Aims: The aim of this thesis was to identify the most cost effective urogynaecological treatment from a range of five standard therapies of 217 female patients, and to test the hypothesis that the conservative treatment of urinary incontinence was more cost effective than surgical or pharmacological interventions, using the cost per Quality Adjusted Life Year (QALY) as a common assessment. Methods: The first step in this process was to determine whether a generic cost effectiveness instrument, the York Quality of Life Questionnaire was sufficiently sensitive to allow its use in the field of urogynaecology. The York Questionnaire was compared with several other quality of life questionnaires and outcome measures that have been previously utilised in urinary incontinence, and was found to be equally sensitive in detecting change in quality of life as a result of treatment. The next step was to measure the costs required to produce this change in quality of life and to calculate the QALY's for five urogynaecological treatments in three prospective trials comprising of: a randomised trial of Nurse Continence Advisor versus Urogynaecologist conservative treatment of urinary incontinence (n=143), a prospective trial of laparoscopic versus open colposuspension (n=62), and the pharmacological treatment of detrusor instability (n=12). Costs assessed included consultation fees, investigations, theatre costs, hospital stay, patient time off work & travel expenses, and reduction in protective pad costs. Results: The cost/QALY for 5 years as a result of each of the five treatments varied from $28,009 for the Nurse Continence Advisor conservative treatment to $134,069 for the open colposuspension treatment. Conclusions: This finding suggests that the conservative treatment of urinary incontinence is the most cost effective, and should be utilised as the first form of treatment. As a consequence, financial resources would be more efficiently utilised in the conservative treatment of urinary incontinence, such as increasing the availability of services offered by Nurse Continence Advisors and physiotherapists.

<p>I uppsatsen utvärderas projektet Vägen in, som drevs av socialförvaltningen i Enköpingskommun 2007—2008. Deltagarna i projektet var individer med missbruksproblematik, oftatillsammans med en historia av kriminalitet och/eller psykisk ohälsa. Syftet med studien är attundersöka vilka kostnader och utfall Vägen in har gett upphov till i jämförelse medsocialtjänstens tidigare insatser för deltagarna, sett ur ett samhällsekonomiskt perspektiv.Bakgrunden till studien är att det i princip saknas samhällekonomiska utvärderingar avmissbruksvård. I studien jämförs samhällets kostnader för deltagarna två år innan projektet(2005-2006) med motsvarande kostnader under projekttiden (2007-2008). Dessa kostnaderställs sedan mot förändringen i deltagarnas kriminalitet samt förändringen av deraslivssituation.</p><p>Samhällets kostnader för deltagarna ökade med över 50 % under projekttiden. Deltagarnasmissbruk har minskat, men det går inte att se någon markant minskning av deltagarnaskriminalitet. Kostnaderna har skjutits över från staten till kommunen. I huvudsak harkostnaderna för psykiatrisk slutenvård och socialtjänstens öppenvård ökat, medanrättsväsendets kostnader har minskat. Samtidigt går det inte att se någon tydlig nedåtgåendetrend vad gäller deltagarnas kriminalitet. För att uttala sig om huruvida de ökade kostnadernakan motiveras med det utfall de ger upphov hade det krävts längre tidsserier med uppgifter omdeltagarnas inkomster. Med hänsyn till storleken på ökningen av samhällets kostnader fördeltagarna under projektet är det dock problematiskt att det inte går att se någon tydligminskning av deltagarnas kriminalitet.</p>

Introduction Physical inactivity is a major cause of reduced quality of life, as well as many common diseases and even premature death. Most people, globally, are scarcely or rarely physically active. Consequently, physical inactivity influences the burden of disease, and increases its societal costs. In view of this, it is necessary to ask how health care should respond when the population and the patients are either inactive or rarely physically active. Cost-effectiveness analyses of the promotion of physical activity in health care can contribute substantially to health care policy. Aims The overall aim of this thesis was to investigate the cost-effectiveness of physical activity promotion in the health care system. The specific aims were: (I) to provide a model for analyzing cost-effectiveness and equity in health for community-promoted physical activity, (II) to review current knowledge about the cost-effectiveness of health care based interventions aimed at improving physical activity, (III) to evaluate the cost effectiveness of physical activity promotion as a treatment method in primary health care, (IV) to illustrate the importance of enjoyment of exercise in interventions aimed at promoting physical activity, and (V) to describe a method of valuing the time spent on exercise. Methods Standard methods for economic evaluation were studied and adapted to create a model for the evaluation of physical activity promotion (I). Relevant databases were searched for published articles, and the articles found were analyzed using this economic evaluation model (II). A trial in primary health care was evaluated in a cost-utility analysis based on the model (III). In the same trial, the association between time spent on exercise and enjoyment of exercise was analyzed (IV). A model for valuing the time spent on exercise was developed based on existing approaches to the valuation of time, and used in two different groups of exercisers; experienced and inexperienced (V). Results An economic evaluation model was developed, as was a model to calculate an intervention’s effect on equity in health (I). In total, 26 articles were found regarding the cost-effectiveness of physical activity promotion in health care, and 20 of these described interventions, which the authors considered to be cost-effective (II). The treatment of patients in primary health care by the promotion of physical activity was shown to be cost-effective (III). For the same group of patients, time spent on exercise was associated with enjoyment of exercise (IV). A model for valuing the time spent on exercise was developed and used. Time costs were significantly higher among inexperienced exercisers (V). Conclusions There are many examples of interventions promoting physical activity that may be regarded as cost-effective. In general, it seems to be cost effective to promote physical activity among patients with increased risk, or who manifest poor health associated with physical inactivity. Unfortunately, there is still little evidence of when physical activity should be used, or what the best design of such an intervention might be. Although there is still a need for stronger evidence, the Swedish health care system should use the promotion of physical activity as a standard method among the following patients: • those who manifest increased risk (such as high blood pressure) of ill health due to a physically inactive lifestyle; • frail older people, especially those with increased risk of fall injuries; • those requiring rehabilitation after heart failure.

At a time where cutbacks on spending are a huge focal point across all government levels, the prison system, and effectively combating crime, has been intensely focused upon. With the United States having the highest rate of incarceration of any country in the world, the significance of this focus is understandable. Its prison system is much larger compared to that of other nations, and therefore is a high priority for the United States. As stated in The Economist, “No other rich country is nearly as punitive as the Land of the Free.” With such high costs associated with the prison system, understanding the most effective ways to operate the facilities and programs is necessary. When looking at the impact of the system on reducing crime, there are various programs that have different effects on crime reduction. Analyzing what has the most potential for reducing crime while taking costs into account is useful for the government in an attempt to most effectively utilize resources and the allotted budget.

Thesis (M.S. in Operations Research)--Naval Postgraduate School, September 1990. / Thesis Advisor(s): McMasters, Alan W. ; Henderson, David R. "September 1990." Description based on title screen as viewed on December 21, 2009. DTIC Descriptor(s): Naval Procurement, Mathematical Models, Parameters, Navy, Theses, Costs, Precision, Procurement, Inventory, Value, Supplies, Naval Logistics, Models, Contracts, Decision Making. DTIC Identifier(s): Navy Inventory Control Points, Navy Procurement Contract Termination Model, Forecasts. Author(s) subject terms: Procurement, Contract, Termination. Includes bibliographical references (p. 57-58). Also available in print.

Thesis (M.B.A.)--Naval Postgraduate School, December 2003. / "MBA professional report"--Cover. Thesis advisor(s): David R. Henderson, Don E. Summers. Includes bibliographical references (p. 53-55). Also available online.

published_or_final_version / Economics / Master / Master of Social Sciences

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