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Karl Whelan - One of the best experts on this subject based on the ideXlab platform.
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tax incentives material inputs and the supply curve for Capital Equipment
Social Science Research Network, 1999Co-Authors: Karl WhelanAbstract:The slope of the supply curve for Capital Equipment has important implications for the macroeconomics of investment and the eects of tax reform on Capital accumulation. Goolsbee (1998) has used changes in investment tax incentives to identify whether this supply curve is signicantly upward-sloping and has concluded that it is. This paper shows that investment tax incentives are a poor instrument for identifying this supply curve because they are spuriously correlated with supply shocks for Equipment producers. Once input costs for Equipment producers are controlled for, there is no evidence of a relationship between tax incentives and Equipment prices. In fact, the evidence favors a flat supply curve interpretation.
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tax incentives material inputs and the supply curve for Capital Equipment
Social Science Research Network, 1999Co-Authors: Karl WhelanAbstract:The slope of the supply curve for Capital Equipment has important implications for the macroeconomics of investment and the effects of tax reform on Capital accumulation. Goolsbee (1998) has used changes in investment tax incentives to identify whether this supply curve is significantly upward-sloping and has concluded that it is. This paper shows that investment tax incentives are a poor instrument for identifying this supply curve because they are spuriously correlated with supply shocks for Equipment producers. Once input costs for Equipment producers are controlled for, there is no evidence of a relationship between tax incentives and Equipment prices. In fact, the evidence favors the interpretation that the supply curve is flat.
Zenichi Ihara - One of the best experts on this subject based on the ideXlab platform.
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economic value of narrow band imaging versus white light endoscopy for the diagnosis and surveillance of barrett s esophagus cost consequence model
PLOS ONE, 2019Co-Authors: Gianluca Furneri, Romy Klausnitzer, Laura Haycock, Zenichi IharaAbstract:Barrett’s esophagus (BE) is an abnormality arising from gastroesophageal reflux disease that can progressively evolve into a sequence of dysplasia and adenocarcinoma. Progression of Barrett’s esophagus into dysplasia is monitored with endoscopic surveillance. The current surveillance standard requests random biopsies plus targeted biopsies of suspicious lesions under white-light endoscopy, known as the Seattle protocol. Recently, published evidence has shown that narrow-band imaging (NBI) can guide targeted biopsies to identify dysplasia and reduce the need for random biopsies. We aimed to assess the health economic implications of adopting NBI-guided targeted biopsy vs. the Seattle protocol from a National Health Service England perspective. A decision tree model was developed to undertake a cost-consequence analysis. The model estimated total costs (i.e. staff and overheads; histopathology; adverse events; Capital Equipment) and clinical implications of monitoring a cohort of patients with known/suspected BE, on an annual basis. In the simulation, BE patients (N = 161,657 at Year 1; estimated annual increase: +20%) entered the model every year and underwent esophageal endoscopy. After 7 years, the adoption of NBI with targeted biopsies resulted in cost reduction of £458.0 mln vs. HD-WLE with random biopsies (overall costs: £1,966.2 mln and £2,424.2 mln, respectively). The incremental investment on Capital Equipment to upgrade hospitals with NBI (+£68.3 mln) was offset by savings due to the reduction of histological examinations (-£505.2 mln). Reduction of biopsies also determined savings for avoided adverse events (-£21.1 mln). In the base-case analysis, the two techniques had the same accuracy (number of correctly identified cases: 1.934 mln), but NBI was safer than HD-WLE. Budget impact analysis and cost-effectiveness analyses confirmed the findings of the cost-consequence analysis. In conclusion, NBI-guided targeted biopsies was a cost-saving strategy for NHS England, compared to current practice for detection of dysplasia in patients with BE, whilst maintaining at least comparable health outcomes for patients.
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Economic value of narrow-band imaging versus white light endoscopy for the diagnosis and surveillance of Barrett’s esophagus: Cost-consequence model
2019Co-Authors: Gianluca Furneri, Romy Klausnitzer, Laura Haycock, Zenichi IharaAbstract:Barrett’s esophagus (BE) is an abnormality arising from gastroesophageal reflux disease that can progressively evolve into a sequence of dysplasia and adenocarcinoma. Progression of Barrett’s esophagus into dysplasia is monitored with endoscopic surveillance. The current surveillance standard requests random biopsies plus targeted biopsies of suspicious lesions under white-light endoscopy, known as the Seattle protocol. Recently, published evidence has shown that narrow-band imaging (NBI) can guide targeted biopsies to identify dysplasia and reduce the need for random biopsies. We aimed to assess the health economic implications of adopting NBI-guided targeted biopsy vs. the Seattle protocol from a National Health Service England perspective. A decision tree model was developed to undertake a cost-consequence analysis. The model estimated total costs (i.e. staff and overheads; histopathology; adverse events; Capital Equipment) and clinical implications of monitoring a cohort of patients with known/suspected BE, on an annual basis. In the simulation, BE patients (N = 161,657 at Year 1; estimated annual increase: +20%) entered the model every year and underwent esophageal endoscopy. After 7 years, the adoption of NBI with targeted biopsies resulted in cost reduction of £458.0 mln vs. HD-WLE with random biopsies (overall costs: £1,966.2 mln and £2,424.2 mln, respectively). The incremental investment on Capital Equipment to upgrade hospitals with NBI (+£68.3 mln) was offset by savings due to the reduction of histological examinations (-£505.2 mln). Reduction of biopsies also determined savings for avoided adverse events (-£21.1 mln). In the base-case analysis, the two techniques had the same accuracy (number of correctly identified cases: 1.934 mln), but NBI was safer than HD-WLE. Budget impact analysis and cost-effectiveness analyses confirmed the findings of the cost-consequence analysis. In conclusion, NBI-guided targeted biopsies was a cost-saving strategy for NHS England, compared to current practice for detection of dysplasia in patients with BE, whilst maintaining at least comparable health outcomes for patients.
Randy W Loftus - One of the best experts on this subject based on the ideXlab platform.
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importance of operating room case scheduling on analyses of observed reductions in surgical site infections from the purchase and installation of Capital Equipment in operating rooms
American Journal of Infection Control, 2020Co-Authors: Franklin Dexter, Johannes Ledolter, Richard H Epstein, Randy W LoftusAbstract:Background We review the impact of the consequences of operating room (OR) management decision making on power analyses for observational studies of surgical site infections (SSIs) among patients receiving care in ORs with interventions versus without interventions involving physical changes to ORs. Examples include ventilation systems, bactericidal lighting, and physical alterations to ORs. Methods We performed a narrative review of operating room management and surgical site infection articles. We used 10-years of operating room data to estimate parameters for use in statistical power analyses. Results Creating pivot tables or monthly control charts of SSI per case by OR and comparing among ORs with or without intervention is not recommended. This approach has low power to detect a difference in SSI rates among the ORs with or without the intervention. The reason is that appropriate OR case scheduling decision making causes risk factors for SSI to differ among ORs, even when stratifying by surgical specialty. Such risk factors include case duration, urgency, and American Society of Anesthesiologists’ Physical Status. Instead, analyze SSI controlling for the OR, where the patient had surgery, and matching patients using these variables is preferable. With α = 0.05, 600 cases per OR, 5 intervention ORs, and 5 or 1 control patients for each intervention patient, reasonable power (≅94% or 78%, respectively) can be achieved to detect reductions (3.6% to 2.4%) in the incidence of SSI between ORs with or without the intervention. Conclusions By using this matched cohort design, the effect of the purchase and installation of Capital Equipment in ORs on SSI can be evaluated meaningfully.
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futility of cluster designs at individual hospitals to study surgical site infections and interventions involving the installation of Capital Equipment in operating rooms
Journal of Medical Systems, 2020Co-Authors: Franklin Dexter, Johannes Ledolter, Richard H Epstein, Randy W LoftusAbstract:Anesthesia workspaces are integral components in the chains of many intraoperative bacterial transmission events resulting in surgical site infections (SSI). Matched cohort designs can be used to compare SSI rates among operating rooms (ORs) with or without Capital Equipment purchases (e.g., new anesthesia machines). Patients receiving care in intervention ORs (i.e., with installed Capital Equipment) are matched with similar patients receiving care in ORs lacking the intervention. We evaluate statistical power of an alternative design for clinical trials in which, instead, SSI incidences are compared directly among ORs (i.e., the ORs form the clusters) at single hospitals (e.g., the 5 ORs with bactericidal lights vs. the 5 other ORs). Data used for parameter estimates were SSI for 24 categories of procedures among 338 hospitals in the State of California, 2015. Estimated statistical power was ≅8.4% for detecting a reduction in the incidence of SSI from 3.6% to 2.4% over 1 year with 5 intervention ORs and 5 control ORs. For ≅80% statistical power, >20 such hospitals would be needed to complete a study in 1 year. Matched paired cluster designs pair similar ORs (e.g., 2 cardiac ORs, 1 to intervention and 1 to control). With 5 pairs, statistical power would be even less than the estimated 8.4%. Cluster designs (i.e., analyses by OR) are not suitable for comparing SSI among ORs at single hospitals. Even though matched cohort designs are non-randomized and thus have lesser validity, matching patients by their risk factors for SSI is more practical.
Tarek Kasah - One of the best experts on this subject based on the ideXlab platform.
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lca of a newsprint paper machine a case study of Capital Equipment
International Journal of Life Cycle Assessment, 2014Co-Authors: Tarek KasahAbstract:Purpose The environmental aspects of paper as a consumer good have been extensively studied. However, the paper machine has been mostly neglected in the literature. The purpose of this article is to present a LCA case study that explicitly focuses on the system of a newsprint paper machine and its environmental impacts and not on the system of the consumer good paper. The relevance of the paper machine as Capital Equipment is analyzed, and conclusions for the environmental improvement of paper machines are drawn based on identified hotspots. The article hereby answers the more general research questions of whether Capital Equipment has rightly been neglected in other studies regarding pulp and paper and which impact categories are important for analyzing the environmental burdens of a paper machine.
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lca of a newsprint paper machine a case study of Capital Equipment
International Journal of Life Cycle Assessment, 2014Co-Authors: Tarek KasahAbstract:The environmental aspects of paper as a consumer good have been extensively studied. However, the paper machine has been mostly neglected in the literature. The purpose of this article is to present a LCA case study that explicitly focuses on the system of a newsprint paper machine and its environmental impacts and not on the system of the consumer good paper. The relevance of the paper machine as Capital Equipment is analyzed, and conclusions for the environmental improvement of paper machines are drawn based on identified hotspots. The article hereby answers the more general research questions of whether Capital Equipment has rightly been neglected in other studies regarding pulp and paper and which impact categories are important for analyzing the environmental burdens of a paper machine. The study has been executed in collaboration with Voith Paper, an original Equipment manufacturer. Hence, in distinction to literature-based studies, primary data on the paper machine was available resulting in a high overall data quality. Based on the ISO 14040 (2006) and 14044 (2006) standards, this article pursues a cradle-to-grave approach for the paper machine. It assesses the environmental impacts in the impact categories defined by the ReCiPe impact assessment methodology. Different types of energy generation are examined in a scenario analysis with combined heat and power generation (CHP) as the baseline case. For interpretation, a normalization and a sectoral analysis are performed. The normalized results indicate fossil resource depletion and global warming as the most important impact categories. Global warming impacts are highly dependent on the energy processes and result to 432.7 kg CO2e per production of 1 t of paper for CHP and to 701.7 kg CO2e for EU25 grid mix. The sectoral analysis shows that the machinery's operations/use phase is clearly dominating most impact categories due to its long lifetime. An exception is the metal depletion, for which the materials and manufacturing processes are most important. These findings prove that for most categories, the operations/use phase of the paper machine is the most important life cycle stage. In systems focusing on the consumer good paper, it is therefore sufficient to model the operation of the paper machine, whereas the manufacturing, transport, and end-of-life processes regarding the paper machine Equipment can be neglected, unless metal depletion is important to the study.
Gianluca Furneri - One of the best experts on this subject based on the ideXlab platform.
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economic value of narrow band imaging versus white light endoscopy for the diagnosis and surveillance of barrett s esophagus cost consequence model
PLOS ONE, 2019Co-Authors: Gianluca Furneri, Romy Klausnitzer, Laura Haycock, Zenichi IharaAbstract:Barrett’s esophagus (BE) is an abnormality arising from gastroesophageal reflux disease that can progressively evolve into a sequence of dysplasia and adenocarcinoma. Progression of Barrett’s esophagus into dysplasia is monitored with endoscopic surveillance. The current surveillance standard requests random biopsies plus targeted biopsies of suspicious lesions under white-light endoscopy, known as the Seattle protocol. Recently, published evidence has shown that narrow-band imaging (NBI) can guide targeted biopsies to identify dysplasia and reduce the need for random biopsies. We aimed to assess the health economic implications of adopting NBI-guided targeted biopsy vs. the Seattle protocol from a National Health Service England perspective. A decision tree model was developed to undertake a cost-consequence analysis. The model estimated total costs (i.e. staff and overheads; histopathology; adverse events; Capital Equipment) and clinical implications of monitoring a cohort of patients with known/suspected BE, on an annual basis. In the simulation, BE patients (N = 161,657 at Year 1; estimated annual increase: +20%) entered the model every year and underwent esophageal endoscopy. After 7 years, the adoption of NBI with targeted biopsies resulted in cost reduction of £458.0 mln vs. HD-WLE with random biopsies (overall costs: £1,966.2 mln and £2,424.2 mln, respectively). The incremental investment on Capital Equipment to upgrade hospitals with NBI (+£68.3 mln) was offset by savings due to the reduction of histological examinations (-£505.2 mln). Reduction of biopsies also determined savings for avoided adverse events (-£21.1 mln). In the base-case analysis, the two techniques had the same accuracy (number of correctly identified cases: 1.934 mln), but NBI was safer than HD-WLE. Budget impact analysis and cost-effectiveness analyses confirmed the findings of the cost-consequence analysis. In conclusion, NBI-guided targeted biopsies was a cost-saving strategy for NHS England, compared to current practice for detection of dysplasia in patients with BE, whilst maintaining at least comparable health outcomes for patients.
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Economic value of narrow-band imaging versus white light endoscopy for the diagnosis and surveillance of Barrett’s esophagus: Cost-consequence model
2019Co-Authors: Gianluca Furneri, Romy Klausnitzer, Laura Haycock, Zenichi IharaAbstract:Barrett’s esophagus (BE) is an abnormality arising from gastroesophageal reflux disease that can progressively evolve into a sequence of dysplasia and adenocarcinoma. Progression of Barrett’s esophagus into dysplasia is monitored with endoscopic surveillance. The current surveillance standard requests random biopsies plus targeted biopsies of suspicious lesions under white-light endoscopy, known as the Seattle protocol. Recently, published evidence has shown that narrow-band imaging (NBI) can guide targeted biopsies to identify dysplasia and reduce the need for random biopsies. We aimed to assess the health economic implications of adopting NBI-guided targeted biopsy vs. the Seattle protocol from a National Health Service England perspective. A decision tree model was developed to undertake a cost-consequence analysis. The model estimated total costs (i.e. staff and overheads; histopathology; adverse events; Capital Equipment) and clinical implications of monitoring a cohort of patients with known/suspected BE, on an annual basis. In the simulation, BE patients (N = 161,657 at Year 1; estimated annual increase: +20%) entered the model every year and underwent esophageal endoscopy. After 7 years, the adoption of NBI with targeted biopsies resulted in cost reduction of £458.0 mln vs. HD-WLE with random biopsies (overall costs: £1,966.2 mln and £2,424.2 mln, respectively). The incremental investment on Capital Equipment to upgrade hospitals with NBI (+£68.3 mln) was offset by savings due to the reduction of histological examinations (-£505.2 mln). Reduction of biopsies also determined savings for avoided adverse events (-£21.1 mln). In the base-case analysis, the two techniques had the same accuracy (number of correctly identified cases: 1.934 mln), but NBI was safer than HD-WLE. Budget impact analysis and cost-effectiveness analyses confirmed the findings of the cost-consequence analysis. In conclusion, NBI-guided targeted biopsies was a cost-saving strategy for NHS England, compared to current practice for detection of dysplasia in patients with BE, whilst maintaining at least comparable health outcomes for patients.
