited that the average project member would save 7 260 SEK annually due to fewer expenses, 128 hours due to reduced commuting and would sleep 59 hours more per year. / Pandemin har haft verkan på nästintill samtliga aspekter av våra liv, inklusive uppgifter så fundamentala som att gå till jobbet. Omställningen har medfört både möjligheter och utmaningar. Tillämpningen av digitala tjänster för att hålla möten, webinarier och konferenser har ökat i en lavinliknande takt. Innan pandemin tog fäste förekom det en mer traditionell syn på arbete - med den allmänna uppfattningen att arbetsuppgifter bör utföras på kontoret. Som en skarp kontrast till denna mer traditionella syn på arbete tvingades nästan 75 procent av de svenska arbetsplatserna att på kort tid gå över till att arbeta på distans och många tror att detta kommer att leda till permanenta förändringar i hur svenska kontor är utformade. Mycket tyder på att de flesta också vill fortsätta arbeta på kontor i framtiden. Samtidigt som framtidens arbetsliv präglas av en ökad efterfrågan på flexibla lösningar. Tidigare studier visade att de flesta organisations- och arbetsvariabler var betydligt relaterade till produktivitet och arbetsnöjdhet, medan individuella och hushållsvariabler var betydligt mindre korrelerade. För organisationer är detta mycket fördelaktigt, eftersom organisatoriska och arbetsrelaterade karakteristiska variabler påverkas mycket lättare av procedurer och HR-policyer snarare än individuell arbetsstil och hushållsfaktorer. Försöksperioden av hemarbete som förorsakats av pandemin har tydligt uppdagat det stora antalet organisationer som har förmågan att implementera distansarbete på permanent basis och att medarbetare i hög grad uppskattar möjligheten att göra det. Samtidigt exponerade det på motsvarande sätt hur essentiellt kontoret är för såväl kollegors interaktion som för samarbete. Denna studie visar att projekt Ostlänken i Stockholm, Sverige skulle spara 182 000 kronor per år och per anställd som arbetar på distans två dagar per vecka till följd av minskad frånvaro, omsättning, utsläpp, kontorsyta, kontinuitet i verksamheten och ökad produktivitet. Slutligen visade studien att den genomsnittliga projektmedlemmen skulle spara 7 260 kronor och 128 timmar årligen till följd av minskade kostnader och minskad pendling samt skulle sova 59 timmar mer per år.

No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.

No / Increasing pressure on health care budgets highlights the need for clinicians to understand the true costs of wound care, in order to be able to defend services against indiscriminate cost cutting. Our aim was to develop and test a straightforward method of measuring treatment costs, which is feasible in routine practice. The method was tested in a prospective study of leg ulcer patients attending three specialist clinics in the UK. A set of ulcer-related health state descriptors were defined on the basis that they represented distinct and clinically relevant descriptions of wound condition ['healed', 'progressing'; 'static''deteriorating; 'severe' (ulcer with serious complications)]. A standardised data-collection instrument was used to record information for all patients attending the clinic during the study period regarding (i) the health state of the ulcer; (ii) treatment received during the clinic visit and (iii) treatment planned between clinic visits. Information on resource use was used to estimate weekly treatment costs by ulcer state. Information was collected at 827 independent weekly observations from the three study centres. Treatment costs increased markedly with ulcer severity: an ulcer which was 'deteriorating' or 'severe' cost between twice and six times as much per week as an ulcer which was progressing normally towards healing. Higher costs were driven primarily by more frequent clinic visits and by the costs of hospitalisation for ulcers with severe complications. This exercise has demonstrated that the proposed methodology is easy to apply, and produces information which is of value in monitoring healing and in potentially reducing treatment costs.

Klimatförändringar till följd av den ökande halten koldioxid i atmosfären är en växande utmaning. Som följd av detta har Uppsala kommun ökat sina hållbarhetsinsatser, varav biokol har visat sig vara ett lovande alternativ. Biokol fungerar som en kolsänka genom att lagra kol långsiktigt i marken, samtidigt som det förbättrar jordens struktur och näringsinnehåll. Denna rapport syftar till att utforska möjligheterna till att upprätta en biokolsanläggning inom Uppsala kommun. För att utreda möjligheterna till en sådan anläggning utförs analys av tillgängligt biomassaflöde, utvärdering av pyrolysteknik samt identifiering av platsspecifika begränsningar. Därtill har tillstånd och krav på en anläggning identifierats och sammanställts.  Metoden bygger på ett teoretiskt ramverk, som appliceras för att utvärdera och sedan maximera lönsamheten vid rekommendation av plats. Intervjuer har genomförts, för att skapa en förståelse för teknik och drift samt för att fastställa diverse kostnadsposter. En budgetkalkyl har sedan skapats utifrån kartlagda kostnader, för vilken en finansiell analys sedan utförts. Med utgångspunkt i den analysen har lämpliga platser valts ut, vilka kompletterats med en rekommendation av optimal teknik och resurshantering. Miljörelaterade externaliteter för rekommenderade platser har tilldelats ett monetärt värde, för att sedan sammanvägas med det finansiella resultatet i en kostnads- och nyttoanalys Utifrån avgränsningen att det finns en stabil marknad och efterfrågan på biokol, har analysen resulterat i en hög avkastning på de rekommenderade investeringarna, samt en märkbar förbättring då externaliteterna inkluderas. Resulterande slutsatser har varit klimatnyttor skulle utgöra en stor del av lönsamheten för Uppsala kommun, men att avgränsningen riskerar att ge missvisande finansiella resultat. Framtida arbeten bör med fördel kartlägga marknaden för biokolsproduktion, samt analysera och utvärdera pris och efterfrågan för avsättningar. / Climate change due to the increasing levels of carbon dioxide in the atmosphere, is a growing challenge. As a result, Uppsala Municipality has increased its sustainability efforts, among which biochar has proven to be a promising alternative. Biochar acts as a carbon sink by storing carbon long-term in the soil, while also improving soil structure and nutrient content. This report aims to explore the possibilities for establishing a biochar facility within Uppsala Municipality. To investigate the feasibility of such a facility, an analysis of available biomass flow, evaluation of pyrolysis technology, and identification of site-specific constraints are conducted. Additionally, the permits and requirements for a facility have been identified and compiled. The methodology is based on a theoretical framework, applied to evaluate and then maximize profitability when recommending a site. Interviews have been conducted to understand technology and operations, and to determine various cost items. A budget calculation has been created based on identified costs, for which a financial analysis has then been performed. Based on this analysis, suitable sites have been selected, complemented with a recommendation of optimal technology and resource management. Environmental externalities for recommended sites have been assigned a monetary value, which is then combined with the financial result in a cost-benefit analysis. Assuming a stable market and demand for biochar, the analysis has resulted in a high return on the recommended investments, along with a noticeable improvement when externalities are included. The resulting conclusions indicate that climate benefits would constitute a significant part of the profitability for Uppsala Municipality, but that the assumption risks providing misleading financial results. Future work would benefit from mapping out the market for biochar production, as well as analyzing and evaluating the price and demand for biochar outputs.

I dagens samhälle är det viktigt att använda sig av optimerade transportförbindelser där det är samhällsekonomiskt lönsamt. Optimala beräkningar och värderingar är viktiga för att inse vilka projekt som kommer att bli lönsamma. Syftet med denna kvantitativa studie är att undersöka de effekterna som påverkar ett infrastrukturprojekt där nyttan och kostnaden av en färjeled jämförs med en bro i ett mindre samhälle. Detta för att se om en broförbindelse mellan Hemsön och Strinningen är samhällsekonomisk lönsam.  Data samlades in från den nuvarande färjeleden mellan Strinningen och Hemsön. Metoden som valdes var en samhällsekonomisk nyttoanalys som utgick från ramverket från ASEK 8, där de påverkande effekterna togs fram och de beräkningsbara effekterna beräknades. Konsumentprisindex tillämpades för att vikta upp de beräkningsbara effekterna till projektets startdatum. Därefter användes nuvärdesmetoden för att vikta kostnader och nyttor över projektets diskonteringsperiod. En Monte Carlo-simulering tillämpades för att beräkna osäkra kostnader och nyttor. Detta gjordes genom att slumpmässigt generera värden i intervallet där de osäkra nyttorna låg med ett stort antal iterationer. Resultatet av de beräkningsbara effekterna visade på en genomsnittlig förlust med en låg sannolikhet för att projektet skulle bli samhällsekonomiskt lönsamt. De ej beräkningsbara effekterna var främst positiva men var med störst sannolikhet inte tillräckligt stora för att göra medelvärdet för nettovinsten positiv. Detta betydde att en ny broförbindelse mellan Strinningen och Hemsön över den ekonomiska livslängden inte skulle bli samhällsekonomiskt lönsam. / In today’s society, it is important to make use of optimized transport links where it is economically viable. Optimal calculations and valuations are important to understand which projects will be profitable. The purpose of this quantitative study is to examine the effects affecting an infrastructure project where the benefit and cost of a ferry link is compared to a bridge in a small city. This is to see if a bridge connection between Hemsön and Strinningen is economically viable.   Data was collected from the current ferry route between Strinningen and Hemsön. The method chosen was a cost benefit analysis that was based on the framework form ASEK 8, where the effects were drawn up and the calculable effects were calculated. The consumer price index was applied to weight up the calculable effects to the projects start date. The present value method was used to weight costs and benefits over the projects discount period. A Monte Carlo simulation was applied to calculate uncertain costs and benefits. This was done by randomly generating values in the range where the uncertain benefits lay with a large number of iterations. The result of the calculable effects showed an average loss with a low probability that the project would be economically viable. The non-calculabe effects were mainly positive but were most likely not large enough to make the average value of the net profit positive. This meant that a new bridge connection between Strinningen and Hemsön over the economic lifespan would not be economically viable.