Preventative interventions often demand that resources be consumed in the present in exchange for future benefits. Understanding these trade-offs, in a context of resource constraints, is essential for policy makers. Cost-effectiveness analysis is one tool to inform decision-making. Targeted testing and treatment (TTT) for latent tuberculosis infection (LTBI) consists in identifying people at high risk for LTBI for preventive treatment to decrease the risk that they will develop active tuberculosis disease (ATBD). The state of Tennessee began conducting TTT statewide in 2001. This study uses a decision tree to evaluate the cost and outcomes of TTT for LTBI in Tennessee, compared to passive ATBD case finding (PACF). Key event probabilities were obtained from the Tennessee TTT program and from the literature. Outcomes are measured in terms of Quality Adjusted Life Years (QALY). The cost-effectiveness threshold was set at $100,000/QALY saved. One-way sensitivity analyses around factors related to study design (exclusion of patient costs, secondary transmission, discount rate and analytical horizon), the program’s environment (prevalence of LTBI and drug resistance, ATBD treatment costs) and program performance (program maturity, treatment initiation and completion rate, testing in low-risk group, test characteristics, screening costs) were conducted, as was probabilistic sensitivity analysis (PSA) which takes into account the uncertainty in multiple parameters simultaneously. The base case, with a 25-year time horizon and 3% discount rate, shows that TTT prevents 47 ATBD cases, and saves 31 QALYs per 100,000 patients screened for LTBI at a societal cost of $12,579 (2011 US$) per QALY saved. Sensitivity analyses identified value thresholds that would trigger a change in preferred policy. PSA shows that the likelihood that TTT would be cost-effective is low. Decision makers interested in implementing TTT should carefully assess the characteristics of the local TB epidemic and expected program performance to determine whether TTT is preferable over PACF from a cost-effectiveness viewpoint.

This paper examines an overview of the economic and environmental aspects of Underground Coal Gasification (UCG) as a viable option to the above ground Surface Coal Gasification (SCG). In addition, some highlights, hurdles and opportunities from early investment to successful commercial application of some worldwide UCG projects will be discussed. Global energy demands have prompted continual crude oil consumption at an astronomical pace. As such, the most advanced economies are looking for local and bountiful resources to challenge crude oil's dependence for which coal provides the best alternative so far. In the U.S, the Department of Energy (DOE), the National Energy Transportation Laboratory (NETL) along with the Lawrence Livermore National Laboratory (LLNL) continue to support pilot programs that develop improved methods for clean coal technologies to produce coal derived fuels competitive with crude oil fuels at about $30 per barrel. Lignite, the softest of the four types of coal, is the best candidate for underground coal gasification due to its abundance, high volatility and water to carbon content in its rock formation. The biggest challenge of modern humans is to find a balance of energy consumption, availability of resources, production costs and environmental conservation. Additionally, UCG has environmental benefits that include mitigating CO₂ emissions through Carbon Capture and Storage (CCS) and reduced overall surface pollutants, making it the preferred choice over SCG. / text

This dissertation examines methods used to evaluate the cost-effectiveness of childhood obesity interventions in order to help decision-makers prioritize among competing health programs using standardized outcomes. Chapter 1 generates inputs for use in cost-effectiveness analyses (CEAs) of childhood obesity interventions. In Chapter 1.1, I use data from the Medical Expenditure Panel Survey to predict expenditures associated with obesity in childhood and adolescence. I found that obese children and adolescents have significantly different expenditures than their normal weight counterparts. I conclude that exclusion of obesity-related medical expenditures can potentially undervalue the cost-effectiveness of interventions. In Chapter 1.2, I use data from the Study of Early Child Care and Youth Development to examine the longitudinal trajectory of child weight. I derived probabilities of transitioning between weight classes that can be used in a decision-analytic model to extrapolate the effectiveness of childhood obesity interventions beyond childhood. I found that deviating from CDC BMI reference categories can more accurately capture the risk of future obesity. In Chapter 2, I evaluate the cost-effectiveness of a primary care-based obesity prevention program, High Five for Kids. Over two years, High Five for Kids was low-cost, but only marginally effective in reducing BMI. I used a decision analytic simulation model to extrapolate trial outcomes over a 10-year horizon, and found that in the long-term, primary care based obesity prevention was likely to be cost-effective relative to usual care. I also found that key methodological considerations can meaningfully influence the cost-effectiveness of childhood obesity interventions. In Chapter 3, I develop an agent-based model to explore the dynamics of the potential spread of obesity within families. I found that the “contagion” of obesity could result in significant collateral weight loss in family members not targeted in an intervention. As a result, CEAs may underestimate the benefits of obesity interventions. Moreover, I found that unless interventions are targeted toward all obese children in a family, the contagion of obesity can hinder weight loss in intervention targets. This model can be leveraged as a tool to optimize family-based obesity intervention strategies and inform randomized controlled obesity prevention trials.

Each year thousands of western waterfowl succumb to disease, predators, mechanical injury and other decimating factors. Based on a review of records it is conservatively estimated that an average of 25,000 ducks have succumbed to botulism on western marsh areas annually. In a recent study, the United States Fish and Wildlife Services valued each duck and goose at $8.00 (McLeod, 1950). Applying this value to the estimated annual numerical loss, a total of $200,000 has been lost each season in mortality of western waterfowl from botulism. Control of this malady would reduce annual waterfowl and monetary losses. Prevention and cure are the only means of controlling botulism in wild ducks. At present, no economical preventative measure exists and control is based on curing stricken birds. The purpose of this study was to evaluate the cost of treatment and rate of recovery of birds stricken with botulism when treated by selected methods. The 4 treatments selected for evaluation were: (1) hospital inoculation, (2) fresh water, (3) field inoculation, and (4) no treatment or control. Research included a comprehensive evaluation of factors such as age, sex, species, body condition, degrees of affliction, reaction to various amounts of antitoxin, and reaction to selected treatment methods, thought to be pertinent in botulism control. This study was conducted during botulism outbreaks of 1953 and 1954, and was confined to state-owned marshlands of Utah.

Preventative interventions often demand that resources be consumed in the present in exchange for future benefits. Cost-effectiveness analysis is a tool to understand these trade-offs, and inform decision-making under resource constraints. Targeted testing and treatment (TTT) for latent tuberculosis infection (LTBI) consists in identifying people at high risk for LTBI for preventive treatment to decrease the risk of active tuberculosis disease (ATBD). The state of Tennessee began conducting TTT statewide in 2001. This study uses a decision tree to evaluate the cost and outcomes of TTT for LTBI in Tennessee, compared to passive ATBD case finding (PACF). Key probabilities were obtained from the Tennessee TTT program and the literature. Outcomes are measured in terms of Quality Adjusted Life Years (QALY). The cost-effectiveness threshold was $100,000/QALY saved. One-way sensitivity analyses around factors related to study design, the program’s environment, and program performance were conducted, as was probabilistic sensitivity analysis (PSA) which takes into account the uncertainty in multiple parameters simultaneously. The base case, with a 25-year analytic horizon and 3% discount rate, shows that TTT prevents 47 ATBD cases, and saves 31 QALYs per 100,000 patients screened at a societal cost of $12,579 per QALY saved. Sensitivity analyses identified value thresholds that would trigger a change in preferred policy. PSA shows that the likelihood that TTT would be cost-effective is low. Decision makers should carefully assess the characteristics of the local TB epidemic and expected program performance to determine whether TTT is preferable over PACF from a cost-effectiveness viewpoint.

The focus of this thesis is on the application of decision models to the economic evaluation of health care technologies. The primary objective addresses the correct choice of modelling technique, as the attributes of the chosen technique could have a significant impact on the process, as well as the results, of an evaluation. Separate decision models, a Markov process and a discrete event simulation (DES) model are applied to a case study evaluation comparing alternative adjuvant therapies for early breast cancer. The case study models are built and analysed as stochastic models: whereby probability distributions are specified to represent the uncertainty about the true values of the model input parameters. Three secondary objectives are also specified. Firstly, the empirical application of the alternative decision models requires the specification of a 'modelling process' that is not well defined in the health economics literature. Secondly, a comparison of alternative methods for specifying probability distributions to describe the uncertainty in the model's input parameters is undertaken. The final secondary objective covers the application of methods for valuing the collection of additional information to inform the resource allocation decision. The empirical application of the two relevant modelling techniques clarifies the potential advantages derived from the increased flexibility provided by DES over Markov models. The thesis concludes that the use of DES should be strongly considered if either of the following issues appear relevant: model parameters are a function of the time spent in particular states, or the data describing the timing of events are not in the form of transition probabilities. The full description of the modelling process provides a resource for health economists wanting to use decision models. No definitive process is established, however, as there exist competing methods for various stages of the modelling process. The main conclusion from the comparison of methods for specifying probability distributions around the input parameters is that the theoretically specified distributions are most likely to provide a common baseline for comparisons between evaluations. The central question that remains to be addressed is which method is the most theoretically correct? The application of a Vol analysis provides useful insights into the methods employed and leads to the identification of particular methodological issues requiring future research in this area.

Background: Variation exists in quality of life (i.e., utility) estimates depending on the utility elicitation method utilized. Using the EQ-5D, VAS, and HUI-III, the aim of this thesis was to determine whether these measures adequately capture HRQOL in a CRC population and assess the relationship between utility estimates generated. Methods: A mixed methods study design was employed to collect health status scores and interview data from a sample of 50 CRC patients in Toronto, Ontario. Results: Mean utility scores between the EQ-5D and HUI-III were identical at 0.76 (95% CI), with an overall VAS score of 0.72 (95% CI). Conclusion: The fact that the EQ-5D and HUI-III resulted in identical mean utility scores provides assurance for future studies using these tools in CRC. However, many factors that CRC patients identify as important to their HRQOL are not captured by these instruments. These findings have implications for informing economic evaluations.

Background: Variation exists in quality of life (i.e., utility) estimates depending on the utility elicitation method utilized. Using the EQ-5D, VAS, and HUI-III, the aim of this thesis was to determine whether these measures adequately capture HRQOL in a CRC population and assess the relationship between utility estimates generated. Methods: A mixed methods study design was employed to collect health status scores and interview data from a sample of 50 CRC patients in Toronto, Ontario. Results: Mean utility scores between the EQ-5D and HUI-III were identical at 0.76 (95% CI), with an overall VAS score of 0.72 (95% CI). Conclusion: The fact that the EQ-5D and HUI-III resulted in identical mean utility scores provides assurance for future studies using these tools in CRC. However, many factors that CRC patients identify as important to their HRQOL are not captured by these instruments. These findings have implications for informing economic evaluations.

There are some alternatives of artificial lift methods to increase the production of oil well or to keep it producing. Sucker rod pumping (SRP) and electrical submersible pumping (ESP) systems are selected for the design and economical evaluation of thirteen oil wells of R field. Although selected wells are already producing artificially, they are redesigned for SRP and ESP. LoadCalC software developed by Lufkin and SubPUMP developed by DSSC are used for SRP and ESP designs respectively. For economic evaluation, the rate of return (ROR) of each design is calculated for ten year period. In technical comparison, advantage of higher production ability with lower power consumption was observed in ESP applications. In wells which have lower production than 100 bpd, SRP takes the advantage as it has the ability of low volume lifting. In economical comparison it was observed that using both methods together was given better result. By increasing the number of wells that were applied ESP, 3.61% of increment in ROR was obtained relative to the present status.

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