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At least 145 records · Page 8Linked to original sources
PubMed2003

Is carotid angioplasty and stenting more cost effective than carotid endarterectomy?

OBJECTIVE: Carotid angioplasty and stenting (CAS) has been advocated as a minimally invasive and inexpensive alternative to carotid endarterectomy (CEA). However, a precise comparative analysis of the immediate and long-term costs associated with these two procedures has not been performed. To accomplish this, a Markov decision analysis model was created to evaluate the relative cost effectiveness of these two interventions. METHODS: Procedural morbidity/mortality rate for CEA and costs (not charges) were derived from a retrospective review of consecutive patients treated at New York Presbyterian Hospital/Cornell (n = 447). Data for CAS were obtained from the literature. We incorporated into this model both the immediate procedural costs and the long-term cost of morbidities, such as stroke (major stroke in the first year = $52,019; in subsequent years = $27,336/y; minor stroke = $9419). We determined long-term survival rate in quality-adjusted life years and lifetime costs for a hypothetic cohort of 70-year-old patients undergoing either CEA or CAS. Our measure of outcome was the cost-effectiveness ratio. RESULTS: The immediate procedural costs of CEA and CAS were $7871 and $10,133 respectively. We assumed major plus minor stroke rates for CEA and CAS of 0.9% and 5%, respectively. We assumed a 30-day mortality rate of 0% for CEA and 1.2% for CAS. In our base case analysis, CEA was cost saving (lifetime savings = $7017/patient; increase in quality-adjusted life years saved = 0.16). Sensitivity analysis revealed major stroke and death rates as the major contributors to this differential in cost effectiveness. Procedural costs were less important, and minor stroke rates were least important. CAS became cost effective only if its major stroke and mortality rates were made equivalent to those of CEA. CONCLUSION: CEA is cost saving compared with CAS. This is related to the higher rate of stroke with CAS and the high cost of stents and protection devices. To be economically competitive, the mortality and major stroke rates of CAS must be at least equivalent if not less than those of CEA.

Aged↗
PubMed2006

Environmental, economic, and energetic costs and benefits of biodiesel and ethanol biofuels.

Negative environmental consequences of fossil fuels and concerns about petroleum supplies have spurred the search for renewable transportation biofuels. To be a viable alternative, a biofuel should provide a net energy gain, have environmental benefits, be economically competitive, and be producible in large quantities without reducing food supplies. We use these criteria to evaluate, through life-cycle accounting, ethanol from corn grain and biodiesel from soybeans. Ethanol yields 25% more energy than the energy invested in its production, whereas biodiesel yields 93% more. Compared with ethanol, biodiesel releases just 1.0%, 8.3%, and 13% of the agricultural nitrogen, phosphorus, and pesticide pollutants, respectively, per net energy gain. Relative to the fossil fuels they displace, greenhouse gas emissions are reduced 12% by the production and combustion of ethanol and 41% by biodiesel. Biodiesel also releases less air pollutants per net energy gain than ethanol. These advantages of biodiesel over ethanol come from lower agricultural inputs and more efficient conversion of feedstocks to fuel. Neither biofuel can replace much petroleum without impacting food supplies. Even dedicating all U.S. corn and soybean production to biofuels would meet only 12% of gasoline demand and 6% of diesel demand. Until recent increases in petroleum prices, high production costs made biofuels unprofitable without subsidies. Biodiesel provides sufficient environmental advantages to merit subsidy. Transportation biofuels such as synfuel hydrocarbons or cellulosic ethanol, if produced from low-input biomass grown on agriculturally marginal land or from waste biomass, could provide much greater supplies and environmental benefits than food-based biofuels.

Agriculture↗
PubMed1999

Medicine and the market: a research agenda.

One of the most important developments in international medicine over the past two decades has been a turn to the market as a way of coping with rising costs and responding to calls for more freedom from government control. A full moral evaluation of the relationship of medicine and the market requires asking a wide range of questions bearing on the meaning and impact of market strategies on the economics of health care and on the clinical and public health outcomes of those strategies. A number of the leading questions are presented and some provisional answers offered.

Biomedical Research↗
PubMed2003

Evaluation of organics leaching from solidified/stabilized hazardous wastes using a powder reactivated carbon additive.

Cement based stabilization/solidification systems have been widely used to minimize leaching of contaminants from hazardous wastes, particularly for stabilization of wastes that contain heavy metals or other inorganic materials. However, few researchers have demonstrated that stabilization/solidification systems can adequately trap and retain organics present in these wastes. Identification of additives that can be used with the inorganic binder to retain organics has attracted much interest. Activated carbon has been found to be the best additive for immobilizing organic contaminants, but it is generally too expensive for routine use. The use of powdered reactivated carbon was studied in this research to prevent organics from leaching from solidified/stabilized waste forms because it is effective and more economically competitive. The Shrinking Unreacted Core leach test method was employed in this study. Stabilization/solidification waste forms were prepared using five organic compounds--phenol, 2-chlorophenol, chlorobenzene, aniline and Methyl Ethyl Ketone (MEK)--that were spiked into the waste forms at two concentration levels each. Reactivated carbon amounts of 0% (as control), 1% and 2% (w/w) were added into each waste form batch to determine how effectively the reactivated carbon can immobilize those organics and the optimum dose of reactivated carbon addition required. Leachate samples were analyzed using gas chromatography. Results show that 1% reactivated carbon addition is generally enough to reduce leaching of all of the organic contaminants by more than 70%, while a 2% addition reduces leaching for most of the organics to less than 1%.

Carbon↗
PubMed1991

Extraction of mercury from groundwater using immobilized algae.

Bio-Recovery Systems, Inc. conducted a project under the Emerging Technology portion of the United States Environmental Protection Agency's (EPAs) Superfund Innovative Technology Evaluation (SITE) Program to evaluate the ability of immobilized algae to adsorb mercury from contaminated groundwater in laboratory studies and pilot-scale field tests. Algal biomass was incorporated in a permeable polymeric matrix. The product, AlgaSORB, packed into adsorption columns, exhibited excellent flow characteristics, and functioned as a "biological" ion exchange resin. A sequence of eleven laboratory tests demonstrated the ability of this product to adsorb mercury from groundwater that contained high levels of total dissolved solids and hard water components. However, use of a single AlgaSORB preparation yielded nonrepeatable results with samples collected at different times of the year. The strategy of sequentially extracting the groundwater through two columns containing different preparations of AlgaSORB was developed and proved successful in laboratory and pilot-scale field tests. Field test results indicate that AlgaSORB could be economically competitive with ion exchange resins for removal of mercury, with the advantage that hardness and other dissolved solids do not appear to compete with heavy metals for binding capacity.

Absorption↗
PubMed1995

Pilot-scale demonstration of a two-stage methanotrophic bioreactor for biodegradation of trichloroethylene in groundwater.

A two-stage methanotrophic bioreactor system was developed for remediation of water contaminated with TCE and other chlorinated, volatile, aliphatic hydrocarbons. The first stage of the reactor was a suspended-growth culture vessel using a bubbleless methane-transfer device. The second stage was a plug-flow bioreactor supplied with contaminated groundwater and cell suspension from the culture vessel. The test objectives were to determine the applicability of microbial culture conditions reported in the literature for continuous, pilot-scale TCE treatment; the technical feasibility of plug-flow bioreactor design for treatment of TCE; and the projected economic competitiveness of the technology considering the cost of methane for growth of methanotrophs. The methanotrophic organism used in the study was Methylosinus trichosporium OB3b. Information on system operation was obtained in bench tests prior to conducting the pilot tests. In bench- and pilot-scale tests, variability in the degree of TCE degradation and difficulty in maintaining the microbial culture activity led to short periods of satisfactory biotreatment. Further development of the microbial culture system will be required for long-term operation. During transient periods of high TCE degradation activity, the bioreactor concept proved feasible by exhibiting both a high degree of TCE biodegradation (typically about 90% at influent TCE concentrations of 0.5-4 ppm) and a close approximation to first-order reactor kinetics throughout the length of the reactor. Actual methane usage in the pilot-scale reactor resulted in projected methane costs of $0.33 per 1000 gallons of water treated. This cost theoretically would be reduced by system modifications. The theoretical minimum methane cost was approximately $0.05 per 1000 gallons.

Biodegradation, Environmental↗
PubMed2004

Measuring visual opacity using digital imaging technology.

The U.S. Environmental Protection Agency (EPA) Reference Method 9 (Method 9) is the preferred enforcement approach for verifying facility compliance with federal visible opacity standards. Supporters of Method 9 have cited its flexibility and low cost as important technological and economic advantages of the methodology. The Digital Opacity Compliance System (DOCS), an innovative technology that employs digital imaging technology for quantifying visible opacity, has been proposed as a technically defensible and economically competitive alternative to Method 9. Results from the field application of the DOCS at EPA-approved Method 9 smoke schools located in Ogden, UT, Augusta, GA, and Columbus, OH, demonstrated that, under clear sky conditions, the DOCS consistently met the opacity error rate established under Method 9. Application of hypothesis testing on the smoke school data set confirmed that the DOCS was equivalent to Method 9 under clear sky conditions. Under overcast sky conditions, human observers seemed to be more accurate than the DOCS in measuring opacity. However, within the smoke school environment, human observers routinely employ backgrounds other than sky (e.g., trees, telephone poles, billboards) to quantify opacity on overcast days. Under conditions that compel the use of sky as plume background (e.g., emission stacks having heights above the tree line), the DOCS appears to be a more accurate methodology for quantifying opacity than are human observers.

Air Pollutants↗
PubMed1991

The economic impact of prospective population changes in advanced industrial countries: an historical perspective.

Demographic projections to the year 2050 for advanced industrial nations, implying low or negative population growth and a sharp rise in old age dependency, have created concerns about the long-term economic outlook in these countries. An analysis of these projections in the light of the demographic and economic experience of the past century raises doubt about these concerns. There is little empirical evidence that declining population growth has slowed the rate of economic growth. Although the burden of aged dependents will reach a new high, the projected total dependency rate is not out of line with prior experience. Thus, the ability of the working population to shoulder the burden of higher taxes to support programs for older dependents will be greater because of reduced needs to support younger dependents. This conclusion holds for a number of variant projections, the only clear exception being one that implies a mortality revolution at older ages.

Adolescent↗