Este estudo teve como objetivo realizar estudos de custos sob a perspectiva do Sistema Único de Saúde em dois temas relevantes para a saúde da população: o manejo clínico da cardiopatia isquêmica e os exames de diagnóstico molecular para rastreamento precoce de câncer hereditário. O estudo contempla a revisão teórica de avaliações econômicas e custos em saúde que consistiram no arcabouço conceitual para os dois temas. Para o estudo na área de cardiopatia isquêmica foi realizada uma coorte restrospectiva com 330 pacientes acompanhados em ambulatório especializado para os quais foram identificados e valorados os recursos utilizados em nível ambulatorial e hospitalar.Os resultados são apresentados no artigo 1. Nos estudos para avaliação de método diagnóstico, o câncer hereditário foi o tema escolhido, realizando-se a identificação dos custos operacionais na realização de diferentes testes para verificação de mutação do gene BRCA1 no câncer de mama hereditário no artigo 2 e para a identificação da mutação do gene TP53 p.R337H relacionado à predisposição de câncer familial no artigo 3. Esses três estudos poderão subsidiar pesquisas em outras áreas clínicas e futuras avaliações de custo-efetividade de estratégias terapêuticas nos temas abordados. / This study aimed to do direct costs analysis from the perspective of the Brazilian public health system, covering two topics which are relevant to the health of the Brazilian population: the clinical management of ischemic cardiomyopathy and of molecular diagnostic technologies for early screening in cancer genetics. The study includes a theoretical review of economic evaluations and of appropriation of costs related to health that composed the conceptual framework for the two topics. For the study of ischemic cardiomyopathy, we did a retrospective cohort with 330 patients followed in a specialized ambulatory, for whom the resources utilized in ambulatory and in-patient level were identified and valuated were used as model. The results are presented in article 1. In the studies to evaluation of diagnosis method, hereditary cancer was the chosen subject and we did the identification of operational costs involved in the testing for the mutation of the BRCA1 gene in hereditary breast cancer in article 2 and in the testing for the mutation of the TP53 p.R337H gene, which relates to the predisposition to familial cancer, in article 3. These three studies may subsidize research in other clinical fields, as well as future cost-effectiveness evaluations of therapeutic strategies regarding the broached subjects.

O presente trabalho foi baseado nos resultados de um experimento conduzido por cinco anos (2003 a 2008), na Estação Experimental Campanha da Fundação de Pesquisa Agropecuária do Estado do Rio Grande do Sul, em pastagem natural do Bioma Pampa. Os tratamentos consistiram de níveis de oferta diária de forragem de 4, 8, 12 e 16 kg de MSFV 100 kg PV-1 dia-1 e um Sistema (SIS) formado por três áreas com manejos complementares (pastagem natural sob oferta de forragem de 12%, pastagem natural diferida e pastagem natural melhorada por fertilização e sobressemeadura de espécies hibernais). Como animais testers foram utilizados quatro novilhos Braford. O delineamento foi o de blocos completamente casualizados com medidas repetidas no tempo e duas repetições de área. As variáveis relacionadas a produção primária demonstraram resposta positiva e linear ao incremento das ofertas de forragem. Os ganhos médios diários no verão e na primavera foram descritos por uma equação linear e única com ponto de estabilização máximo na oferta de forragem de 10,1%. Já no outono, a resposta foi quadrática com valor máximo na oferta de forragem de 14%, enquanto no inverno foi linear, sendo necessário garantir uma oferta de forragem mínima de 12% para a manutenção do peso dos animais. A taxa de lotação apresentou resposta linear e descrescente no verão e na primavera. A análise econômica dos tratamentos determinou o maior custo total de produção, receita líquida operacional e margem bruta considerando a totalidade dos custos para o tratamento “SIS”. Além disso, foi responsável pela maior produtividade e, portanto facilmente atingiu o ponto de equilíbrio do custo total de produção. Desse modo, dentre as possibilidades testadas o “SIS” foi a melhor alternativa econômica de forrageamento para recria e terminação de bovinos em pastagem natural. Para recria e terminação, exclusivamente em pastagem natural, a melhor alternativa econômica é a manutenção de uma oferta de 12%. Considerando a possibilidade indicada pelo “SIS”, e simulando diferentes proporções de pastagem melhorada, para a recria e terminação de novilhos e engorda de vacas, o melhoramento de 25% da área de pastagem natural mostra ser a alternativa de maior eficiência econômica. / This work was based on the results of an experiment conducted for five years (2003-2008), at Estação Experimental Campanha, Fundação de Pesquisa Agropecuária do Estado do Rio Grande do Sul in natural grasslands of the Pampas Biome. Treatments consisted of four levels of forage allowance (FA) 4, 8, 12 and 16 kg of DMGF/100 kg of LW and a System (SYS) comprising three areas with complementary managements (natural grassland 12% FA, deferred natural grassland and improved natural pasture by fertilization and oversowing of winter cultivated species). Grazing method was continuous, with variable stocking rate, using four Braford steers as testers. The design was a completely randomized block with repeated measures in time (years) and two repetitions of area. The variables related to primary production showed positive and linear response to the increase in forage allowance. The average daily gain in the summer and spring were described by linear regression with a break point in forage allowance of 10.1%. In the autumn, the response was quadratic with maximum value at 14% FA, while in winter it was linear, being necessary to ensure a forage allowance of 12% to assure animal maintainance. The stocking rate showed a decreasing linear response in the summer and spring. The economic analysis of treatments determined the highest total production cost, net income and gross margin considering all the costs for treatment "SYS". In addition, it was responsible for increased productivity and therefore easily reached the point of economical equilibrium of the total production cost. Thus, among the possibilities tested the "SYS" was the best economic alternative for growing and fattening cattle on natural grassland. To rearing and finishing exclusively on natural grassland, the best economical alternative is the use of 12% of forage on offer all year round. Considering the possibility indicated by the "SYS" and using simulations for production systems for growing and finishing steers and fattening cows, the improvement of 25% of the natural pasture area shows the alternative of greater economic efficiency.

Associated natural gas is produced as a by-product from crude oil exploration and production. When perceived as a non-desirable product, it is wasted during gas flaring. Globally, about 100 Billion Cubic Meters (BCM) of gas is flared annually, leading to release of about 300 million tons of carbon dioxide yearly into the environment. Russia and Nigeria flare more than other countries to the tune of 35.5 and 18.27 BCM, respectively. The consequence of gas flaring has continued to pose significant threats to the environment as well as the economy of oil and gas producing countries. Therefore, this research is aimed at developing a sustainable framework that could enable management of flared gas in an oil and gas environment by generating energy and also minimise environmental impact that arises from gas flaring process. Three major research gaps were identified and they include lack of existing gas flare management framework in Nigeria, lack of economic evaluation of gas to wire (GTW) technology for flared gas reduction and, lack of cordial relationship and understanding between oil and gas producing/flaring companies and electricity producing sectors towards gas flare management. A qualitative research strategy was employed – utilising the single case study approach with embedded units of analysis. Three case study companies were used - one oil and gas producing company, and two electricity-generating companies. Data collection involved semi structured interviews, documentation, observation, and review of relevant literature. Data was analysed using QSR Nvivo version 10. A framework for flared gas reduction was developed based on literature review and also from information made available by experts operating in the oil and gas and electricity sectors. The framework shows inputs from various stakeholders, as well as an evaluation of volume of gas produced, utilized and flared. An economic assessment of GTW technology was carried out to determine the cost effectiveness of the framework. Findings from the study showed that GTW is a viable means of management, and could reduce the total volume of flared gas in Nigeria to 7.1%. This reduces environmental, health and safety hazards. It is also economically profitable. A total capital investment of £1.64b is required in the Nigerian context, with a net profit of £1.26b/year, and has a rate of return of investment of 16.3%. This study has demonstrated that GTW is a sustainable technology for reducing flared gas in Nigeria and other countries facing similar challenges as Nigeria; and capable of minimising adverse environmental and health impact associated with gas flaring. Therefore, the developed framework is also recommended for effective management of flared gas in such countries.

O presente trabalho tem por finalidade realizar uma análise econômica dos possíveis impactos gerados na economia brasileira pelo Programa Nacional de Produção e Uso do Biodiesel (PNPB) e pela Lei N 11.097, que define percentuais mínimos obrigatórios de adição de biodiesel ao óleo diesel. Para atingir tal objetivo, apresenta-se uma avaliação econômica por meio do método de investigação conhecido como Matriz de Análise de Política (MAP). O emprego deste instrumental proporciona uma avaliação em termos de competitividade e eficiência do sistema de produção com base em um estudo comparativo da cadeia produtiva de biodiesel selecionando duas matérias-primas a soja e a mamona. Neste sentido, inicialmente investiga-se a cadeia produtiva do biodiesel no Brasil para diagnosticar as vantagens no que tange a escala de produção, a escolha de matérias-primas, bem como o custo de oportunidade, método de comercialização e distribuição e também a questão tributária. Os resultados da analise econômica revelaram que o emprego do óleo de soja para geração do biodiesel apresenta maior rentabilidade privada e social indicando ser mais competitivo e eficiente frente ao sistema produtivo que emprega o óleo de mamona. Os resultados da pesquisa evidenciando não apenas os aspectos econômicos como os sócio-ambientais favoráveis ao PNPB mostrando que o Brasil tem todas as condições para tornar-se um grande produtor de biodiesel. / Purpose of this study is to analyse the by the National Program of Biodiesel Production (PNPB) and by the federal law n 11.097, that defines a minimum compulsory value of biodiesel to be added to diesel. In order to accomplish this task an economic evaluation is presented through a method known as Politic Analysis Matrix (MAP). This methodology enables an evaluation focused on the effiency and competitivity of the biodiesel productive system, based on comparative studies of the biodiesel productive chains of selected components: soy and castor oil plant. In this sense, the Brazilian biodiesel productive chain is investigated in order to diagnostic the advantages concerning the production scale, the selection of insums as well as the cost of opportunity, commercialization method and financial aspects. In conclusion, the analysis results show that Brazil has the potencial to become a great biodiesel producer.

A presente dissertação aborda a avaliação de três sistemas fotovoltaicos de bombeamento, que compreendem duas configurações com equipamentos dedicados à tecnologia fotovoltaica e um com equipamentos alternativos com potências entre 0,75 CV e 1,0 CV. Os resultados mostram que a configuração alternativa apresenta menor eficiência diária do sistema motobomba. A avaliação econômica revela a competitividade da configuração alternativa frente aos sistemas importados dedicados à tecnologia fotovoltaica. Alia-se a isso a disponibilidade dos equipamentos de condicionamento de potência e a facilidade de reposição. Verificou-se também que a configuração alternativa, conversor de freqüência WEG CFW08 e motobomba SOMAR de 1,0 CV e 8 estágios, trabalha com eficiência diária próxima aos 30% na faixa de operação de 20 a 40 metros de coluna dágua. Portanto, com uma adequada escolha da motobomba para a configuração alternativa, podem-se obter desempenhos semelhantes aos obtidos com sistemas importados dedicados à tecnologia fotovoltaica. Para 30 metros, a configuração alternativa bombeou somente 1% a menos do que o sistema Grundfos. O custo do volume bombeado para 30m de altura manométrica total do sistema alternativo é 22% menor do que o sistema Grundfos e 51% mais econômico do que o sistema Solarjack (Sun Pumps). / The present dissertation shows the evaluation of three Photovoltaic Pumping Systems, which involves two configurations: the equipment dedicated to the photovoltaic technology and the alternative equipment with nominal powers between 0.75 CV and 1.0 CV. The results show that the alternative configuration attained minor daily efficiency of the motopump system. The economic evaluation reveals the competitiveness of the alternative configuration in comparison with imported photovoltaic technology dedicated systems. It also should be considered the availability of equipment for power conditioning and the facility of replacement. It was also verified that the alternative configuration, variable speed drive WEG CFW08 and 1.0 CV SOMAR motor pump with 8 stages, works with daily efficiency near 30% in the 20 to 40 meters operation range. Therefore, with an adequate choice of the motor pump for the alternative configuration, performances similar to the imported photovoltaic technology dedicated systems can be obtained. For 30 meters, the alternative configuration pumped only 1% less than the Grundfos system. The cost of pumped volume for 30 meters of manometer total height of the alternative system is 22% cheaper than the system Grundfos and 51% cheaper than the system Solarjack (Sun Pumps).

The aim of this thesis was to examine the cost-effectiveness of specific advanced home care and home rehabilitation interventions and to improve economic evaluation methods when applied to advanced home care. This included a comparison of two alternative ways of administering oxygen at home to patients with chronic hypoxaemia, as well as a review of scientific evidence on costs and effects of home rehabilitation after stroke. Also included were studies on prominent methodological issues in advanced home care - the redistribution of care efforts among caregivers and costing of informal care efforts. For patients with chronic hypoxaemia, a randomised, controlled trial showed that mobile liquid oxygen was considerably more costly compared to concentrator treatment. However, the treatment effects showed that liquid oxygen had a better impact on patient quality of life. The literature review revealed that the outcomes and costs of home rehabilitation after stroke are equal to those of alternative treatment strategies. Similar results were obtained in a study comparing hospital-based and home-based stroke rehabilitation, which also showed that there is a considerable redistribution of costs between health care providers and social welfare providers. Studies of patients in advanced home care in the county of Östergötland, Sweden, showed that the cost of informal care constitutes a considerable part of the care effort in all costing approaches used. Also, informal care costs were higher among patients who were men, who were younger, who had their own housing and had a cancer diagnosis. This thesis reveals that advanced home care interventions can differ regarding costs as well as effects, and thus comparisons between alternative home care interventions must also be performed. Further, redistribution effects are important to consider in evaluations. The cost of informal care is substantial in advanced home care. These costs must be included in evaluations with a societal perspective or else the comparisons will be biased.

Work-related disorders due to biomechanical exposures have been subject to extensive research. Studies addressing these exposures have, however, paid limited attention to an efficient use of resources in exposure assessment. The present thesis investigates cost-efficient procedures for assessment of work-related biomechanical exposures, i.e. procedures aiming at a proper balance between statistical and economic performance. Paper I is a systematic review of tools used in literature providing cost-efficient data collection designs. Two main approaches were identified in nine publications, i.e. comparing cost efficiency among alternative data collection designs, and optimizing resource allocation between different stages of data collection, e.g. subjects and samples within subjects. The studies presented, in general, simplified analyses, in particular with respect to economics. Paper II compared the cost-efficiency of four video-based techniques for assessing upper arm postures. The comparison was based both on a comprehensive model of cost and error and additionally on two simplified models. Labour costs were a dominant factor in the cost efficiency comparison. Measurement bias and costs other than labour cost influenced the rank and economic evaluation of the assessment techniques. Paper III compared the cost efficiency of different combinations of direct and indirect methods for exposure assessments. Although a combination of methods could significantly reduce the total cost of obtaining a desired level of precision, the total cost was, in the investigated scenario, lowest when only direct measurements were performed. However, when the total number of measurements was fixed, a combination was the most cost efficient choice. In Paper IV, demand functions were derived for a four-stage measurement strategy with the focus of either minimizing the cost for a required precision, or maximizing the precision for a predetermined budget. The paper presents algorithms for identifying optimal values of measurement inputs at all four stages, adjusted to integers, as necessary for practical application. In summary, the thesis shows that it is important to address all sources of costs and errors associated with alternative measurement designs in any particular study, and that an optimal determination of samples at different stages can be identified in several cases not previously addressed in the literature.

Hepatitis B virus (HBV) infection is a global leading cause of death as a result of its role in the development of cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). In industrialized nations such as the United States, chronic hepatitis B infection represents a significant and disproportionate disease burden among the foreign-born population. A Markov cohort decision model was developed to determine the cost-effectiveness of HBV screening among new immigrants for the purposes of early detection and treatment, as compared to usual care. The incremental cost-effectiveness ratio for the screening strategy was $45,570 per quality adjusted life year saved. Given the potential for health gains for the immigrant cohort as well as the economic attractiveness of the intervention, some consideration should be given to the addition of a universal HBV screening program to U.S. immigration policy.

Hepatitis B virus (HBV) infection is a global leading cause of death as a result of its role in the development of cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). In industrialized nations such as the United States, chronic hepatitis B infection represents a significant and disproportionate disease burden among the foreign-born population. A Markov cohort decision model was developed to determine the cost-effectiveness of HBV screening among new immigrants for the purposes of early detection and treatment, as compared to usual care. The incremental cost-effectiveness ratio for the screening strategy was $45,570 per quality adjusted life year saved. Given the potential for health gains for the immigrant cohort as well as the economic attractiveness of the intervention, some consideration should be given to the addition of a universal HBV screening program to U.S. immigration policy.

The objective of this study is to evaluate and compare, both technically and economically, various glucose feeding concentrations and different redox potential settings on ethanol production under very-high-gravity (VHG) conditions. Laboratory data were collected for process modeling and two process models were created by two individual process simulators. The first one is a simplified model created and evaluated by Superpro Designer. The second one is an accurate model created by Aspen Plus and evaluated by Aspen Icarus Process Evaluator (Aspen IPE). The simulation results of the two models were also compared. Results showed that glucose feeding concentration at 250±3.95 g/L to the fermentor resulted in the lowest unit production cost (1.479 $/kg ethanol in the Superpro model, 0.764 $/kg ethanol in the Aspen Plus model), with redox potential control effects accounted. Controlling redox potential at -150 mV increased the ethanol yield under VHG fermentation conditions while no significant influences were observed when glucose feeding concentration was less than 250 g/L. Results of product sales analysis indicated that for an ethanol plant with a production rate of 85~130 million kg ethanol/year, only maintaining the glucose feeding concentration to the fermentor at around 250 g/L resulted in the shortest payout period of 5.33 years in average,, with or without redox potential control. If 300±6.42 g/L glucose feeding concentration to the fermentor is applied, it is essential to have the redox potential only controlled at -150 mV in the fermentor to limit the process payout period within 6 years. In addition, fermentation processes with glucose feeding concentration at around 200 g/L to the fermentor were estimated to be unprofitable under all studied conditions. For environmental concerns, two disposal alternatives were presented for CO2 produced during fermentation process rather than emission into atmosphere. One is to sell CO2 as byproduct, which brought 1.52 million $/year income for an ethanol plant with a capacity of 100 million kg ethanol/year. Another option is to capture and transport CO2 to deep injection sites for geological underground storage, which is already a safe and mature technology in North America, and also applicable to many other sites around the world. This would roughly add 4.78 million dollars processing cost annually in the studied scenario. Deep injection of captured CO2 from ethanol plants prevents emission of CO2 into the atmosphere, thus makes it environmental friendly.