Monitoring cost effectiveness

Jones, R.A. Lopez, L.M. Beall, D.G. Cost-effective implementation of clinical pharmacy services in an ambulatory care clinic. Ho.sp. Pharm. 1991, 26, 778-782. Chrymko, M.M. Meyer, J.D. Kelly, W.N. Target drug monitoring Cost-effective service provided by staff pharmacists. Hosp. Pharm. 1994, 29, 347, 350 -352. 

Evaluation of cost-effectiveness of the program is one of the most difficult enterprises in public health. Vouchers simplify this process, however, often making it possible to accurately measure both costs and project-specific outcomes. If costs and outcomes are monitored, monitoring cost-effectiveness becomes simply a matter of calculating the ratio of positive outcomes to the cost of the program. Problems arise, however, when one wishes to compare alternative subsidy schemes or the status quo, because accurate information on costs and outcomes is much harder to come by. 

Intrinsic bioremediation is becoming an acceptable option in locations where the contaminated groundwater poses Htde threat to environmental health. Nevertheless, although intrinsic bioremediation is appealingly simple, it may not be the lowest cost option if there are extensive monitoring and documentation costs involved for several years. In such cases it may well be more cost effective to optimize conditions for biodegradation. 

The more effective deflvery of natural gas is being realized by the use of computerized operation centers that allow rapid responses to the variations ia gas demand. Automated valves, more precise measuting systems, and high speed communication networks make it possible to closely monitor and manage the transmission and deflvery of natural gas. This translates iato improved service and cost effectiveness. 

Detailed sampling can include, but is not limited to, the installation of monitoring well networks. After the wells have been installed, aquifer tests are typically performed. Once the aquifer tests are performed and the aquifer characteristics are determined, time series sampling for a given contaminant, or a surrogate, is undertaken. The combined results of these efforts provide the basis for development of a treatment strategy. Modeling can be used as part of this effort to help determine the best technical and most cost-effective techniques to be used at a site. 

Develop monitoring/detection devices that are more durable, cost effective, reliable, and accurate... 

In the absence of a trim system with feedback, it is likely to prove cost-effective to use a simple portable efficiency monitor on a regular basis, perhaps weekly for small boilers. The change of reading is as important as the actual value of the reading. A deviation from what is known to be a good post-commissioning setting will indicate a drift from ratio and the need for remedial action. 

For routine monitoring of machine vibration, however, this approach is not cost effective. The time required to manually isolate each of the frequency components and transient events contained in the waveform is prohibitive. However, time-domain data has a definite use in a total plant predictive maintenance or reliability improvement program. 

A side benefit of predictive maintenance is the automatic ability to monitor the mean-time-between-failures, MTBF. This data provides the means to determine the most cost-effective time to replace machinery rather than continue to absorb high maintenance costs. The MTBF of plant equipment is reduced each time a major repair or rebuild occurs. Predictive maintenance will automatically display the reduction of MTBF over the life of the machine. When the MTBF reaches the point that continued operation and maintenance costs exceed replacement cost, the machine should be replaced. 

Most plants can be cost-effectively monitored using a microprocessor-based system designed to use vibration, process parameters, visual inspection and limited infrared temperature monitoring. 

Class IV machinery would include other plant equipment that has a proven history of impacting either production or maintenance costs. All equipment in this classification must be evaluated to determine whether routine monitoring is cost-effective. In some cases, replacement costs are lower than the annual costs required to monitor machinery in this classification. 

The next step is to determine the best method or technique for cost-effectively monitoring the operating condition of each item on the list. To select the best methods for regular monitoring, you should consider the dynamics of operation and normal failure modes of each machine or system to be included in the program. 

A crucial issue for antiviral therapy is the fact that all antiviral substances rapidly select for resistance thus, monitoring and overcoming resistance has become a most important clinical paradigm of antiviral therapy. This calls for cautious use of antiviral drugs and implementation of combination therapies. In parallel, efforts in drug discovery have to be continued to develop compounds with novel mode-of-action and activity against resistant strains. This book reviews the current status of antiviral therapy, from the roads to development of new compounds to their clinical use and cost effectiveness. Individual chapters address in more detail all available drug classes and outline new approaches currently under development. 

Monitoring programs must have their own quality assurance programs. These may be called project quality assurance plans or protocols for specific purposes O). If reliable vendors of services are used, the bulk of the quality assurance effort can be placed on those activities unique to the program. Without reliable vendors, QA efforts will be ineffective since it is not cost effective to police quality assurance practices at all lower levels nor to screen all data for its validity. 

The workhorses in national monitoring programs are multi-residue methods. Any official method collection of any EU Member State contains at least one multi-residue method. For multi-analyte and/or multi-matrix methods, it is likely to be impractical to validate a method for all possible combinations of analyte, concentration and type of sample matrix that may be encountered in subsequent use of the method. Therefore, initial validation should incorporate as many of the target analytes and matrices as practicable. For practical reasons this validation and the evaluation of other methods with limited scope often cannot be conducted in inter-laboratory studies. Other concepts based on independent laboratory validation or validation in a single laboratory have been developed and can provide a practical and cost-effective alternative (or intermediate) approach. 

In Chapter 9, lecturers V. Ortun Rubio of Pompeu Fabra University and L. Cabiedes Miragaya of the University of Oviedo address the subject of measures intended as a way of influencing prescriber decisions. The authors place special emphasis on analysing prescriber incentive policies, distinguishing between incentives of a financial nature (both coercive and non-coercive) and non-financial incentives (information, training, treatment protocols, monitoring of prescription practices, cost-effectiveness guidelines, interaction with other professionals, pressure from patients and so on). The authors advocate incentive policies based on a combination of financial and non-financial incentives. 

The continuous determination of compounds, which may adversely affect ecosystems and/or human health, is a major regulative and legislative goal of environmental protection nowadays. Considering the costs and efforts related to this task corroborates a clear demand for portable, real-time, in-situ, field applicable and cost-effective monitoring techniques. Due to their inherent properties, vibrational spectroscopic sensors, in particular fibre-optic sensors show a high potential to contribute to these applications. 

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