Browsing by Subject "Cost"
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Item Adherence to antidepressants and healthcare resource utilization and costs among medicare advantage beneficiaries with Parkinson’s disease and depression(2016-08) Ling, You-Li; Rascati, Karen L.; Barner, Jamie C; Wilson, James P; Lawson, Kenneth A; Suehs, Brandon TDepression is the most common comorbid psychiatric disorder in patients with Parkinson’s disease (PD) and imposes a significant negative impact on PD. Studies have shown that antidepressants (ADs) may both treat depression and ameliorate its negative effects on PD. However, little has been reported regarding how improved adherence to antidepressants affects the outcomes among PD patients with depression. The purpose of this study was to examine antidepressant use patterns (adherence, persistence, switching, and combination therapy) and evaluate the associated healthcare utilization and costs in PD patients with comorbid depression. A retrospective cohort analysis using claims data from the Humana healthcare insurance plan (2007-2010) was conducted. Medicare Advantage with Prescription Drug (MAPD) Plan insured patients with ADs and a diagnosis of both depression and PD were identified and followed for one year. Healthcare resource utilization and costs were compared between adherent and non-adherent AD users while adjusting for demographic and clinical covariates. Adherence was defined as having at least 80 percent of AD coverage for the year, using proportion of days covered (PDC) calculations. A total of 856 PD patients initiating AD treatment were included. Less than half (N= 355 (41.5%) were considered adherent. The mean PDC (±SD) for antidepressants was 0.63 (± 0.31). The mean persistence (using a 30-day gap period) for antidepressants was 194 days. Having a regimen modification, (11% of patients had switching or combination therapy) was associated with a greater likelihood of being adherent (odds ratio = 2.97, 95% CI = [1.88, 4.68], p < 0.001) and a lower likelihood of discontinuation (hazard ratio = 0.63, 95% CI = [0.47, 0.84], p = 0.0016). After adjusting for covariates, adherent AD users had fewer all-cause and PD-related inpatient visits (all p < 0.05). Adherent AD users also had lower all-cause nursing facility, inpatient, emergency room (ER), and total costs (all p < 0.05) than non-adherent AD users. However, the results were no longer significant when assessing PD-related costs. In conclusion, regimen modification (switching, or combination therapy) to antidepressants was associated with better adherence and persistence in depressed PD patients. Adherent AD users had some lower healthcare utilization and costs than non-adherent AD users among depressed PD patients.Item The application of systems engineering to a Space-based Solar Power Technology Demonstration Mission(2012-05) Chemouni Bach, Julien; Fowler, Wallace T.; Guerra, Lisa A.This thesis presents an end-to-end example of systems engineering through the development of a Space-based Solar Power Satellite (SSPS) technology demonstration mission. As part of a higher education effort by NASA to promote systems engineering in the undergraduate classroom, the purpose of this thesis is to provide an educational resource for faculty and students. NASA systems engineering processes are tailored and applied to the development of a conceptual mission in order to demonstrate the role of systems engineering in the definition of an aerospace mission. The motivation for choosing the SSPS concept is two fold. First, as a renewable energy concept, space-based solar power is a relevant topic in today's world. Second, previous SSPS studies have been largely focused on developing full-scale concepts and lack a formalized systems engineering approach. The development of an SSPS technology demonstration mission allows for an emphasis on determining mission, and overall concept, feasibility in terms of technical needs and risks. These are assessed through a formalized systems engineering approach that is defined as an early concept or feasibility study, typical of Pre-Phase A activities. An architecture is developed from a mission scope, involving the following trade studies: power beam type, power beam frequency, transmitter type, solar array, and satellite orbit. Then, a system hierarchy, interfaces, and requirements are constructed, and cost and risk analysis are performed. The results indicate that the SSPS concept is still technologically immature and further concept studies and analyses are required before it can be implemented even at the technology demonstration level. This effort should be largely focused on raising the technological maturity of some key systems, including structure, deployment mechanisms, power management and distribution, and thermal systems. These results, and the process of reaching them, thus demonstrate the importance and value of systems engineering in determining mission feasibility early on in the project lifecycle.Item Cost Comparison of Public Elementary School Construction Costs Based on Project Delivery System in the State of Texas(2012-02-14) Reinisch, AshleyIf a correlation exists between cost and project delivery system then this is crucial knowledge for any group organizing a new construction project. It has been observed anecdotally that the construction cost per student of public elementary schools has been observed to continue to increase in the state of Texas, even with the recent downturn in the economy. The recent economic depression in the USA has seen construction material costs stagnate and construction costs dropping. This is a direct result of the competitive nature of a market that has a lack of business. The issue of a rising cost at the time of a falling market is of more than a passing research interest to school superintendents and the people of Texas. This study investigated the relationship between cost and project delivery systems. A survey was sent to all school superintendents in Texas requesting recent data on elementary school enrollment, project delivery type and construction costs. One hundred and thirty six responses were received from one thousand and seventy six Texas school districts. A comparative means test was used to determine if a relationship exists between construction cost per student and project delivery system for public elementary schools in Texas. The research shows that Texas school districts are primarily using two types of project delivery systems for their new school construction, Construction Management at Risk and Competitive Sealed Proposals. After comparing the average construction cost per student for these two project delivery systems, the statistical analysis showed that Competitive Sealed Proposals cost approximately four thousand dollar less per student than Construction Management at Risk. The clear question is then as to why are districts using Construction Management at Risk when the comparative benefits of the contract type are not worth this amount of money per student.Item Development of a tool for estimation of total cost of commute in Austin(2015-12) McElduff, Kelsey Ann; Machemehl, Randy B.; Zhang, Zhanmin, 1962-While intelligent consumers aim to investigate all costs and benefits prior to making travel mode decisions, much of the information needed is not readily available to them. There is even less knowledge of the costs and benefits to society that reflect those decisions. If there were a tool for transportation users to see the actual cost of their commute they would be able to make more informed decisions about travel. The purpose of this research is to create the background information for a tool in the form of a web application that will enable users to visualize the individual and societal costs and benefits of their own commutes. The information will materialize in the form of eight equations for estimating internal and external cost by four different modes of travel.Item Estimating production and cost for clamshell mechanical dredges(Texas A&M University, 2005-02-17) Adair, Robert FletcherClamshell dredges are used around the United States for both navigational and environmental dredging projects. Clamshell dredges are extremely mobile and can excavate sediment over a wide range of depths. The object of this thesis is to develop a methodology for production and cost estimation for clamshell dredge projects. There are current methods of predicting clamshell dredge production which rely on production curves and constant cycle times. This thesis calculates production estimation by predicting cycle time which is the time required to complete one dredge cycle. By varying the cycle time according to site characteristics production can be predicted. A second important component to predicting clamshell dredge production is bucket fill factor. This is the percent of the bucket that will fill with sediment depending on the type of soil being excavated. Using cycle time as the basis for production calculation a spreadsheet has been created to simplify the calculation of production and project cost. The production calculation also factors in soil type and region of the United States. The spreadsheet is capable of operating with basic site characteristics, or with details about the dredge, bucket size, and region. Once the production is calculated the project cost can be determined. First the project length is found by dividing the total amount of sediment that is to be excavated by the production rate. Once the project length is calculated the remainder of the project cost can be found. The methods discussed in this thesis were used to calculate project cost for 5 different projects. The results were then compared to estimates by the government and the actual cost of the project. The government estimates were an average of 39% higher than the actual project cost. The method discussed in this thesis was only 6% higher than the actual cost.Item Evaluation of a pharmacist-led medication management program in high-risk diabetic patients: impact on clinical outcomes, medication adherence, and pharmacy costs(2009-12) Hanson, Kristin Anne; Wilson, James P.; Rascati, Karen L.; Godley, Paul J.; Browne, Barry A.Diabetes mellitus is a group of metabolic disorders caused by a relative or absolute lack of insulin. Currently, 23.6 million Americans have diabetes. Diabetes can lead to serious microvascular and macrovascular complications, such as cardiovascular disease, blindness, kidney disease, lower-limb amputations, and premature death. Due to the potential cardiovascular complications and the high prevalence of co-morbid hypertension and/or hyperlipidemia in patients with diabetes, diabetes management should include close monitoring of blood glucose, blood pressure, and cholesterol levels. Medical management of diabetic patients is costly; approximately 1 in every 10 health care dollars is currently spent treating diabetes. Studies have shown that in chronic conditions such as diabetes, increased medication use results in demonstrable improvements in health outcomes, reduced hospitalization rates, and decreased direct health care costs. To date no studies have evaluated the impact of a pharmacist-led intervention on diabetic medication adherence. The purpose of this investigation was to analyze the impact of a pharmacist-led medication management program on medication adherence and pharmacy costs and to evaluate clinical measures of diabetes, hypertension, and hyperlipidemia. This study was a quasi-experimental, longitudinal, pre-post study, with a control group. Scott & White Health Plan (SWHP) patients with diabetes (type 1 or type 2), poor glycemic control (most recent A1C >7.5%), and living within 30 miles of participating pharmacies were invited to participate in the intervention which consisted of monthly appointments with a clinical pharmacist and a co-payment waiver for all diabetes medications and testing supplies. A total of 118 patients met study inclusion criteria and were enrolled in the intervention between August 2006 and July 2008. Intervention patients were matched on sex and age to SWHP patients with poor diabetes control living more than 30 miles from a participating pharmacy. To measure the impact of the intervention, medical and pharmacy data were evaluated for one year before and after the study enrollment date. A significant difference was seen in the percentage of patients with type 1 diabetes in the intervention group (14) and the control group (3). The medication management program significantly improved A1C levels in intervention patients relative to controls (-1.1% vs. 0.6%) and was more effective in lowering A1Cs in type 2 diabetics than type 1 patients. Although the generalized linear model did not show that the intervention significantly improved the percentage of patients achieving the ADA goal A1C of <7% compared to controls, the multivariate logistic regression, which controlled for factors such as diabetes type, showed that patients participating in the intervention were 8.7 times more likely to achieve the A1C goal. Persistence with diabetic medications and the number of medications taken significantly increased in the intervention group; however, adherence rates, as measured by medication possession ratio (MPR), did not significantly improve relative to controls. The expenditure on diabetic medications and testing supplies increased substantially more in the intervention group than in the control group. The percentage of patients adherent with antihypertensive medications (MPR ≥80%) increased from 76% to 91% in the intervention group and decreased from 68% to 63% in the control group (P<0.05); no significant difference in blood pressure control was observed. For hyperlipidemia medications, adherence and persistence increased and pharmacy costs decreased in both groups, likely due to the introduction of the first generic HMG-CoA reductase inhibitor into the market during the study period. Future research is needed on the impact of the intervention on medical resource utilization and costs.Item An evaluation of cost in government aircraft acquisition programs(2011-08) Reynolds, Robert Paul; McCann, Robert Bruce, 1948-; Nichols, Steven Parks, 1950-Aircraft system development has been steadily increasing in cost since the inception of human flight. Several factors have influenced this including economics, increasing complexity and increased customer expectations and requirements. In addition, the contractors which produce these systems have almost consistently been unable to complete them within the originally contracted budget and schedule. The factors which influence cost increase have been studied extensively by industry, government and private organizations and a study of those findings will be conducted in the following work with the intention of determining the factors which are primarily responsible for cost increase in aircraft acquisition programs. Following the discussion of data, recommendations for reducing cost will made with the goal of identifying the methods with which systems engineering can be used to improve the process at the system and program level. The intent will be to show how improved techniques for managing programs, meeting customer requirements and improving cost estimates can be implemented to manage cost growth. The ultimate goal of this study is to show that program risk can and should be managed more effectively and that high technology programs can be executed if they are properly managed.Item The metrics of spacecraft design reusability and cost analysis as applied to CubeSats(2012-05) Brumbaugh, Katharine Mary; Lightsey, E. Glenn; Guerra, LisaThe University of Texas at Austin (UT-Austin) Satellite Design Lab (SDL) is currently designing two 3U CubeSat spacecraft – Bevo-2 and ARMADILLO – which serve as the foundation for the design reusability and cost analysis of this thesis. The thesis explores the reasons why a small satellite would want to incorporate a reusable design and the processes needed in order for this reusable design to be implemented for future projects. Design and process reusability reduces the total cost of the spacecraft, as future projects need only alter the components or documents necessary in order to create a new mission. The thesis also details a grassroots approach to determining the total cost of a 3U CubeSat satellite development project and highlights the costs which may be considered non-recurring and recurring in order to show the financial benefit of reusability. The thesis then compares these results to typical models used for cost analysis in industry applications. The cost analysis determines that there is a crucial gap in the cost estimating of nanosatellites which may be seen by comparing two widely-used cost models, the Small Satellite Cost Model (SSCM <100 kg) and the NASA/Air Force Cost Model (NAFCOM), as they apply to a 3U CubeSat project. While each of these models provides a basic understanding of the elements which go into cost estimating, the Cost Estimating Relationships (CERs) do not have enough historical data of picosatellites and nanosatellites (<50 kg) to accurately reflect mission costs. Thus, the thesis documents a discrepancy between widely used industry spacecraft cost models and the needs of the picosatellite and nanosatellite community, specifically universities, to accurately predict their mission costs. It is recommended to develop a nanosatellite/CubeSat cost model with which university and industry developers alike can determine their mission costs during the designing, building and operational stages. Because cost models require the use of many missions to form a database, it is important to start this process now at the beginning of the nanosatellite/CubeSat boom.Item Parametric estimating for early electric substation construction cost(2009-12) Wall, Darden Lee; Ambler, Tony; McCann, Robert B.Developing accurate construction estimates is critical for electric utilities to make reliable financial plans for their future. Parametric estimating is just one of several techniques available to help estimate the cost of a construction project. Other estimating methods may have some advantages over parametric estimating in the latter stages of a project but parametric estimating is possibly the most accurate method in the very early stages of a project. This report delves into the analysis and development of a parametric equation for use primarily in the very early stages of a construction project. The result of this research is a functional equation that can be used for estimating future electric substation construction cost with a fair level of confidence.Item Quantifying the impacts of regulatory delay on housing affordability and quality in Austin, Texas(2015-05) Shannon, Megan Elizabeth; Wegmann, Jake; Mitchell, TerryRegulatory delay during site plan review of multifamily projects in Austin has three primary impacts: 1) it generates unexpected development costs which increases housing prices over-time; 2) it stifles innovation and decreases quality of development; and 3) it promotes exurban growth. These impacts reduce affordability and quality of life for all Austinites and thwart the goals of the Imagine Austin comprehensive plan. As regulatory delays have increased remarkably since 2009, strong rent growth has compensated for this growing uncertainty throughout the Austin market. If regulatory delays are eliminated and developers receive approvals for multifamily projects within the 120 day mandate instead of the 223 day average, renters could see relief of 4-5% on their rent, or an average of $60 per month or $720 annually in Central Austin. Interviews with 14 Austin-area residential developers confirm these delays, costs, and impacts on their projects. On average it takes 3.5 additional months to receive site plan approvals in Austin in addition to the code mandated four month cycle. Austin's peer cities fare differently. The average delay in Denver, Colorado is three weeks, and is just several days in Raleigh, North Carolina. Whereas land use regulations theoretically generate positive externalities, delays in administering those regulations generate no benefits to the community. During this unforeseen 3.5 months, developers accrue unexpected costs such as legal fees, and developer overhead which includes the opportunity costs of not pursuing other deals. Construction costs increase during delays, and developers must continue to pay for land options and carry costs. In the short-term, developers pay for these unexpected costs out-of-pocket, and by reducing construction costs, which can result in lower quality materials or amenities. Unexpected costs roll into the project's overall budget, resulting in more expensive development projects. More expensive projects require higher rents in order to maintain the development team's expected yield on cost. Further, interviews with urban designers and civil engineers reveal that regulatory delay stifles private sector innovation in the built environment. Developer interviews and case studies suggest that regulatory delay promotes exurban growth instead of urban infill in the Austin metropolitan area.Item Safety, effectiveness, and cost among Texas Medicaid patients with Diabetic Macular Edema (DME) or Age-Related Macular Degeneration (AMD)(2014-12) Jiang, Shan, 1986-; Barner, Jamie C.Although bevacizumab is one of the most commonly used treatments for DME and AMD, there are concerns regarding safety and effectiveness due to its off-label use. The study objectives were to determine if: 1) the risk of cardiovascular/ hemorrhagic events (safety) and visual impairment (effectiveness) differed by bevacizumab use (i.e., use vs. non-use and number of treatments) among DME and AMD patients; and 2) direct medical costs differed between DME and DME control patients. A retrospective cohort analysis was conducted with Texas Medicaid medical and prescription data (9/1/07-12/31/12) for patients: 18- 63 years, continuously enrolled 1-year pre- and post-index, and diagnosed with DME or AMD. The index date was the first date of diagnosis. The dependent variables were: 1) cardiovascular/hemorrhagic risk; 2) visual impairment; 3) direct medical costs. The independent variables were bevacizumab use and number of bevacizumab treatments. Covariates were disease state, Charlson Comorbidity Index (CCI) score, total medication use, number of laser treatments, and demographics. Propensity scoring technique was used to match: 1) bevacizumab users and non-users; and 2) DME and DME control cohorts. Descriptive analyses, logistic regression, Cox-regression, and generalized linear models were employed. A final cohort of 3,647 DME, 297 AMD, and 57,897 DME control patients were included. The majority (DME and AMD) was between 45-63 years of age (86.6%), Hispanic (54.0%), and female (65.1%). The mean total number of unique medications and mean CCI were 2.7 ± 3.4 and 6.0 ± 3.3, respectively. Total direct medical costs/person (Mean (±SD)) incurred by DME, DME control, and AMD subjects in the post-index period were $6,704(±9,338), $5,495(±10,153), and $4,935(±12,702), respectively. No differences in cardiovascular/ hemorrhagic risk were found between bevacizumab users and non-users. The claims data lacks the detail to determine the effectiveness of bevacizumab. DME control patients had lower overall direct medical costs than DME patients (p<0.0001). In conclusion, although bevacizumab is a less expensive off-label alternative of ranibizumab, the choice between bevacizumab and ranibizumab should be made through careful consideration. However, as the use of anti-VEGF agent increases, further research should be conducted to determine if any changes in cardiovascular adverse events occur.Item Segmented and total direct cost-of-care for advanced squamous cell carcinoma of the head and neck in a privately insured population(2013-05) Reveles, Ivan Alexander; Koeller, JimIntroduction: Current treatment recommendations for advanced SCCHN include the use of combined modality therapy (e.g., radiation plus chemotherapy/biologic therapy). The new biologic agent, cetuximab, is considered a primary cost driver for SCCHN management. Cetuximab’s impact, however, has not been factored into SCCHN cost estimates; furthermore, costs have not been delineated for diagnostic, treatment, and end-of-life segments of advanced SCCHN management. We aim to characterize SCCHN segmented and overall costs, before and after cetuximab’s approval. Methods: This was a retrospective analysis of the PharMetrics Choice database. Patients >20 years of age with ICD-9-CM codes suggestive of advanced SCCHN diagnosed between 3/1/2003 and 3/1/2008 were included. Patients were divided into cohorts by diagnosis date: “pre-biologic” and “post-biologic.” Descriptive statistics were used to summarize patient characteristics, monthly and total medical costs, and cost drivers. The Mann-Whitney U test was used to compare costs between segments and cohorts; whereas, least squares regression was used to ascertain the impact of covariates. Results: A total of 365 patients met study criteria. Patients were predominately male (78%), with a median age of 57 years. Median monthly costs were: diagnosis ($2,199), treatment ($4,161), end-of-life ($6,614), and total ($4,167). Total direct medical costs were primarily driven by outpatient costs (23%). Patient age and length of follow-up had a significant impact on total costs, with older age associated with lower costs. When treatment segment was isolated, median monthly costs were lower in the “pre-biologic” as compared to the “post-biologic” era ($3,301 vs. $4,381, p=0.0024); biologic therapy accounted for 4.2% of total cost in the study period. In those patients experiencing all segments of care (“benchmark group”), median monthly costs were: diagnosis ($1,733), treatment ($8,265), end-of-life ($6,614), and total ($7,817). There were no significant differences in monthly medical costs between cohorts for the benchmark group. Conclusions: Median total cost exceeded $4,000/month for SCCHN patients; treatment and end-of-life segments incurred higher costs. Outpatient costs were the biggest cost-driver. Median monthly cost for the treatment segment increased by approximately $1,000 following cetuximab’s approval; however, this difference dissipated when the analysis was limited to those patients who experienced all segments of care.Item The true impact of late deliverables at the construction site(2014-05) Barry, William Ryan; Leite, Fernanda; O'Brien, William J.Given that a construction site is both temporary and unique, the outcome of every construction project is dependent upon having all of the proper resources delivered to the site at the appropriate time. Although this is common knowledge in the construction industry, late deliverables to the site continue to be a major impediment to project success. In order to better understand late deliverables and their impacts on performance, the Construction Industry Institute, in collaboration with the Construction Users Roundtable, commissioned Research Team (RT) 300 to investigate how various types of late deliverables affect the cost, schedule, quality, safety, and organizational performance of industrial construction projects. Using case studies, industry surveys and questionnaires, existing literature, and internal team expertise, RT 300 developed two research thrusts: investigate how the industry understands, manages, and is affected by late deliverables, and document and give visibility to the true risks and impacts associated with late deliverables. When examining how late deliverables affect the construction industry, RT 300 found that (1) there is limited understanding of the full range of late deliverables and their far-reaching impacts, (2) the most common late deliverables tend to have the most severe impacts on projects, (3) project teams are typically reactionary when managing late deliverables, (4) project stakeholders have varying perceptions of the risks and impacts associated with late deliverables, and (5) proactively managing late deliverables and impacts is key for improvement in the industry. With these findings and the second research thrust in mind, RT 300 created a database tool, the Late Deliverable Risk Catalog (LDRC), to document common types of late deliverables, give visibility to the full range of impacts, and help project teams recognize risks, improve alignment, and proactively manage late deliverables and mitigate the impacts. RT 300 has also developed implementation recommendations for the LDRC, prevention recommendations for the highest risk deliverables, and lessons learned in managing late deliverables. Altogether, this research can help improve the understanding of late deliverables and resulting impacts and risks in order to improve project delivery, productivity, and predictability as well as enhance safety, quality, and organizational and individual performance.Item Understanding resistance factors in professional e-learning: a literature review(2015-12) Young, Alexandra Marie; Hughes, Joan E.; Liu, MinProfessional training involving the use of online tools and technology (also called “e-learning”) has become a lucrative alternative to live, in-person instruction in today’s 21st century workplaces. However, several factors can impact the adoption of these online services. This report reviews literature concerning employer and employee-related factors that have caused resistance or otherwise hindered adoption of e-learning services in professional settings. This review identified two factors associated with employer resistance—(a) unclear leadership goals and (b) high cost—and two factors associated with employee resistance—(a) individual learner differences and (b) work environment. The limitations of this literature review, as well as possible future research and directions, are also discussed.