Nesta tese são desenvolvidos três estudos sobre o risco associado aos acidentes de trânsito, com o objetivo de avaliar como a população o percebe, e o valor que estaria disposta a pagar para reduzi-lo. As análises foram feitas com duas diferentes metodologias econométricas e dois diferentes conjuntos de dados da população de Porto Alegre. O primeiro estudo procurou avaliar que fatores de risco contribuem para aumentar a gravidade dos acidentes de trânsito, utilizando dados de acidentes de trânsito ocorridos na cidade de Porto Alegre no período 2000-2008, através de modelos logit ordenados generalizados. Os resultados indicam que a maioria das vítimas feridas em acidentes de trânsito são condutores jovens, do sexo masculino e que estavam em motocicletas ou cujo acidente foi um choque contra obstáculos. Contudo, as vítimas fatais têm maior probabilidade de morte são os pedestres, com mais de 60 anos de idade. Os acidentes com maior gravidade ocorrem em maior proporção a noite ou finais de semana, em locais mais afastados do centro da cidade, o que sugere comportamento associado à alta velocidade e uso de substâncias psicoativas como álcool. Para os demais estudos utilizaram-se dados de um survey feito com a população de Porto Alegre em 2009. O segundo estudo avalia como as características sócio-demográficas, a experiência no trânsito e a informação recebida, afetam a percepção do risco e o comportamento no trânsito. Os resultados indicam que os indivíduos que tem risco maior de morte no trânsito subestimam seu próprio risco e vice-versa; e que os mais jovens têm maior percepção deste risco, assim como os que tiveram experiência de acidente de trânsito ou passam mais tempo expostos a ele. O risco do consumo de bebidas alcoólicas associado ao trânsito, no entanto é percebido maior pelos idosos, mulheres, não bebedores ou quem não tem comportamento de risco, assim como pelos que têm mais informação do risco. Da mesma maneira, o comportamento de risco no trânsito associado ao consumo de álcool está negativamente relacionado a percepção deste risco e a idade. O terceiro estudo estimou a disposição a pagar ( ) dos entrevistados pela redução no seu próprio risco de sofrer lesões em um acidente de trânsito e o valor de uma vida estatística ( ), utilizando modelos lineares e não-lineares ajustados através de uma transformação Box-Cox. Os resultados indicam que a esta relacionada de forma decrescente com a idade e com a não utilização de dispositivos de segurança, mas aumenta com a renda, o tempo de exposição ao trânsito, a experiência com acidentes, para as mulheres e para os que têm dependentes. O valor médio eliciado da para reduzir a zero o risco das lesões mais graves, que resultam em morte, implicou em de cerca de R$ 13,4 milhões (US$7,3 milhões) - valor menor, porém comparável ao encontrado para países desenvolvidos e em estudo para o Brasil. / This thesis develops three studies on the risk associated with traffic accidents, in order to assess how people perceive it and the value they would be willing to pay to reduce it. The analysis was made with two different econometric methods and two different sets of data from Porto Alegre's population. The first study to assess at risk factors that contribute to increased severity of accidents, using data obtained from traffic accidents in the city of Porto Alegre between the years 2000 and 2008, and applying the generalized ordered logit. The results indicate that most of the victims injured in accidents are young drivers, males, motorcyclists and whose crash was a “collision with obstacles”. However, fatal victims have a different profile: they are pedestrians, over 60 years old. The most serious accidents occur in greater proportions at nights or weekends, at locations further away from the city center, which suggests behavior associated with high speed driving and the use of psychoactive substances, such as alcohol. The other two studies used data from a survey done with the population of Porto Alegre in 2009. The second study evaluates how socio-demographic characteristics, traffic experience and the information received about the risks of driving under the influence of alcohol, affect risk perception and behavior in the traffic. The results indicate that individuals who have greater risk of dying in traffic, underestimate their own risk and vice versa; and that young people as well as those who have been in an accident or those who spend a lot of time in traffic, have a greater perception of their risk. On the other hand, the risk of alcohol consumption associated with traffic, is perceived better by older people, women, non-drinkers, people without risky behavior, and those who are more aware of the risks of driving under the influence of alcohol. Similarly, risky behavior in traffic, related to alcohol consumption, is inversely proportional to perception of risk and to age. The third study estimated the respondents' willingness to pay ( ) for the reduction in their risk of suffering injuries in a traffic accident, as well as the value of a statistical life ( ), using linear and nonlinear models adjusted by the Box-Cox transformation. The results indicate that the decreases with age and with not using safety devices, but increases with income, exposure to traffic, and the accidents experience, for women and for those who have dependents. The average value elicited by to reduce to zero the risk of severe injuries that result in death, implied a of about R$13.4 million (US$ 7.3 million) - lower, but still a comparable value to that found in developed countries, and studied in Brazil.

Introdução: As avaliações econômicas em saúde (AES) têm participado como ferramenta de apoio ao processo de decisão no setor de Saúde. No Brasil, seu uso passou a ser amplamente difundido na última década, já sendo obrigatória sua apresentação em processos de incorporações de novas tecnologias no sistema único de saúde. Embora muitas avaliações econômicas de saúde tenham sido conduzidas, nenhum estudo revisou sistematicamente a produção e qualidade das avaliações brasileiras. Objetivo: Revisar sistematicamente e avaliar a qualidade do relato dos estudos publicados de avaliação econômica de tecnologias em saúde desenvolvidos no Brasil. Métodos: Foi conduzida uma revisão sistemática incluindo AES completas e parciais desenvolvidas no Brasil, e publicadas entre 1980 e 2013. Foram utilizadas as bases de dados eletrônicas (Medline, Embase, Lilacs, Scielo, NHS EED, HTA database, Bireme e BVS ECO); os índices de citação (Scopus, Web of science) e Sisrebrats. Resultados: Foram incluídos 535 artigos, dos quais 36,8% foram considerados AES completas, sendo 39,1% análises de custo-efetividade. Quase metade (46,4%) dos estudos não relatou o tipo de análise conduzida, desses 91,9% eram AES parciais. Entre as que informaram, houve concordância entre o relato e o conduzido em 71,4% dos estudos. As modalidades das tecnologias, mais frequentemente, avaliadas foram procedimentos (34,8%) e medicamentos (28,8%) cujo objetivo principal era o de tratamento (72,1%). As três categorias de doenças cujas tecnologias foram, mais frequentemente, avaliadas foram: doenças infecciosas (17,4%), doenças do aparelho circulatório (12,9%) e neoplasia (10,3%). Entre as tecnologias avaliadas pelos estudos incluídos, apenas 64 haviam sido objeto de análise por comissões nacionais de incorporação (CITEC e CONITEC). A maioria dos artigos foi conduzida por autores da academia (65,1%), que se concentram, principalmente, na região Sudeste (73,6%) e Sul (12,5%). O principal veículo de publicação foram as revistas nacionais (72,5%), com escopo médico (55,5%). Apenas 43,5% dos estudos relataram a fonte de financiamento e 36,1% relataram presença de conflito de interesse. Setenta e nove por cento das AES completas obtiveram resultados favoráveis para as tecnologias avaliadas. Com relação à qualidade do relato, apenas 6,6% dos estudos relataram todos os itens avaliados no checklist, mas 47,7% foram considerados em conformidade (relato minimamente satisfatório). Alguns itens como 1) métodos utilizados para mensuração dos dados de custos, 2) taxa de desconto, 3) fontes de financiamento, e 4) conflitos de interesse foram relatados em apenas metade dos estudos. A qualidade do relato apresentou associação estatística significativa (p < 0,001) com o período de publicação (estudos mais recentes apresentaram maior qualidade) e com a presença de conflito de interesse (estudos com conflito de interesse apresentaram maior qualidade). As fontes de dados clínicos, de uso de recursos e de custos foram considerados com melhor nível de evidência quando comparadas às fontes de utilidade. Nos últimos anos, houve um aumento da produção de análises de custo-utilidade, porém a maioria dos estudos utilizou utilidades de outros países validadas por painéis de especialistas brasileiros. Conclusão: Um grande número de AES foi publicado no Brasil entre 1980 e 2013. A qualidade do relato foi considerada satisfatória, principalmente na AES publicadas mais recentemente. Para que as AES possam aumentar sua contribuição nos processos de decisão nacionais, são necessários esforços para melhora da qualidade dos relatos, transparência e padronização da metodologia utilizada e o aperfeiçoamento do sistema de revisão pelos pares nas revistas nacionais não específicas em economia da saúde / Introduction: Health Economic Evaluation (HEE) have participated as a supportive tool to decision-making in health sector. In Brazil, their use has been widespread in the last decade having become mandatory as part of the processes for new technologies in the Brazilian Unified National Health System. Although many Health Economic Evaluation have been conducted, there are no studies that have systematically reviewed the production and quality of Brazilian evaluations. Objective: To systematically review and evaluate the quality of reporting of published studies of health economic evaluation developed in Brazil. Methods: Was conducted a systematic review including full and partial HEE developed in Brazil and published between 1980 and 2013. Electronic databases (Medline, Embase, Lilacs, Scielo, NHS EED, HTA database, Bireme and the BVS ECO); citation indexes (Scopus, Web of science) and Sisrebrats were searched. Results: We included 535 articles, of which 36.8% were considered full HEE, being 39.1% cost-effectiveness analysis. Almost half (46.4%) of the studies did not report the type of analysis conducted, of these 91.9% were partial HEE. Among the reported, there was 71.4% agreement between the reported and conducted in the studies. The most frequent evaluated modalities of technologies were procedures (34.8%) and drugs (28.8%), whose main objective was treatment (72.1%). The three most often evaluated categories of diseases were infectious diseases (17.4%), cardiovascular diseases (12.9%) and cancer (10.3%). Among the technologies evaluated by the included studies, only 64 had been the subject of analysis by incorporating national commissions (CITEC or CONITEC). Most articles were developed by Authors from academia (65.1%), who are mainly concentrated in the Southeast (73.6%) and South (12.5%) regions. The main vehicles for publication were national journals (72.5%), with medical scope (55.5%). Only 43.5% of the studies reported the source of funding and 36.1% reported conflict of interest. Seventy-nine percent of the full HEE obtained favourable results for the evaluated technologies. Regarding the quality of reporting, only 6.6% of the studies had all items evaluated in the checklist, but 47.7% was considered to be in accordance with the reporting requirements (minimally satisfactory reporting). Items such as 1) methods used to measure the cost data, 2) discount rate, 3) funding sources, and 4) conflicts of interest were reported in only half of the studies. The quality of reporting was significantly related (p < 0.001) to the publication period (more recent studies presented higher quality) and the presence of conflict of interest (presence of conflict of interest presented higher quality). Compared to the utilities, the clinical effect size, resources, and costs data were mostly estimated based on high-ranked evidence. In recent years, there has been an increase in production of cost-utility analysis, but most studies used utilities from other countries validated by Brazilian expert panels. Conclusion: A large number of HEE was published in Brazil between 1980 and 2013. The quality of reporting was considered satisfactory, particularly in most recently published HEE. To increase their contribution in national decision-making processes, efforts are needed in order to improve the quality of reports, transparency and standardization of the methodology and the improvement of the peer-review system in national non-specific journals of health economics

É possível medir a eficiência do Estado? A proposta desta dissertação de mestrado é apresentar a avaliação de impacto regulatório AIR como uma das ferramentas possíveis e existentes para atender a esse desafio exigido pela Constituição Federal a partir da Emenda Constitucional 19/98, tendo como referencial analítico as decisões regulatórias. A AIR é instrumento de controle da atividade regulatória do Estado por meio de procedimento administrativo voltado à análise das decisões regulatórias a serem adotadas ou já adotadas pelos agentes reguladores com base em evidências empíricas, resultando na introdução de mecanismos de legitimação democrática e de responsabilização do regulador. Ela se baseia no uso sistemático de análises dos possíveis custos e benefícios das várias alternativas existentes para atender à(s) finalidade(s) desejada(s) e sinalizada(s) nas políticas públicas setoriais. Fala-se em mecanismos de legitimação democrática e de responsabilização do regulador diante do seu potencial de reduzir o déficit democrático presente no modelo do Estado regulador, em que o agente administrativo não eleito, no exercício de seus poderes, toma decisões que podem gerar impacto significativo aos particulares. Sustenta-se que isso é possível por meio da transparência e da publicidade do processo de tomada de decisão a partir da utilização da AIR pelos agentes reguladores. Esse aspecto leva a outro: a AIR como instrumento de controle. Essa ferramenta também possibilita a redução do risco da agência presente na delegação de poder do principal (Poder Legislativo e o Chefe do Poder Executivo) para o agente (agentes reguladores). A AIR ganha especial importância com o Programa de Fortalecimento da Capacidade Institucional para Gestão em Regulação (instituído pelo Decreto 6.062 de 16 de março de 2007) que tem como objetivo idealizar e implementar essa ferramenta na administração pública federal. / Is it possible to measure State efficiency? This dissertation aims to introduce regulatory impact assessment RIA as an existing possible tool to tackle this challenge assigned by the Federal Constitution in the constitutional amendment 19/98. RIA is an instrument to control the State via an administrative procedure based on the analysis of empirical evidences of regulatory decisions either to be taken or already taken by regulators. As a result, it introduces democratic legitimacy mechanisms and accountability of regulators. Its methodology is based on the systematic use of cost-benefit analysis of proposed alternatives in order to apply a public policy in a regulated sector. The mechanisms for democratic legitimation and accountability of regulators are justified by its potential to reduce the democratic deficit within the regulatory State, in which the non-elected administrative agent, in the exercise of his/hers own powers, makes decisions that can impact individuals. This is due to the transparency and publicity of the decision-making process that derives from the adoption of RIA. Another aspect then arises: RIA as an instrument of control. This tool will enable the reduction of the agency risk characteristic of the power delegation from the principal (Legislative Power and chief of Executive Power) to the agent (regulators). RIA gets more attention with the creation of the governmental program for strengthening the institutional capacity for regulation (Presidential Decree 6.062, March, 16th of 2007), whose scope is to conceptualize and implement such a tool in the federal public administration.

Sistemas gerenciais em estabelecimentos de saúde podem ser considerados sistemas complexos, tendo em vista interação entre diferentes tipos de agentes na tomada de decisão (médico, paciente, gestor, entre outros), observação de transições de fase em epidemiologia, emergência de padrões de comportamento auto-organizado entre profissionais de saúde e incertezas quanto ao desfecho em saúde pós-tratamento. Em geral, os sistemas de apoio à decisão médica buscam maximizar resultados positivos e minimizar riscos em saúde aos pacientes, assim como propor diretrizes terapêuticas padronizadas e controlar custos em saúde. Há evidências de diferenças nos custos e benefícios derivados de sistemas decisórios Bayesianos centralizados (única distribuição a priori) e descentralizados (uma distribuição a priori por médico) aplicados ao processo de decisão de reserva de leito de Unidades de Terapia Intensiva (UTI) para períodos pós-operatórios. A existência de interação entre médicos com diferentes papéis no sistema decisório de indicação de UTI requer técnicas sofisticadas de avaliação econômica para comparação de vantagens e desvantagens associadas sistemas decisórios Bayesianos centralizados e descentralizados; tendo em vista que a aplicação de técnicas simples, como árvores de decisão ou cadeias de Markov, podem apresentar resultados imprecisos. Os objetivos deste estudo foram analisar a relação custo-benefício de sistemas de apoio à decisão médica centralizados e descentralizados para indicação de reserva de leito de UTI pós-operatório da perspectiva do sistema de saúde. Foi utilizada modelagem baseada em agentes, a partir de simulação de agentes usando raciocínio e atualização de crenças Bayesianos implementada no software NetLogo com análise de sensibilidade em Behavior Space. O modelo de decisão descentralizada apresenta benefício três vezes superior ao modelo centralizado (R$600 contra R$200). O modelo decisório descentralizado apresenta melhor razão custo-benefício ao sistema de saúde, permitindo maior flexibilidade na decisão médica e adaptabilidade dos agentes a diferentes situações. / Management systems in health facilities may be considered complex systems, due to the interaction among different types of agents in the decision process (physician, patient, manager, among other), observation of phase transitions in epidemiology, emergence of patterns in self-organized behavior among health professionals, and uncertainty in relation to health outcomes after treatment. In general, the medical decision support systems seek to maximize positive results and minimize risks in health to patients, as well as to propose standard therapeutic guidelines and to control the treatment costs. There are evidences of differences in costs and benefits derived from centralized (unique distribution a priori) and decentralized (one distribution a priori for each physician) Bayesian decision systems applied to the process related to decision of post-operatory booking of hospital beds in Intensive Care Unit (ICU). The existence of interaction among physicians in different roles in the decision system for ICU indication requires sophisticated techniques in economic evaluation for comparison of advantages and disadvantages associated to centralized and decentralized Bayesian decision systems; since other techniques, as decision trees and Markov chains, may present imprecise results. The objective of this study was to analyze the cost-benefit ratio of centralized and decentralized medical decision support systems for indication of booking of ICU beds in post-operatory period using the perspective of the health system. One agent-based model was applied, using simulation of agents based on Bayesian reasoning and beliefs updating implemented in the software NetLogo with sensitivity analysis in Behavior Space. The decentralized decision model presents benefits three times higher than the centralized decision model (US$270.27 versus US$90.09). The decentralized decision model presents better cost-benefit ratio to the health system, allowing enhanced flexibility in the medical decision process and adaptability of the agents to different situations.

Made available in DSpace on 2016-04-28T20:16:31Z (GMT). No. of bitstreams: 1 2006-Alziro Vasconcelos Carneiro.pdf: 455403 bytes, checksum: 96b519d909bc30f30ddc42546978acfb (MD5) Previous issue date: 2006-07-31 / There are several pathogens causing bovine mastitis, but only Streptococcus agalactiae is feasible to be eradicated from a herd. Two herd data ( A and B ) were used to evaluate the economic and technical viability of the eradication of this pathogen, based on this pathogen attack program. It was used a 24 month period data from production; somatic cells count (SCC), clinical mastitis and expenditures. A cost-benefit analysis was carried out through mathematical models. It was identified 16 infected cows with S. agalactiae in herd A , and in herd B , there were 42, from which 31 associated with Staphylococcus aureus. The therapy effectiveness in eliminating S. agalactiae was about 100% in both herds. However, 18 cows kept the infection of S. aureus after the therapy (42% of effectiveness). The number of cases and cows with mastitis decrease was about 18% and 21%, respectively. For herd B it was found a SCC growing tendency on infected group and on total milk, 12 months before the therapy (980x10P 3 P and 968x10P 3 P cells/ml averages, respectively) and stabilization after treatment (577x10P 3 P cells/ml and 563x10P 3 P cells/ml averages, respectively). Treatment cost was about R$ 175.95 per cow considering the following higher cost items: laboratory exams (39%); milk discard (31%); veterinary medicaments and labor for additional operations (20%); and veterinary fees (10%). Payment due to quality and to the decrease in clinical mastitis cases represented about 55% e 34% of total benefit. However, it was not found significant milk production increase for treatment program (p>0.05), in treated group, nor in herd B . It was estimated about 11.67; 6.45 and 2.61 monetary unit return for each unit invested. Prophylactic procedures were important to eradicate and maintain the herd free from S. agalactiae, they have also contributed for lower incidence of clinical mastitis, decreasing SCC and discard/precocious mortality, so its adoption is recommended. Considering Brazilian requirements relative to somatic cells and milk total bacterial as well as S. agalactiae role in increasing these parameters, it is suggested an eradication program of this pathogen, which may help farmers to maintain production under standard requirements, as well as the consumers reducing risk and Government income loss due to taxes collection. / Entre os v?rios pat?genos causadores de mastite, o ?nico que pode ser erradicado do rebanho ? Streptococcus agalactiae. Dados de dois rebanhos, 'A' e 'B', foram utilizados para avaliar a viabilidade t?cnica e econ?mica de um programa de erradica??o deste pat?geno. Foram utilizados dados de produ??o, contagem de c?lulas som?ticas (CCS), mastite cl?nica e financeiros, de 24 meses. An?lise custo/benef?cio foi realizada com aux?lio de modelos matem?ticos. Identificaram-se 16 vacas infectadas com S. agalactiae no rebanho 'A' e 42 no rebanho 'B', sendo que destas ?ltimas, 31 apresentaram infec??o associada com Staphylococcus aureus. A efic?cia da terapia de ataque foi de 100% nos dois rebanhos. Entretanto, 18 vacas no rebanho B mantiveram a infec??o por S. aureus ap?s a terapia (42% de efic?cia). No rebanho 'B', a redu??o do n?mero de casos e de vacas com mastite cl?nica foi de 18 e 21%, respectivamente. A CCS apresentou tend?ncia crescente no grupo infectado e no leite total, nos 12 meses antecedentes ? terapia, com as m?dias de 980x103 e 968x103 c?l/ml, respectivamente. Ap?s o tratamento, as m?dias estabilizaram-se em 541x103 e 563x103 c?l/ml, respectivamente. O custo do tratamento foi de R$ 175,95 por vaca/tratada, sendo 39% deste com exames laboratoriais, 31% descarte de leite, 20% medicamentos e m?o-de-obra devido a opera??es adicionais e 10% honor?rios do m?dico veterin?rio. O pagamento por qualidade e a redu??o dos custos com a mastite cl?nica representaram 55% e 34% do benef?cio. Aumento significativo n?o foi observado (p>0,05) na produ??o m?dia de leite dos grupos tratados e do rebanho 'B'. Estimaram-se retornos de 11,67, 6,45 e 2,63 unidades monet?rias para cada unidade investida no programa de erradica??o de S. agalactiae. As medidas terap?uticas e profil?ticas foram eficazes para erradicar e manter o rebanho livre de S. agalactiae, al?m de contribu?rem para reduzir a CCS do leite, a incid?ncia de mastite cl?nica, o descarte/mortalidade precoce e proporcionou ganhos em programa de pagamento por qualidade, sendo sua ado??o recomend?vel. Considerando as exig?ncias brasileiras com rela??o ao limite de c?lulas som?ticas e de bact?rias totais no leite e o papel de S. agalactiae no aumento desses par?metros, o programa de erradica??o deste pat?geno pode significar a perman?ncia do produtor na atividade formal, al?m de reduzir risco para os consumidores e perdas de receitas do Governo com recolhimento de impostos.

Esta tese representa o aprofundamento do estudo das estimativas de custos, componente integrante e determinante das avaliações econômicas, enquanto parte do projeto de pesquisa Estudos de custo-efetividade da incorporação de novas vacinas à rotina do Programa Nacional de Imunizações: Rotavírus, Varicela, Pneumocócica conjugada, Meningocócica C conjugada e Hepatite A desenvolvido por solicitação do Programa Nacional de Imunização/PNI da Secretaria de Vigilância em Saúde/SVS do Ministério da Saúde, a partir de 2005. A tese teve como objetivo analisar as condições de uso, dificuldades e repercussões de diferentes métodos de estimativas de custos em estudos de custo-efetividade de vacinas de duas tecnologias específicas, vacinas contra rotavírus e varicela, assim como a relação entre as estimativas de custos e os resultados. As estimativas de custos estão condicionadas pelas características gerais da doença sob análise (aguda no caso de rotavírus e com seqüela no caso de varicela), assim como por questões metodológicas gerais (escolha teórico-conceitual, métodos e fontes de dados) e especificidades do caso brasileiro. Para esta tese, houve maior detalhamento das estimativas de custos diretos no cuidado da doença, com a inclusão de custos específicos do sistema de saúde suplementar para as duas doenças, inclusão de participação pública na dispensação de medicamentos no caso de rotavírus e inclusão de custos de medicamentos do sistema público de saúde no caso de varicela. Como resultado, houve aumento do custo total da doença estimado de 16% para rotavírus e 11% para varicela, assim como aumento de economia (custo total da doença evitado) de 18% e 16%, respectivamente, com a introdução de cada vacina. Apesar do maior detalhamento das estimativas de custos ter reduzido a razão de custo-efetividade incremental em 20% para rotavírus e 4% para varicela, o nível de custo-efetividade dos dois programas de vacinação não foi alterado. Os resultados das avaliações econômicas de vacinação contra rotavírus e varicela mostraram-se mais sensíveis às estimativas de custos do programa de vacinação, em especial o preço da vacina, apontando a relevância do custo da tecnologia sob análise para incorporação em comparação aos demais custos / This thesis represents a deeper study of the cost estimates, an integrant and determinative component of economic evaluations, as part of the project Costeffectiveness studies of the incorporation of new vaccines into the routine of the National Immunisation Program: Rotavirus, Varicella, Pneumococcal conjugate, Meningococcal C conjugate and Hepatitis A. The project has been developed on the request of the National Immunisation Program/PNI of the Secretary of Sanitary Surveillance/SVS of the Ministry of Health since 2005. The objective of the thesis was to analyse the conditions of use, difficulties and repercussions of different cost estimates methods in the cost-effectiveness studies of two specific technologies, vaccines against rotavirus and varicella, as well as the relationship between the cost estimates and the results. The cost estimates are conditioned by general characteristics of the disease under analysis (acute in the case of rotavirus and with long-term disability in the case of varicella), general methodological issues (theoretical choice, methods and sources of data) and specificities to the Brazilian case. This thesis brings a more detailed estimation of direct medical costs, with the inclusion of specific costs of the private health care system for the two diseases, inclusion of public participation for dispensing drugs in the case of rotavirus and inclusion of drugs costs in the public health care system in the case of varicella. As a result, there was an estimated disease total cost increase of 16% for rotavirus and 11% for varicella, as well as increase of savings (disease total cost avoided) of 18% and 16%, respectively, with the introduction of each vaccine. Although the more detailed cost estimates have reduced the incremental cost-effectiveness ratio by 20% for rotavirus and 4% for varicella, the cost-effectiveness level of the two vaccination programs was not altered. The results of the economic evaluations of vaccination against rotavirus and varicella were more sensitive to the vaccination program cost estimates, especially the vaccine price, pointing out the relevance of the cost of the technology under analysis for incorporation comparatively to the other costs

<p>The purpose of this thesis is to present an approach for good practice with regards to using cost benefit analysis (CBA) as a value-adding activity in the information security investment process for large enterprises. The approach is supported by empirical data.</p><p>From a MIO model perspective, this report is focused on the phase of strategic choices regarding organization, i.e. trying to find optimal investments for efficient operations. To assess, improve and monitor the operational effectiveness and management’s internal control environment is essential in today’s business execution. Executive management and boards are increasingly looking for an information security governance framework that encompasses information technology and information security: a single framework through which all information assets and activities within the organisation can be governed, to provide the optimum capability for meeting the organisation’s objectives, in terms of functionality and security.</p><p>The investment decision is one of the most visible and controversial key decisions in an enterprise. Some projects are approved, others are bounced, and the rest enter the organisational equivalent of suspended animation with the dreaded request from the decision makers to “redo the business case” or “provide more information.”</p><p>The concept of cost benefit analyses of information security helps management to make decisions on which initiatives to fund with how much, as there needs to be an approach for measuring and comparing different alternatives and how they meet business objectives of the enterprise. Non-financial metrics are identified using different approaches: governance effectiveness, risk analysis, business case analysis or game theory. The financial performance metrics are driven by the main value disciplines of an enterprise. These lead to the use of formulas enabling the measurement of asset utilisation, profit or growth: ROI (ROIC), NPV, IRR (MIRR), FCF, DCF, Payback Period, TCO, TBO, EVA, and ROSI.</p><p>The author shows research in the field of good corporate governance and the investment approval process, as well as case studies from two multinational enterprises. The case from Motorola demonstrates how IT governance principles are equally applicable to information security governance, while the case from Ericsson demonstrates how an information security investment decision can be supported by performing a cost benefit analysis using traditional marketing approaches of business case analysis (BCA) and standard financial calculations.</p><p>The suggested good practice presented in this thesis is summarised in four steps:</p><p>1. Understand main rationale for the security investment</p><p>2. Identify stakeholders and strategic goals</p><p>3. Perform Cost Benefit Analysis (non-financial and financial performance metrics)</p><p>4. Validate that the results are relevant to stakeholders and strategic goals</p><p>DISCLAIMER</p><p>This report is intended for academic training only and should not be used for any other purposes. The contents are not to be considered legal or otherwise professional advice. No liability is taken, whatsoever, by the author.</p>

<p>Denna uppsats handlar om hur den särskilda tillåtlighetsregeln i 11 kap. 6 § miljöbalken tillämpas vid tillståndsprövning av vattenverksamheter. Av paragrafen följer att en vattenverksamhet endast får bedrivas om den samlade nyttan av verksamheten överväger de kostnader samt skador och olägenheter som verksamheten medför. Syftet med paragrafen är att hindra vattenverksamheter som inte är <em>samhällsekonomiskt motiverade</em> samt utgöra ett extra skydd för miljön utöver miljöbalkens generella miljökrav.</p><p>Syftet med studien är undersöka hur denna paragraf tillämpas i praktiken – både i rättspraxis och i ansökningsförfarandet. Studien bygger i första hand på rättsvetenskaplig metod men ger även en mer allmän introduktion till samhällsekonomiska analysmetoder. Studien visar att det är mycket svårt att finna vägledning i praxis för <em>hur</em> en bedömning av samhällsnyttan bör gå till. Praxis visar dock att även faktorer som verksamhetens överensstämmelse med olika miljökvalitetsmål, art- och områdesskydd och estetiska värden kan få betydelse vid samhällsnyttobedömningen. Från sökandenas sida riktas generellt ett för stort fokus mot den privata eller företagsekonomiska nyttan av verksamheten. Sammantaget medför detta en risk för att miljövärden inte värderas på ett korrekt sätt när de vägs mot en mer konkret uttryckt monetär nytta. Ett bredare perspektiv på bedömningen bör därför antas. Vidare diskuteras även hur tillämpningen av bestämmelsen skulle kunna förbättras mot bakgrund av olika värderingsmetoder.</p> / <p>The subject matter of this Bachelor’s thesis is the special permit condition applying to water operations in accordance with chapter 11 section 6 of the Swedish Environmental Code. The article states that water operations may only be undertaken if the benefits, from the point of view of public and private interests, are greater than the costs and damages associated with them. The purpose of the regulation is to prevent water operations that are not socially efficient and to provide an additional protection for the environment, in excess of the general rules of consideration in the Code.</p><p>The purpose of this study is to look into how this particular article is applied in practice. This is done by analysing the legal usage as practiced by the court as well as by the applicants. The general rule is that the applicant has to show that the operation, for which the permit is being sought, is in compliance with the obligations associated with the activity. The study shows that it is very difficult to find guidance from case law on <em>how</em> an assessment of the social efficiency is to be carried out. Court practice indicates that circumstances such as whether the operation is in compliance with certain environmental objectives can be used to weight different aspects in the social efficiency assessment. However, the assessments carried out by the applicants are in general focused on the economic benefits for the applicant. This practice might entail a risk for environmental values not being properly valued when weighted against more tangible monetary benefits. A broader perspective is therefore called for. Potential improvements on the practice of the article are discussed against different valuation methods.</p>

<p>Samhället är mer eller mindre konstant utsatt för risker. De flesta av dem är så små, och har kanske till och med så pass obetydande effekter för individen om de realiseras, att vi negligerar dem i våra dagliga beslut. Vid vissa tillfällen står vid dock inför beslut som är betydligt svårare, t.ex. i vilken mån vi ska handla kostsamma försäkringar för stora olyckor som högst osannolikt inträffar men skulle få katastrofala konsekvenser. Liknande situationer uppstår för centrala beslutsfattare där man fattar beslut att genomföra riskreducerande åtgärder i samband med potentiella katastrofer. Sådana åtgärder finansieras genom skattemedel och kanske kan man då kräva att myndigheter åtminstone försöker redovisa de förväntade kostnaderna och fördelarna som följs av besluten. För detta ändamål kan man använda kostnads-nyttoanalys, vilket vanligtvis rekommenderas för riskhantering inom t.ex. vägtrafik, eller i viss mån den mindre avancerade kostnads-effektanalysen. Riskanalysens utformning är bl.a. beroende av om man hanterar risk (man kan tilldela utfallen sannolikheter) eller osäkerhet (man känner till utfallen men kan inte tilldela dem sannolikheter) och begränsas vanligtvis av en mängd ovissheter, såsom värden för olika ingående parametrar (t.ex. värdet på ett statistiskt liv).</p><p>Detta arbete tar upp teori angående värdering ex ante av kostnader i samband med potentiella katastrofer och hur dessa värden kan användas under risk eller osäkerhet i en kvantitativ riskanalys. Med hjälp av det försöker jag beskriva i stora drag hur man skulle kunna värdera den ekonomiska nyttan av riskreducerande åtgärder i samband med den s.k. fågelinfluensan. Mina slutsatser är att en probabilistisk ansats och en kvantitativ riskanalys försvåras av bl.a. ett knapphändigt material för sannolikhetstolkningar, förekomsten av kollektiv risk och svårigheter i att värdera t.ex. statistiska liv. Socialstyrelsen är nationell samordnare av arbetet med förebyggande åtgärder i samband med potentiella pandemier men varken använder eller rekommenderar andra myndigheter att använda nyttobaserade beslutskriterier som en del av beslutsunderlaget i samband med den s.k. fågelinfluensan (i detta fall). Kanske borde det tillhöra deras uppgifter att se över möjligheterna att använda samhällsekonomiska utredningar vid sådana situationer. Istället använder de vad som liknar en försiktighetsprincip, vilket också kan försvaras under förutsättningen att riskerna är påtagliga. För stora och långsiktiga beslut borde man istället införa en snävare anti-katastrof-princip innefattande en prioriteringsordning för när man, baserat på om det är möjligt och utredningsekonomiskt motiverat, ska genomföra kostnads-nyttoanalyser och när man istället ska genomföra kostnads-effektanalyser. De kan sedan vara en del av ett större beslutsunderlag.</p> / <p>Our society is constantly exposed to risks. Most of them are so small, and maybe even have so little effect if they occur, that we disregard them in our daily decisions. Quite often, however, we face decisions that are harder for us to make, as whether or not to buy expensive insurance to cover for accidents that have only a small probability to occur but also catastrophic consequences. Similar situations appear for central decision makers when they decide whether or not to reduce a certain catastrophic risk for the society as a whole. Those actions are financed through taxes and therefore it might be fair to say that the authorities should at least try to account for the possible benefits and costs associated with a risk reducing programme. For this you may use Cost-Benefit Analysis (CBA), which is usually recommended for use in, for example, risk management for traffic risks, or the less advanced Cost-Effectiveness Analysis (CEA). The shape and form of the risk analysis is to a great deal dependent of whether you are dealing with risk (it’s possible to assign the predicted states probabilities) or uncertainty (it’s not possible to assign the predicted states probabilities) and is also usually limited by a number of other uncertainties, say in value parameters (e.g. the value of a statistical life, VSL).</p><p>This paper deals with theories regarding how to value (ex ante) the costs of potential catastrophes and how these values could be used in dealing with risk or uncertainty in a quantitative risk analysis. From there I try to describe how, possibly, you could value the benefits from programmes reducing risks of an avian influenza. My conclusions are that a probabilistic approach in a quantitative analysis is complicated by, among other things, the short amount of data necessary to compute objective probabilities, the existence of collective risks and for example difficulties in measuring VSL. The Swedish National Board of Health and Welfare (Socialstyrelsen) is the national coordinator for all work regarding risk reducing actions for potential pandemics, but the board neither uses nor recommends other authorities to use utility-based criteria as a part of their decision material when dealing with, in this case, the bird flue. Quite possibly it should be a part of their work to look into the possibilities of using economic evaluations in these situations. Instead they use what resembles a Precautionary Principle, which also can be used on justified grounds as long as the risks are highly present. What should be done for large and long term decision making, though, is to define a narrower Anti-Catastrophe Principle containing orders of priorities for when, based on if its possible and financially motivated, to use CBA and when to use CEA. Those analyses could then be used along with any other decision material.</p>

När en kommersiell hamn byggs ut fordras omfattande muddringsarbete för att säkerställa ett brukligt djup för sjöfart. Då stora delar av muddermassorna ofta är förorenade av tungmetaller och miljögifter krävs särskilt omhändertagande av dessa. Traditionella omhändertagningsalternativ består av att deponera massorna på särskild avsedd plats på land eller tippa till havs, något som inte tillåts för förorenade sediment. En relativt ny metod är stabilisering/solidifiering (S/S) som innebär att muddermassorna behandlas med ett bindemedel för att sedan kunna användas som fyllnadsmaterial i exempelvis kajkonstruktioner. Dessa alternativ behöver noga vägas mot varandra med hänsyn till ekonomiska och miljömässiga aspekter. Föreliggande studie undersöker  ventuella brister i de ekonomiska värderingar som genomförts inför  utbyggandet av Oxelösunds hamn. Vidare genomförs en begränsad cost-benefit analys (CBA) för att värdera alternativen utifrån emissionsnivåer till luft och vatten. Resultatet visar att S/S innan nyttiggörande är det samhällsekonomiskt mest attraktiva alternativet. / When a commercial port is expanding its activities there is need for dredging to secure a safe depth for water borne traffic. The sediments are to a large extent contaminated by metals and toxins which calls for certain treatment. Traditionally sediments have either been disposed of at a specific location on land or dumped at sea; the latter is however not permitted by law. A relatively new method is stabilization/solidification (S/S) which means that the sediments are treated using a solidifying agent after which it is possible to use the dredged materials as filling in construction of jetties. These alternatives need to be carefully compared with respect to economical and environmental aspects. This thesis investigates the potential shortcomings of conducted economical evaluations prior to the expansion of Oxelösund port. Further, a limited cost-benefit analysis is conducted to evaluate the alternatives with respect to emissions of contaminants to air and water. The results show that S/S before utilization of the dredged materials is the most attractive alternative from an economical point of view. / STABCON