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Faculty of health Sciences, School of Pharmacy, Msc (Med)Research Thesis. / Objective: To assess the relative cost effectiveness of moxifloxacin once-daily empirical monotherapy and ofloxacin/ metronidazole twice daily combination therapy for the treatment of uncomplicated pelvic inflammatory disease in adult female patients. Design: This is a retrospective cost analysis using data from a clinical trial in order to perform the economic anlysis from a funder perspective. The cost analysis is based on the clinical results of the MAIDEN study which is a prospective, randomized, double-blind, multicentre, multinational Phase III study comparing the efficacy and safety of moxifloxacin 400 mg po od for 14 days with ofloxacin 400mg po bid plus metronidazole 400mg po bid for 14 days in patients with uncomplicated pelvic inflammatory disease. Decision analysis is used to characterise the economic outcomes between groups and provide a structure upon which to base the sensitivity analyses. Published 2004 cost values are used throughout. Cost values for moxifloxacin are based on the retail price of Avelon tablets in South Africa as appears on the Orderwise Retail Pharmacy Ordering System (September 2004). Cost values for the comparator, ofloxacin and metronidazole, are based on the cheapest available generics on the South African market i.e. Zanocin 400 and Metazol 400mg respectively. Method: The cost analysis is based on the clinical results obtained from the MAIDEN study. Patients were enrolled in either the moxifloxacin treatment group (Group A) or the ofloxacin / metronidazole comparator group (Group B). Resource utilization included: - cost for study antimicrobials (total number of doses for the study period) - treatment for adverse events occurring up to 7 days after stopping the study medication - treatment for failures (includes patients continued on antimicrobial therapy after the 14 day course of therapy) - cost of additional physician visits to treat adverse events and treatment failures The primary end-point is the overall cost of treatment per patient as determined by: Clinical response 7 to 14 days after the last dose of study medication (Test-of-Cure visit) Since the clinical findings from the MAIDEN study showed that moxifloxacin treatment was at least as efficacious as ofloxacin/metronidazole treatment, a cost-minimization analysis was performed and the results were analysed according to decision analysis. Decision analysis was used to characterise the economic outcomes between the groups and provided a structure upon which to base the sensitivity analyses. The outcomes were depicted on a decision tree which proportionately determined the cost of treatment per patient in the two treatment groups. Results: No significant differences in clinical success rates were detected. Differences were mainly due to the cost of treating adverse events in the two groups. Costs per patient in the monotherapy vs combination therapy comparisons were R10 847.00 for moxifloxacin and R16 630.00 for ofloxacin/metronidazole treatment. Sensitivity analyses revealed that moxifloxacin monotherapy can be cost effective compared with ofloxacin/metronidazole combination therapy in different situations. Conclusion: Per patient, the cost of drug treatment and treatment of adverse events and clinical relapses was R10 847.00 for treatment with moxifloxacin therapy and R16 630.00 for ofloxacin/metronidazole therapy . In comparison to ofloxacin/metronidazole combination therapy, moxifloxacin monotherapy was therefore cost saving.

BACKGROUND: Until recently budget allocation for public hospitals in the Gauteng Province were based on the historical values and not on the costed activities. It is therefore unknown how much of the allocated budget is used per discipline in an institution. Because of recurrent over expenditure by institutions, Gauteng Department of Health and Social Development have decided to change policy for budget allocation of funding public health facilities from historical allocation to activity based costing. Although good financial management of hospitals is a priority for the government, data on real costs of providing health care services is scarce and unreliable. No formal study has been done to estimate the cost to provide inpatient services in the Helen Joseph Hospital, a regional hospital in the Gauteng Province. In view of that, it was decided to initiate this study at the Orthopaedic unit of the Hospital, which would then be extended to the other units. AIM: To estimate the caseload, profile of patients and operational cost of providing the inpatient orthopaedics services at a regional hospital in Gauteng. METHODOLOGY: A cross-sectional study design was used based on retrospective review of patients’ and hospital records of patients admitted during one month study period at the two Orthopaedic Ward in the Helen Joseph Hospital, situated in the Johannesburg Health District in the Gauteng Province. RESULTS: Total number of patients admitted in the Orthopaedic Unit of the Hospital in the year 2009/2010 was 2160 (The mean number of inpatients per month was 180 ± 28). Profile of patients One hundred and ninety seven patients were admitted during one month study period. There were more male than female patients. The median age was 41 years (IQR 31-53 years). More black patients were admitted during this period, even though the main catchment population for the Hospital is predominantly white and coloured. The majority of patients were from a low socio-economic class as reflected by their classification for user fee payment using the means test. The median inpatient day was 3. The most common cause of admissions is due to injury, poisoning and certain other consequences of external causes as expected in an Orthopaedic Ward. A low complication rate (4.5%) was found to be the lowest as compared to other units in the Hospital. The majority of patients were discharged. Cost drivers The major cost driver was human resource which accounted for 70% of the total expenditure. Other cost drivers were material resources used in the unit, which includes: laboratory, blood and blood products, radiology and pharmaceuticals. Expenditure on these items account for only 13.7% of total expenditure. Cost driver Amount Unit cost Laboratory R61,215.57 R412.26 Blood and blood products R53,164.41 R269.87 Radiology R52,085.50 R264.39 Pharmaceuticals R17,315.82 R87.90 The total expenditure during this period was R 1,481,363.30 or R 17,776,359.60 annually. The unit cost of laboratory services (Ward 4: R926.30 and Ward 5: R272.97), blood and blood products (Ward 4: R463.05 and Ward 5: R217.52), radiology (Ward 4: R659.97 and Ward 5: R157.20) and pharmaceuticals (Ward 4: R236.63 and Ward 5: R47.60) and varied significantly between Ward 4 and Ward 5 which might be due to difference in clinical practices between the two Wards. CONCLUSION: This study showed the operational costs needed to provide an inpatient orthopaedic service at a regional health facility. Further study based on more detailed costing at individual patient level is necessary to develop a better understanding of costing at these Wards. This study highlighted the significance of understanding the importance of determining the actual costs needed to provide an inpatient service in a health facility. Simple cost analysis method could easily be done at Unit/ Ward level to provide more insight to Hospital managers who are always criticized for overexpenditure.

"Submitted in partial fulfillment of the requirements for the degree of Master of Business Administration from the Naval Postgraduate School, December 2009." / Advisor(s): Jones, Lawrence R. ; Potvin, Lisa. "December 2009." "MBA Professional report"--Cover. Description based on title screen as viewed on January 28, 2010. Author(s) subject terms: Navy Working Capital Fund, Net Operating Result (NOR), Accumulative Operating Result (AOR), Naval Facilities Engineering Command (NAVFAC), Public Works Department (PWD), Utilities, Labor Hours, Expenses, Revenues, Break Even, Budget Forecasting, Business Model, Variance Analysis, Stabilized Rate, Financial Management, Operations, Policy, Workload, Industrial Business Information System (IBIS). Includes bibliographical references (p. 71-73). Also available in print.

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Thesis (M.B.A.)--Boston University

BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development goals (WHO, 2002). The Maternity unit of the Job Shimankana Tabane (JST) Hospital, situated in the Rustenburg city (regarded as the fastest growing city within South Africa) is burdened with increasing number of patients for the last few years with resultant increased resource utilisation. However, there is no systematic study done to describe this situation. The above mentioned scenario necessitates this study to assess the operational cost of the Obstetrics Unit in relation to caseload, profile of patients, and resource utilization. AIM: To determine the operational costs within the Obstetrics Unit of the JST Hospital in terms of caseload, profile of patients, and resource utilization METHODOLOGY: Cross sectional study design was used for this study. Retrospective record review was done and information extracted from various sources of hospital information system. No primary data was collected for this study. Setting of this study was the Obstetrics unit at Job Shimankana Tabane Hospital situated within Rustenburg city of Bojanala District in North West Province. Data was collected on various variables that are relevant to the function of women health services and resource utilization in Obstetrics unit of this Hospital. Results: Obstetric unit of Job Shimankana hospital experienced high caseload due to patient bypassing primary health care service points including district hospitals with highest number being seen afterhours; and due to inappropriate referrals from clinics. Analysis of profile of these patients showed 93% being Africans, 90% unemployed; and 70% being single. Hospital obstetric unit operational costs amount to just over R1.3 million with 57% accounted for by goods and services and human resource accounting for the remaining 43%. The average was R7, 717.75, which is very high. Conclusion: The operational cost of this obstetric unit was found to be very high and quality may have been compromised due to increased caseload, leading to low length of stay.

The objective of this thesis is to undertake a cost analysis of an HIV/AIDS prevention programme targeting vulnerable groups in Benin. The AIDS-3 project (Projet Sida 3), a project targeting Female Sex Workers (FSWs), which was implemented from 2001 to 2005, is used as a case study to see how costs vary with location, volume of activities, and HIV prevalence rate. Activities and delivery modes were documented, and cost data have been collected both retrospectively (data on previous “Projet Sida 3” costs already available) and prospectively, using an ingredients-based costing methodology to consider both the financial and economic costs. Output measures were compiled directly from the intervention, and are related to the efficient delivery of different components of the intervention. Average cost per output or per outcome was estimated and cost variation within and between health centres over time was assessed. Results reveal that only the volume of activity is a prominent factor that affects the average cost. The location of the project and the experience of the staff also affect costs as well, but their significance is low. Field work activities that are more efficient in urban areas than in rural communities appear to be paramount in the fight against HIV as far as costs are concerned. / HIV/AIDS Cost analysis

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management May 2013 / Laboratory tests are considered a critical clinical intervention in the diagnosis and treatment of various medical conditions. However, ordering of laboratory tests is not immune from abuse (under / over-use), which necessitates that the service be effectively managed. It has been a matter for concern that there actually are no benchmarks in existence against which district hospitals laboratory test ordering patterns can be measured. This study concerns the generation and compilation of a body of knowledge that will serve as a baseline / benchmark for comparison purposes on a month-to-month basis at Brits District Hospital, as well as for comparisons with other district hospitals, towards the development of best practices.

The economic viability of farming in Saskatchewan is eroding and the future of the industry is becoming uncertain given the current economic state. The combination of low commodity prices, increasing input and transportation costs, ongoing drought conditions, inadequate safety net programs, and environmental concerns resulting from agricultural greenhouse gas emissions has led to this uncertainty. One possible solution for producers to help overcome or at least minimize the negative trends occurring in agriculture, which is proposed, is afforestation of agricultural land. Afforestation not only provides net private benefits of timber income but external benefits, including carbon sequestration, and preservation of native forests, which provides areas for hunting, wildlife viewing, and conservation of land. The economic efficiency of afforestation was examined using a transitional benefit cost framework for both crop and pasture systems. This allowed for both private and social perspectives, along with the opportunity costs, to be included and the economic efficiency of afforestation from each perspective was determined. The potential conversion of agricultural land to afforestation was based solely on economic efficiency and assumed producers demonstrated an economically rational decision making process. The results from the benefit cost analysis indicated that the net private benefits from afforestation were never significant enough to warrant the conversion of either crop or pasture systems to afforestation. The results did however show that the net social benefits from afforestation would warrant the conversion of crop systems to afforestation for a limited number of situations. Crop systems on physically marginal land with a carbon payment of either $22.58 or $33.55 tonne of C would warrant conversion to afforestation, using either a single or infinite rotation. The infinite rotation resulted in a larger allocation of land to afforestation. The role afforestation can play in helping producers diversify and increase income levels is limited. The low price paid for timber and the high costs of establishment for afforestation are the main constraints. In order for afforestation to become economically efficient on a large scale the constraints facing producers needs to be addressed.