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Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence‐based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost‐effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this systematic literature review was to report the results and complications of recent remnant preservation techniques in posterior cruciate ligament (PCL) reconstruction. Methods: A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms "posterior cruciate ligament" or "PCL" and "remnant preserving." The outcome measures extracted from the studies were the Lysholm score, the International Knee Documentation Committee's (IKDC) subjective and objective scores, Tegner scores, Orthopädische Arbeitsgruppe Knie (OAK) rate of return to sports, and rate of complications. Data were also extracted from studies that used stress radiographs to perform a quantitative assessment of the preoperative and postoperative anteroposterior stability. Results: The systematic review included 13 studies. The patient cohort of consisted of 643 participants (544 [84.6%] men and 99 [15.4%] women) with a mean age of 32.9 ± 4.0 years. The mean postoperative follow-up was 34.5 ± 10.9 months (range: 24–96 months), while the mean time from injury to surgery was 14.4 ± 9.9 months (range: 0–240 months). All studies reported clinically significant improvement at final follow-up, as evident from the measured subjective and objective IKDC scores, Lysholm score, Tegner score, and OAK rate. Only three studies reported return to sports activity, with a mean percentage of 90.8% (99/109). All studies showed a significant improvement in posterior translation, from 11.5 ± 1.2 mm to 3.3 ± 1.1 mm, using radiography (side-to-side difference). This systematic review revealed 13 (2.0%) failures and 33 (5.1%) minor complications: 10 (1.6%) cases of stiffness, 21 (4.9%) screws removal, 1 (0.2%) injury of the peroneal nerve, and 1 (0.2%) fibular fracture. Conclusions: With the currently available data, all studies included in the review on posterior cruciate ligament reconstruction with remnant preservation demonstrated satisfactory outcomes at mid-term follow-up (> 24 months), despite varying surgical techniques and graft types, and intervals from injury to surgery. For clinical relevance, standard PCL reconstruction is a highly effective operation in terms of improvement in functional status, knee stability, quality of life, and cost effectiveness. The remnant preservation technique requires more comprehensive diagnostic assessments of the PCL remnant patterns and more complicated surgical procedures. Given the absence so far of high quality studies with long-term follow-up, the remnant-preserving techniques should be recommended only by experienced knee arthroscopic surgeons. Level of evidence: Level IV. Study registration: reviewregistry1376—www.researchregistry.com. [ABSTRACT FROM AUTHOR]

Despite of being rich in fossil fuels, the Middle East is currently the main energy consumer and is projected to have the highest growth in energy demand in the world. Due to its great potential in the Middle East, solar energy can play an important role in the plans of energy decision-makers in the region. According to the studies done so far, no study has been done to show the potential benefit of using home-scale solar systems in the Middle East. Therefore, in this work for the first time, the potential of solar electricity production in the capitals of Middle Eastern countries has been studied using HOMER V2.81 software. The investigations are technical, economic, energy, and environmental, and the studied solar system is connected to the national electricity grid. The results showed that in Nicosia, due to the sale of electricity to the grid, the levelized cost of electricity (LCOE) is equal to -0.759 $, which is the lowest price for produced electricity and leads to a return on investment time of 5.69 years for this system. The solar fraction for the Nicosia station is 92%, which prevents the emission of more than 8 tons of CO2 pollutants during the year. The highest value of LCOE with the amount of $0.25 is related to Sana'a, whose investment return time, solar fraction, and annual CO2 emission prevention amount are 14.1 years, 53%, and 1162 kg, respectively. Ranking analysis was done on the results of 5 outputs of the HOMER software as well as 3 other influential parameters using 4 multicriteria decision-making (MCDM) methods. TOPSIS, GRA, WSM, and AHP methods were used, and the final ranking of each station was considered the average of the 4 methods. According to the results, Cyprus and Kuwait stations were the best and worst, respectively. [ABSTRACT FROM AUTHOR]

Objectives: Some pregnant women are not ready or do not want to quit smoking completely, and currently there is no support provided for these women in the UK. Offering help to reduce smoking could reduce the health risks associated with smoking and increase the limited reach of the NHS Stop Smoking Services (SSS) for pregnant women. This study aimed to design and evaluate a hypothetical intervention aimed at pregnant women who are not yet ready or do not want to quit smoking entirely.Methods: A hypothetical intervention, the Reduced Smoking During Pregnancy (RSDP) intervention, was conceptualised based on the best available evidence. The intervention was evaluated, using a decision-analytic model developed for SDP interventions. Two different scenarios, a base-case and a cautious-case were developed, and a cost-utility analysis and return on investment analysis were conducted. The uncertainty around the estimates was assessed, using deterministic and probabilistic sensitivity analyses.Results: The RSDP intervention could prevent the loss of 13 foetuses and generate 43 quitters 1 year after delivery per 1000 women. In the lifetime analysis, the intervention was cost-effective in both scenarios, with an incremental cost of £363 (95% CI £29 to £672) and 0.44 (95% CI 0.32 to 0.53) QALYs gained in the base-case.Conclusions: The study found that the hypothetical reduction intervention would produce significant health benefits, reduce smoking and be cost-effective. Offering pregnant smokers help to reduce smoking could reduce health inequalities, widen the reach of SSS and improve health. This economic evaluation of a novel, intensive intervention could inform the piloting of such interventions. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) leads to significant disability, unemployment, and substantial healthcare costs. The cost-effectiveness of vocational rehabilitation (VR) interventions is important to consider when determining which services to offer. This study assesses the cost-effectiveness and return on investment of Individual Placement and Support (IPS) compared to transitional work (TW) programs. Employment outcomes from a multisite randomized trial comparing IPS to TW in military veterans with PTSD (n = 541) were linked to Veterans Health Administration (VHA) archival medical record databases to examine the comparative cost-effectiveness and return on investment. Effectiveness was defined as hours worked and income earned in competitive jobs. Costs for VR, mental health, and medical care and income earned from competitive sources were annualized and adjusted to 2019 US dollars. The annualized mean cost per person of outpatient (including vocational services) were $3970 higher for IPS compared to TW ($23,245 vs. $19,276, respectively; P = 0.004). When TW income was included in costs, mean grand total costs per person per year were similar between groups ($29,828 IPS vs. $26,772 TW; P = 0.17). The incremental cost-effectiveness analysis showed that while IPS is more costly, it is also more effective. The return on investment (excluding TW income) was 32.9% for IPS ($9762 mean income/$29,691 mean total costs) and 29.6% for TW ($7326 mean income/$24,781 mean total costs). IPS significantly improves employment outcomes for individuals with PTSD with negligible increase in healthcare costs and yields very good return on investment compared to non-IPS VR services. [ABSTRACT FROM AUTHOR]

This study sought to estimate the net benefits and return on investment (ROI, %) of the Coping and Promoting Strength (CAPS) program to families and insurers, respectively, using data from a multi-year follow up of 136 US families who had participated in a randomized efficacy trial of CAPS. CAPS is a brief parent-focused psychosocial intervention that was compared to information monitoring in the trial. Of the 136 original participants, 113 (83%) completed follow-up interviews 7.1 years, on average, after the CAPS study baseline (mean follow-up age: 15.8 years; range: 13.1 to 20.8 years). Parent-reported willingness-to-pay values and estimates of behavioral healthcare cost savings from delayed onset of anxiety were used to simulate the average net benefits of CAPS to families and insurance plans, respectively, assuming patients pay 20% coinsurance. Psychologists in private offices were expected to charge an average of approximately $195 per CAPS session or $1417 in total in 2020 dollars. The estimated family share of the total CAPS session cost was $283 per youth, while the insurer share was $1134 per youth. Given these costs, the CAPS intervention was estimated to result in average overall net benefits of $1033 per youth (95% CI: -$546 to $2611). Families gained $344 (95% CI: $232 to $455 per family) for an ROI of 121%. Insurance plans on average gained a net savings of $689 per youth (95% CI: -$778 to $2156 per youth) for an average ROI of 61%. In this multiyear follow-up of offspring of anxious parents, exposure to the CAPS pediatric anxiety prevention program was found to be more economically efficient than was waiting for an anxiety disorder to be diagnosed. ClinicalTrials.gov Identifier: NCT00847561. [ABSTRACT FROM AUTHOR]

A case study was conducted on 44 residential homes using both traditional house wrap and ZIP System systems to measure the overall airtightness and compare estimated energy usages. The labor, material, and overhead and profit (O&P) costs were analyzed and used to determine the optimal choice for long-term benefits in terms of cost and performance. The impact of insulation installation is considered a key factor in improving the strategy of reducing energy consumption. Improved installation practices can affect the airtightness of common wall assemblies to reduce the building energy performance gaps and provide insight on how to allocate resources better. A framework was developed to analyze operational costs and building energy performance to address how installation quality is a factor in the return of investment in building construction for heating and cooling systems within the thermal envelope. With this methodology, aggressive energy performance goals will be met while balancing the tradeoff between installation techniques and building systems efficiency based on the introduced probabilistic investment return (PIR) metric. [ABSTRACT FROM AUTHOR]

[Display omitted] • Cost benefit analysis of a municipal solid waste recycling facility. • Internal Rate of Return and Net Present Value of a project. • MATLAB, Python and R-Studio for comparation and validation. Rapid population and economic growth, changes in consumption pattern etc. have become major contributing factors to severe municipal solid waste generation globally. Thus, various methods are being employed to manage the incessant municipal solid waste generation for a sustainable solid waste management and one of the viable approaches is the recycling option. The main objective of this paper is to determine the cost benefit analysis of setting up a recycling facility for the processing of various wastes for use as raw materials by industries. The cost benefit analysis was carried out based on historic data obtained from the municipality and some recent waste composition data. The overall analysis was done using Excel software. From the Excel software analysis, Internal Rate of Return on investment was 42%, Internal Rate of Return on equity was 98% and Net Present Value was R 63, 420,000 (USD$ 4646225.33). In ascertaining the result obtained from the Microsoft Excel, three data analysis and technical computing software (MATLAB, Python, and R-Studio) were employed. This was necessary to compare and validate the cost-benefit indicators (Net Present Value and Internal Rate of Return). Besides, evaluating the performance of each software with regards to the cost-benefit evaluation is ideal for a recycling plant like this to establish the feasibility of the project. Moreover, sensitivity analysis was conducted, and a breakeven point of 211 tons of waste was obtained. In addition, the total benefit of recycling was valued and was given as R 486,008,582.85 (USD$ 35605572.16). From the overall analysis, it was observed that the IRR and Net Present Value were alike, about 677 potential jobs could be created on the project and the Net Present Value > 0. Based on the overall analysis, it was concluded that the project is viable. [ABSTRACT FROM AUTHOR]

The importance of knowledge management as a competitive advantage is evident to everyone, and it is considered one of the critical factors of successful organizations. The capitalist view of knowledge management has led to the measurement of the return on investment resulting from it, and the return on investment has been recognized as a financial indicator for measuring knowledge management. What are the main components of knowledge management? Have components the same coefficients? The impact of the components is different and has different values. In order to achieve this importance, the present study was conducted to develop a return on investment model in knowledge management. This Practical research is mixed method, and in the form of exploratory schema in three stages, qualitative (using grounded theory and the use of interview tools), quantitative (using a descriptive method, a survey using questionnaire tool), quantitative (using a descriptive method, a survey using questionnaire tool) has been done. Each method is analyzed using, respectively, MAX QDA and SPSS software. The findings of the first stage of the study include identifying the benefit and costs of knowledge management. Then, the components validity is obtained, and then in the third stage, a coefficient is assigned to each of them. Identifying costs and benefit Components is a first stage achievement. Experts measured the validity of each component to identify components accurately. Furthermore, finally, in the third stage, each of these components was assigned a coefficient. The development of a new formula, taking into account each of these coefficients, is considered research innovation. [ABSTRACT FROM AUTHOR]

The performance of floating photovoltaics (FPV) was assessed by this study, a technology with rising popularity in the sustainable energy sector, by comparing its economic and environmental benefits to various types of photovoltaic technologies by utilizing Life Cycle Assessment (LCA) and Cost-Benefit Analysis. The largest impacts were shown from this LCA of a 150 MW FPV plant with a 30-year lifespan, which resulted from the roughly 73 kg of greenhouse gases and 110 m3s of water per MWh generated. Additionally, 21 reservoirs were considered in Thailand to house new FPV plants. Projected power generation scenarios varied between 0.64 GW and 13.28 GW when reservoir coverage percentages ranging from 1% to 20% were used. The Levelized Cost of Energy for several different photovoltaic systems yielded 0.24 USD per kWh for the FPV system, while the ground based polycrystalline and thin film systems were 0.43 USD and 0.54 USD per kWh, respectively. The payback period for FPV was 7.5 years, while for the polycrystalline and thin film it was 7.8 and 16.3 years. This combined with other factors made for a high return on investment for the FPV system. This study recommends a 10% coverage of 21 reservoirs throughout Thailand, allowing for potentially 6.52 GW of installed capacity, which would substantially help the country to reach their 2036 goal of having 30% of the energy mix from renewable sources. • Life Cycle Assessment was conducted of a floating solar plant in Thailand. • A 150 MW plant was found to emit 73 kg of greenhouse gases per megawatt. • The Payback Period for the floating solar plant was 7.5 years. • Thailand could install between 0.64 and 13.28 GW at 21 reservoirs. [ABSTRACT FROM AUTHOR]

The article discusses how Return on investment (ROI) is calculated for investments in forecasting software and talent, and the different factors that need to be considered. It mentions investment in demand planning resources; and also mentions labor savings generates the expected financial benefit from the project investment.

Is solar energy an economically competitive option for Floridian consumers? By 2028, Florida Power and Light (FPL), the leading electricity provider for the State of Florida, projects to source nearly 15% of its electricity supply from solar power. As an Investor-Owned Utility serving the electricity needs of approximately half of Floridians, policy changes to its energy portfolio greatly impact consumers through base rate increases to subsidize the technological transition. The present study investigates the potential profitability of FPL's solar projects by conducting a cost-benefit analysis (CBA) and a sensitivity analysis to determine how varying generation parameters impacts profits. This research simulates 110,880 CBA scenarios with only 2.4% of scenarios showing profit while holding base rates constant. Among scenarios with a time-period of 30 years, this study finds approximately 19.5% are profitable. However, this study shows that FPL's solar projects are profitable, but likely not within the regulatory rate of return. Simulations in this study show less than 1% of scenarios are profitable. This research suggests that consumer base rate increases are likely to enable FPL to achieve its allowable rate of return for its future solar projects. [ABSTRACT FROM AUTHOR]

Background: Smoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain. Methods: The economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding. Results: Smoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was €1753 with a benefit of €503, achieving a net economic benefit of €4·8 million per year. Given the annual cost of the intervention (€17·4 million, of which €5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to €1·29 per €1 of investment. Conclusion: From the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs. [ABSTRACT FROM AUTHOR]

Among the significant problems in the sago processing, the extraction of the starch from its trunk tops the list. The extraction process involves a debarking and rasping process that is very tedious, unsanitary and time consuming that dramatically affects the quality of starch production since the local processor relies mainly on conventional method of extraction. This paper presents the design, fabrication and performance evaluation of sago pith extraction machine. The design concept made was to rasp the sago pith using a rotating rasper without debarking the log to minimize the steps on the extraction process. Four different teeth spacing of the rasper were considered during the testing and replicated three times; 1 cm, 2 cm, 3 cm, and no teeth as controlled parameters, respectively. Results revealed that teeth spacing has a significant effect on the performance of the machine such as extraction capacity, extraction efficiency and fineness of rasped pith. Based on average, the highest extraction capacity was recorded at 217.47 kg/h using 3 cm teeth spacing, and the highest extraction efficiency was 96.12% using 2 cm teeth spacing and the finest rasped pith having the lowest fineness modulus of 2.15 was when 1 cm teeth spacing is used. Compared to manual and other existing mechanical rasper accounting the process of debarking, machine's extraction capacity is higher, more efficient, safer and hygienic. Cost and benefit analysis supports that the machine is profitable and the financial efficiency is high having a 65% rate of return and 1.8 years payback period. [ABSTRACT FROM AUTHOR]

Agricultural development projects have a poor track record of success mainly due to risks and uncertainty involved in implementation. Cost-benefit analysis can help allocate resources more effectively, but scarcity of data and high uncertainty makes it difficult to use standard approaches. Bayesian Networks (BN) offer a suitable modelling technology for this domain as they can combine expert knowledge and data. This paper proposes a systematic methodology for creating a general BN model for evaluating agricultural development projects. Our approach adapts the BN model to specific projects by using systematic review of published evidence and relevant data repositories under the guidance of domain experts. We evaluate a large-scale agricultural investment in Africa to provide a proof of concept for this approach. The BN model provides decision support for project evaluation by predicting the value—measured as net present value and return on investment—of the project under different risk scenarios. [ABSTRACT FROM AUTHOR]

To determine the influence of the weight of the economic effectiveness evaluation criteria of the major investments of listed enterprises, and provide new management ideas for the development of the follow-up enterprises, firstly, the financial benefit evaluation system of investment projects is analyzed and constructed, and the specific evaluation process is analyzed. Then, on this basis, the evaluation index is refined; the basic structure of BP neural network (BPNN) is introduced, and genetic algorithm is used to improve BP neural network. The cost-benefit analysis model is constructed based on the improved BPNN. The listed company A is taken as an example to analyze its development data in recent years, and then the data of 10 listed companies are taken as the research object. Matlab simulation software is used to train and verify the improved BPNN model, analyze and predict the weight value of the financial benefit index of the investment projects of these 10 companies, and then determine the index to improve the financial benefit of the investment projects. Under the analysis of the development data of listed company A in the past 10 years, it is found that the indicators of the listed company's profitability per share, debt risk operation ability, development, and growth ability in the past 10 years are in relatively stable state. The principal component analysis of its 20 secondary sub-indexes is conducted based on the four primary indicators: profitability, debt risk, operational capacity, and development and growth. A total of eight principal components including return on equity (ROE), return on assets (ROA), (total asset turnover) TATO, turnover of account receivable (AR), asset-liability ratio, interest protection multiple, income growth rate, and year-on-year rate of increase for complete assets are extracted. The average error between the final output value, the actual value, and the expected value is 0.0304 and 0.0169, respectively. The weight coefficient of the monetary benefits evaluation indicator of investment items is calculated, and the computed results show that year-on-year rate of increase for complete assets, TOTA, ROA, turnover of total capital, and ROE are important indexes in the financial benefit evaluation of investment projects. It indicates that to improve the financial benefit of investment projects of listed enterprises, it is necessary to enhance the year-over-year growth degree of total properties and ROA. [ABSTRACT FROM AUTHOR]

Economic models to inform decision-making are gaining popularity, especially for preventive interventions. However, there are few estimates of the long-term returns to parenting interventions used to prevent mental health problems in children. Using data from a randomised controlled trial evaluating five indicated parenting interventions for parents of children aged 5–12, we modeled the economic returns resulting from reduced costs in the health care and education sector, and increased long-term productivity in a Swedish setting. Analyses done on the original trial population, and on various sized local community populations indicated positive benefit–cost ratios. Even smaller local authorities would financially break-even, thus interventions were of good value-for-money. Benefit–cost analyses of such interventions may improve the basis for resource allocation within local decision-making. [ABSTRACT FROM AUTHOR]

To perform a cost-utility analysis of 2018 United States real dollars for cataract surgery. Center for Value-Based Medicine, Hilton Head, South Carolina, USA. Cost-utility analysis. A base-case 14-year cost-utility model using the ophthalmic cost perspective was used. Third-party insurer and societal cost perspectives were also analyzed. Patient outcomes and costs were discounted with net present value analysis at 3% a year. First-eye cataract surgery resulted in a 2.523 quality-adjusted life-year (QALY) gain, a 33.3% patient value gain, and 25.5% quality-of-life gain. Bilateral surgery yielded a 44.1% patient value gain, while second-eye cataract surgery alone conferred an 8.1% value gain. First-eye cataract surgery resulted in a gain of 2.52 QALYs, while second-eye surgery added an incremental gain of 0.81 QALYs. The ophthalmic-cost-perspective average cost-utility ratio was $2526/2.523 = $1001/QALY for first-eye cataract surgery. The societal-cost-perspective average cost-utility ratio was −$370 018/2.523 = −$146 629/QALY. The second-eye ophthalmic-cost-perspective cost-utility ratio was $2526/0.814 = $3101/QALY, while the ophthalmic-cost-perspective cost-utility ratio for bilateral cataract surgery was $5052/3.338 = $1514/QALY. The 14-year U.S. 2018 real-dollar societal-cost-perspective net return on investment for first-eye cataract surgery was $370 018 above the $2526 cost expended for cataract surgery. Cataract surgery in both the first eye and second eye, when analyzed by standard health economic methodologies, is highly cost-effective. Cataract surgery in 2018 was 73.7% more cost-effective than in 2000. [ABSTRACT FROM AUTHOR]

This research was implemented on rice farmers in An-Najaf Alshraf Province. It aims at economic assess of rice brands Jasmine – Anbar 33 – Anbar Albaraka .on random layer sample with ratio of 5% . The research depend, to achieving its targets, on using Cost-Benefit Analysis CBA and ADOPT program to assess these brands and identify how far farmers will be familiar to the best brand. Many conclusions have been achieved. The most important ones maybe: the net retuen which is 331 thousands Dinar/ dunums in case of cultivating the brand. This is higher than the net benefit in case of cultivating jasmine brand which is 289 thousand Dinars/ dunums. The interned rate of return was 1.23 . The standard ratio of benefit to the cost is 1.63% . and this refers that the Dinar invested in cultivating Anbar Albaraka brand will benefit with amount equal to 1.63 Dinar. Results also showed that it is expected to adopt brand of 52% of farmers during a duration of 14.9 years. The programs of ADOPT program have showed that it is expected there will be adaptation for the technology from 52% of farmers within a time duration may be about 14.9 . The sensitivity analysis indicated that there could be decrease or increase in this duration by effecting on number of factors such as short term financial restrictions-simple experimental of brand on limited scale- the degree of technical complexity- average awareness and cognition for farmers in using the brand – finally, the first investment to the annual benefit. So, according to the results, the adaptation of Anbar Albaraka will contribute, when cultivated on a large scale, in improving the standard of living of farmers and achieving part of developing targets in the agriculture sector. [ABSTRACT FROM AUTHOR]

Threats to biodiversity and the integrity of ecological systems are escalating globally, both within and outside of protected areas. Decision makers have inadequate resources to manage all threats and typically lack information on the likely outcomes and cost‐effectiveness of possible management strategies. Priority Threat Management (PTM) is an emerging approach designed to address this challenge, by defining and appraising cost‐effective strategies for mitigating threats to biodiversity across regions. The scientific and practical impacts of PTM are increasing, with a growing number of case study applications across the globe.Here, we provide guidance and resource material for conducting the PTM process based on our experience delivering six large‐scale projects across Australia and Canada. Our handbook describes the four stages of PTM: scoping and planning; defining and collecting key elements; analysing the cost‐effectiveness of strategies; and communicating and integrating recommendations. We summarise critical tips, strengths, and limitations and scope for possible enhancements of the approach.Priority Threat Management harnesses scientific and expert‐derived information to prioritise management strategies based on their benefit to biodiversity, management costs and feasibility. The approach involves collaboration with key experts and stakeholders in a region to improve knowledge sharing and conservation support. The PTM approach identifies sets of regional level strategies that together provide the greatest benefits for multiple species under a limited budget, which can be used to inform existing processes for decision‐making.The PTM approach applies some generalisations in management strategies and resolution, in order to address complex challenges. Further developments of the approach include testing in a greater range of socioecological systems with adaptations that cater for multiobjective decisions.Synthesis and applications. Priority Threat Management is a decision science approach that brings people together to define and prioritise strategies for managing threats to biodiversity across broad regions. It delivers a prospectus for investment in the biodiversity of a region that is transparent, repeatable, participatory, and based on the best available information. Our handbook provides the necessary guidance and resources for expanding the Priority Threat Management approach to new locations, contexts, and challenges. Priority Threat Management is a decision science approach that brings people together to define and prioritise strategies for managing threats to biodiversity across broad regions. It delivers a prospectus for investment in the biodiversity of a region that is transparent, repeatable, participatory, and based on the best available information. Our handbook provides the necessary guidance and resources for expanding the Priority Threat Management approach to new locations, contexts, and challenges. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate potential health and economic returns from implementing smoking cessation interventions in Hungary. Methods: The EQUIPTMOD, a Markov‐based economic model, was used to assess the cost‐effectiveness of three implementation scenarios: (a) introducing a social marketing campaign; (b) doubling the reach of existing group‐based behavioural support therapies and proactive telephone support; and (c) a combination of the two scenarios. All three scenarios were compared with current practice. The scenarios were chosen as feasible options available for Hungary based on the outcome of interviews with local stakeholders. Life‐time costs and quality‐adjusted life years (QALYs) were calculated from a health‐care perspective. The analyses used various return on investment (ROI) estimates, including incremental cost‐effectiveness ratios (ICERs), to compare the scenarios. Probabilistic sensitivity analyses assessed the extent to which the estimated mean ICERs were sensitive to the model input values. Results: Introducing a social marketing campaign resulted in an increase of 0.3014 additional quitters per 1 000 smokers, translating to health‐care cost‐savings of €0.6495 per smoker compared with current practice. When the value of QALY gains was considered, cost‐savings increased to €14.1598 per smoker. Doubling the reach of existing group‐based behavioural support therapies and proactive telephone support resulted in health‐care savings of €0.2539 per smoker (€3.9620 with the value of QALY gains), compared with current practice. The respective figures for the combined scenario were €0.8960 and €18.0062. Results were sensitive to model input values. Conclusions: According to the EQUIPTMOD modelling tool, it would be cost‐effective for the Hungarian authorities introduce a social marketing campaign and double the reach of existing group‐based behavioural support therapies and proactive telephone support. Such policies would more than pay for themselves in the long term. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To assess the cost‐effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). Design: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov‐based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self‐helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life‐time costs and benefits. Setting: Spain. Participants: Adult smoking population (16+ years). Measurements: Health‐care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality‐adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. Findings: The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life‐time benefit–cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost‐saving: less expensive to run and generated more QALYs) from the life‐time perspective, compared with the current provision. The life‐time benefit–cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline‐standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. Conclusions: According to the EQUIPTMOD modelling tool it would be cost‐effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro‐active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany. Design: A Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. Setting: Germany. Participants: Cohort of current smoking population (18+ years) in Germany. Interventions: Interventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England. Measurements: EQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment. Findings: The highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1. Conclusions: Increasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective. [ABSTRACT FROM AUTHOR]

Summary Vaccination rates vary significantly across countries, and the intensity of vaccination programs is a matter of public choice, infrastructure limitations, budget constraints, and many other factors. The link between better health and better economic performance is by now well established, and many vaccines have been shown to generate significant ROI in a classical cost-benefit framework. To our knowledge, the longer term macroeconomic benefits of improved vaccination programs have not been estimated. We modify the standard conditional convergence model to account for changes in vaccination rates across time and countries, and use the modified model to estimate the macroeconomic gains from improved vaccination rates, using the DTP vaccine as a proxy for vaccination programs generally. We find evidence to suggest economically and statistically significant and sustained increases in the GDP growth rate associated with lagged increases in vaccination rates; furthermore, we find these effects increasing over time. We find that investments of the sort made by the Global Alliance for Vaccination and Immunization (Gavi) are linked to measurably higher DTP rates, and we estimate the returns to such investments as at least 12:1. For countries on the threshold of graduating from Gavi, these results suggest that much is at stake: reducing investment in vaccination could reverse both the public health improvements and tangible economic benefits associated with ongoing improvements in vaccination rates. [ABSTRACT FROM AUTHOR]

Brigham Young University, willing to experiment and pilot new e-book models, has established a comprehensive e-book strategy that includes demand-driven acquisitions, short-term loans, evidence-based acquisitions, subscription packages, purchased packages, and title-by-title purchases. This broad approach has reduced the number of titles purchased under the general domestic approval plan. At the same time, it has added value by providing access to more content, increasing usage, and lowering cost per use while maintaining the same annual expenditure. [ABSTRACT FROM AUTHOR]

Objectives. To estimate the association of 1 activity of the Prevention and Public Health Fund with hospital bloodstream infections and calculate the return on investment (ROI). Methods. The activity was funded for 1 year (2013). A difference-in-differences specification evaluated hospital standardized infection ratios (SIRs) before funding allocation (years 2011 and 2012) and after funding allocation (years 2013 and 2014) in the 15 US states that received the funding compared with hospital SIRs in states that did not receive the funding. We estimated the association of the funded public health activity with SIRs for bloodstream infections. We calculated the ROI by dividing cost offsets from infections averted by the amount invested. Results. The funding was associated with a 33% (P < .05) reduction in SIRs and an ROI of $1.10 to $11.20 per $1 invested in the year of funding allocation (2013). In 2014, after the funding stopped, significant reductions were no longer evident. Conclusions. This activitywas associatedwitha reductioninbloodstreaminfections large enough to recoup the investment. Public health funding of carefully targeted areas may improve health and reduce health care costs. [ABSTRACT FROM AUTHOR]

Investment in the capabilities of the world's 1·2 billion adolescents is vital to the UN's Sustainable Development Agenda. We examined investments in countries of low income, lower-middle income, and upper-middle income covering the majority of these adolescents globally to derive estimates of investment returns given existing knowledge. The costs and effects of the interventions were estimated by adapting existing models and by extending methods to create new modelling tools. Benefits were valued in terms of increased gross domestic product and averted social costs. The initial analysis showed high returns for the modelled interventions, with substantial variation between countries and with returns generally higher in low-income countries than in countries of lower-middle and upper-middle income. For interventions targeting physical, mental, and sexual health (including a human papilloma virus programme), an investment of US$4·6 per capita each year from 2015 to 2030 had an unweighted mean benefit to cost ratio (BCR) of more than 10·0, whereas, for interventions targeting road traffic injuries, a BCR of 5·9 (95% CI 5·8-6·0) was achieved on investment of $0·6 per capita each year. Interventions to reduce child marriage ($3·8 per capita each year) had a mean BCR of 5·7 (95% CI 5·3-6·1), with the effect high in low-income countries. Investment to increase the extent and quality of secondary schooling is vital but will be more expensive than other interventions-investment of $22·6 per capita each year from 2015 to 2030 generated a mean BCR of 11·8 (95% CI 11·6-12·0). Investments in health and education will not only transform the lives of adolescents in resource-poor settings, but will also generate high economic and social returns. These returns were robust to substantial variation in assumptions. Although the knowledge base on the impacts of interventions is limited in many areas, and a major research effort is needed to build a more complete investment framework, these analyses suggest that comprehensive investments in adolescent health and wellbeing should be given high priority in national and international policy. [ABSTRACT FROM AUTHOR]

Background: ParentCorps is a family-centered enhancement to pre-kindergarten programming in elementary schools and early education centers. When implemented in high-poverty, urban elementary schools serving primarily Black and Latino children, it has been found to yield benefits in childhood across domains of academic achievement, behavior problems, and obesity. However, its long-term cost-effectiveness is unknown.Methods: We determined the cost-effectiveness of ParentCorps in high-poverty, urban schools using a Markov Model projecting the long-term impact of ParentCorps compared to standard pre-kindergarten programming. We measured costs and quality adjusted life years (QALYs) resulting from the development of three disease states (i.e., drug abuse, obesity, and diabetes); from the health sequelae of these disease states; from graduation from high school; from interaction with the judiciary system; and opportunity costs of unemployment with a lifetime time horizon. The model was built, and analyses were performed in 2015-2016.Results: ParentCorps was estimated to save $4387 per individual and increase each individual's quality adjusted life expectancy by 0.27 QALYs. These benefits were primarily due to the impact of ParentCorps on childhood obesity and the subsequent predicted prevention of diabetes, and ParentCorps' impact on childhood behavior problems and the subsequent predicted prevention of interaction with the judiciary system and unemployment. Results were robust on sensitivity analyses, with ParentCorps remaining cost saving and health generating under nearly all assumptions, except when schools had very small pre-kindergarten programs.Conclusions: Effective family-centered interventions early in life such as ParentCorps that impact academic, behavioral and health outcomes among children attending high-poverty, urban schools have the potential to result in longer-term health benefits and substantial cost savings. [ABSTRACT FROM AUTHOR]

Optimal asset replacement is analysed under non-exponential technological improvement, whereby the asset capital cost and the operational cost reduce for newer assets, and the relative rate of this decrease varies with time. We establish that the optimal lifetime of sequentially replaced assets increases if the relative rate of technological change decreases, and converse. Next, the two-cycle replacement algorithm is employed to take the unequal asset lifetime into account. The algorithm is adjusted to the case of several discrete estimates of changing asset costs and demonstrates good performance in various scenarios of improving technology. [ABSTRACT FROM AUTHOR]

This study was carried out in the Department of Forestry and Range Management, University of Agriculture, Faisalabad, Pakistan during the year 2014. Five villages of tehsil Khushab, Punjab were randomly selected. From each village, three trees having 1-15 years age each were randomly selected. Thus 45 trees were selected from each village making a total of 225 trees from 5 villages. Price of each standing tree was determined by the farmer and recorded through a short questionnaire. It was observed that trees of one year age were not salable, so the data regarding one year trees were omitted from the study. Remaining number of trees of all ages was 210. Three rotation options (15, 10+ 5 and 5+5+5) with the same life span (15 years) were tested using net present worth (NPW), benefit cost ratio (BCR) and return on investment (ROI) as economic tools. At a rotation of 15 years, NPW was Rs. 2039.05, BCR 449.59 and ROI, 44859.20 percent. At a rotation of 10+5 = 15 years, NPW was Rs. 2519.82, BCR 401.10 and ROI 40010.47 percent. At a rotation of 5+5+5 =15 years, NPW was Rs. 1578.92, BCR 401.10 and ROI 40010.47 percent. The rotation of 10+5 = 15 years was most profitable. So, farmers are advised to grow Dalbergia sissoo trees at a rotation of 10+5 =15 years on their farmlands. [ABSTRACT FROM AUTHOR]

In conservation, as in most other subjects, there is a division of expenditure into problem identification, solution testing, and practice. However, research concentrates on problem identification rather than solution testing. We calculate the return on the investment of research (a PhD thesis) examining the effectiveness of conservation interventions for birds of prey in three European countries. We show that the economic return from investing in a PhD thesis could be substantial, in the order of hundreds of thousands euros over 10 years or a return on investment of between 292% and 326% over that period. We derived the values of return on investment by first setting a common biological target (the total number of raptor fledglings produced per year). We then compared overall costs in achieving such target via the wide implementation of the results from the thesis (i.e., allocating resources to the most effective intervention) versus a business as usual scenario. We identify other theses that also show considerable benefits in improving effectiveness. We suggest that further research examining effectiveness would be cost-effective in improving practice. [ABSTRACT FROM AUTHOR]

Background: Among HIV+ patients, alcohol use is a highly prevalent risk factor for both HIV transmission and poor adherence to HIV treatment. The large-scale implementation of effective interventions for treating alcohol problems remains a challenge in low-income countries with generalized HIV epidemics. It is essential to consider an intervention's cost-effectiveness in dollars-per-health-outcome, and the long-term economic impact -or "return on investment" in monetary terms.Methods: We conducted a cost-benefit analysis, measuring economic return on investment, of a task-shifted cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use in a modeled cohort of 13,440 outpatients in Kenya. In our base-case, we estimated the costs and economic benefits from a societal perspective across a six-year time horizon, with a 3% annual discount rate. Costs included all costs associated with training and administering task-shifted CBT therapy. Benefits included the economic impact of lowered HIV incidence as well as the improvements in household and labor-force productivity. We conducted univariate and multivariate probabilistic sensitivity analyses to test the robustness of our results.Results: Under the base case, total costs for CBT rollout was $554,000, the value of benefits were $628,000, and the benefit-to-cost ratio was 1.13. Sensitivity analyses showed that under most assumptions, the benefit-to-cost ratio remained above unity indicating that the intervention was cost-saving (i.e., had positive return on investment). The duration of the treatment effect most effected the results in sensitivity analyses.Conclusions: CBT can be effectively and economically task-shifted to paraprofessionals in Kenya. The intervention can generate not only reductions in morbidity and mortality, but also economic savings for the health system in the medium and long term. The findings have implications for other countries with generalized HIV epidemics, high prevalence of alcohol consumption, and shortages of mental health professionals.Trial Registration: This paper uses data derived from "Cognitive Behavioral Treatment to Reduce Alcohol Use Among HIV-Infected Kenyans (KHBS)" with ClinicalTrials.gov registration NCT00792519 on 11/17/2008; and preliminary data from "A Stage 2 Cognitive-behavioral Trial: Reduce Alcohol First in Kenya Intervention" ( NCT01503255 , registered on 12/16/2011). [ABSTRACT FROM AUTHOR]

Background: Participation in daily physical activity and consuming a balanced diet high in fruits and vegetables and low in processed foods are behaviours associated with positive health outcomes during all stages of life. Previous literature suggests that the earlier these behaviours are established the greater the health benefits. As such, early learning settings have been shown to provide an effective avenue for exploring and influencing the physical activity and healthy eating behaviours of children before school entry. However, in addition to improving individual level health of children, such interventions may also result in a number of social benefits for the society. In fact, research among adult populations has shown that sufficient participation in physical activity can significantly lower hospital stays and physician visits, in turn leading to positive economic outcomes. To our knowledge there is very limited literature about economic evaluations of interventions implemented in early learning centers to increase physical activity and healthy eating behaviours among children. The primary purpose of this paper is to identify inputs and costs needed to implement a physical activity and healthy eating intervention (Healthy Start-Départ Santé (HS-DS)) in early learning centres throughout Saskatchewan and New Brunswick over the course of three years. In doing so, implementation cost is estimated to complete the first phase of a social return on investment analysis of this intervention.Methods: In order to carry out this evaluation the first step was to identify the inputs and costs needed to implement the intervention, along with the corresponding outputs. With stakeholder interviews and using existing database, we estimated the implementation cost by measuring, valuing and monetizing each individual input.Results: Our results show that the total annual cost of implementing HS-DS was $378,753 in the first year, this total cost decreased slightly in the second year ($356,861) and again in the third year ($312,179). On average, the total annual cost is about $350,000 which implies an annual cost of $285 per child. Among all inputs, time-cost accounted for the larger share of total resources need to implement the intervention. Overall, administration and support services accounted for the largest portion of the total implementation cost each year: 74% (year 1), 79% (year 2), and 75% (year 3).Conclusions: The results from this study shed lights for future implementation of similar interventions in this context. It also helps to assess the cost effectiveness of future interventions. [ABSTRACT FROM AUTHOR]

The article discusses investments on public agricultural research and extension delivery in the U.S. Tackled are issues on agricultural productivity growth and social cost-benefit analysis on government-funded programs in the country. Explored is the rate of return to investments in research in the agricultural industry.

Background: The European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) project aimed to study transferability of economic evidence by co-creating the Tobacco Return On Investment (ROI) tool, previously developed in the United Kingdom, for four sample countries (Germany, Hungary, Spain and the Netherlands). The EQUIPT tool provides policymakers and stakeholders with customized information about the economic and wider returns on the investment in evidence-based tobacco control, including smoking cessation interventions. A Stakeholder Interview Survey was developed to engage with the stakeholders in early phases of the development and country adaptation of the ROI tool. The survey assessed stakeholders' information needs, awareness about underlying principles used in economic analyses, opinion about the importance, effectiveness and cost-effectiveness of tobacco control interventions, and willingness to use a Health Technology Assessment (HTA) tool such as the ROI tool.Methods: A cross sectional study using a mixed method approach was conducted among participating stakeholders in the sample countries and the United Kingdom. The individual questionnaire contained open-ended questions as well as single choice and 7- or 3-point Likert-scale questions. The results corresponding to the priority and needs assessment and to the awareness of stakeholders about underlying principles used in economic analysis are analysed by country and stakeholder categories.Results: Stakeholders considered it important that the decisions on the investments in tobacco control interventions should be supported by scientific evidence, including prevalence of smoking, cost of smoking, quality of life, mortality due to smoking, and effectiveness, cost-effectiveness and budget impact of smoking cessation interventions. The proposed ROI tool was required to provide this granularity of information. The majority of the stakeholders were aware of the general principles of economic analyses used in decision making contexts but they did not appear to have in-depth knowledge about specific technical details. Generally, stakeholders' answers showed larger variability by country than by stakeholder category.Conclusions: Stakeholders across different European countries viewed the use of HTA evidence to be an important factor in their decision-making process. Further, they considered themselves to be capable of interpreting the results from a ROI tool and were highly motivated to use it. [ABSTRACT FROM AUTHOR]

We conducted a GIS return on investment (ROI) study for King County (Washington). A with-and-without methodology assessed how GIS altered county output, effort levels, and production capabilities, compared to GIS development and annual operation costs. We first conducted key interviews to gauge the role of GIS in agencies and the types of tasks performed. A survey of employees and managers who use GIS provided detailed productivity data. Survey responses were compiled to build an aggregate estimate of production with and without GIS. Changes were monetized to estimate benefits in terms of pre-GIS levels of output with GIS, as well as GIS-aided production level without GIS. GIS appears to be an efficient, highly beneficial investment for King County. Our most conservative estimate finds that GIS produced $775 million in net benefits from 1992 to 2010. The report also discusses strengths and weaknesses of the assessment method and provides guidance for future studies. [ABSTRACT FROM AUTHOR]

The purpose of the performed and presented financial analyzes, in the case of the two units, does not allow major discrepancies between the estimated and achieved situation. The authors have based the research on the technical-economic and financial analysis of investments, which sets economic efficiency and investments viability and assumes forecast of revenue, expenses, profit and loss account, balance sheet and cash flow: a) static analysis of indicators; b) dynamic analysis of indicators, c) cost-benefit analysis. Analysis of economic efficiency and sustainability of investments aimes at both static indicators of investment analysis and dynamic analysis of economic efficiency. The goal of research was to improve analyzes and economic indicators for assessing the effectiveness and sustainability of investments and the objectives targeted technical and economic analysis, solvency and viability of investments and the impact of the investment on key indicators of economic and financial technical analysis. Case studies, carried out at S.C. NORD INTERMED CONSULTING GROUP S.R.L. Dorneşti, Suceava county and S.C. ANDIMIR TOP S.R.L. Mihălăşeni, Botoşani county, led to a series of measures to improve the financial analysis of economic efficiency and sustainability of investments. [ABSTRACT FROM AUTHOR]

This article briefly describes how to structure a program evaluation to embrace the ROAR Factor. ROAR stands for return on allocated resources, which implies that we need to measure ALL the allocated resources, not just direct out-of-pocket costs, and ALL the returns, not just reductions in medical costs or similar objective outcomes. The ROAR Factor also means focusing programs on what makes people feel great, what makes them leant to roar, and measuring how well we are doing in helping people feel great. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to discuss a social media campaign used to promote a digital library of archival resources. Design/methodology/approach – Librarians planned and executed a social media campaign using Tumblr and Pinterest and consulted Google Analytics and database reports to determine the impact. Findings – The campaign resulted in few conversions back to the digital library and little return on investment. Research limitations/implications – The campaign has been in effect for only five months, a longer testing period may be needed. Also, additional social media platforms will be added to the test. Originality/value – This is one of few examples of return on investment applied to social media and digital library promotion. [ABSTRACT FROM AUTHOR]

• Within our partner community, household investments in sanitation and food preparation environments yield a positive net benefit. • Among the four regions we examined, only the state of San Marcos, Guatemala had a positive return on investment for households at year 60. • 'WaSH mobility' is a household's ability to improve its WaSH technology status. • Limited household options for improving WaSH technologies reduces WaSH mobility via reductions in return on investment. • SEM provides a novel method to allocate benefit estimates to multiple WaSH technologies in improving child height-for-age. The child stunting rate (low height-for-age) in Guatemala is the sixth worst in the world. Child stunting is correlated both with short and long-term economic costs. While technologies to improve water, sanitation and hygiene (WaSH) are effective at ameliorating child stunting, current household investment in WaSH technologies is constrained (i.e., self-supply). To understand this constraint, data on household spending priorities and barriers to investment in WaSH technologies must be assessed. We utilize primary data from our partner community in Totonicapán, Guatemala to populate a structural equation model and benefit-cost analysis assessing the association between household WaSH technologies and child height-for-age. To test regional variations, we scale-up our approach to examine four additional regions across western Guatemala. The results suggest there is limited monetary gain for households to invest in WaSH technologies. Among the communities and regions where higher returns on investment for households were identified, significant WaSH technologies were cumulatively low cost and simple to obtain and use. We encourage stakeholders supporting a self-supply model to evaluate that incremental improvements in WaSH technologies financed by the household do not impose large costs without sufficient benefits, facilitating healthy WaSH mobility (a household's ability to improve their WaSH technology status). [ABSTRACT FROM AUTHOR]

Value of information analysis is a quantitative method to estimate the return on investment in proposed research projects. It can be used in a number of ways. Funders of research may find it useful to rank projects in terms of the expected return on investment from a variety of competing projects. Alternatively, trialists can use the principles to identify the efficient sample size of a proposed study as an alternative to traditional power calculations, and finally, a value of information analysis can be conducted alongside an economic evaluation as a quantitative adjunct to the 'future research' or 'next steps' section of a study write up. The purpose of this paper is to present a brief introduction to the methods, a step-by-step guide to calculation and a discussion of issues that arise in their application to healthcare decision making. Worked examples are provided in the accompanying online appendices as Microsoft Excel spreadsheets. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the effectiveness of the Well at Dell comprehensive health management program in delivering health care and productivity cost savings relative to program investment (i.e., return on investment). Design. A quasi-experimental design was used to quantify the financial impact of the program and nonexperimental pre-post design to evaluate change in health risks. Setting. Ongoing worksite health management program implemented across multiple U.S. locations. Subjects. Subjects were 24,651 employees with continuous medical enrollment in 2010-2011 who were eligible for 2011 health management programming. Intervention. Incentive-driven, outcomes-based multicomponent corporate health management program including health risk appraisal (HRA)/wellness, lifestyle management, and disease management coaching programs. Measures. Medical, pharmacy, and short-term disability pre/post expenditure trends adjusted for demographics, health status, and baseline costs. Self-reported health risks from repeat HRA completers. Analysis. Propensity score-weighted and multivariate regression-adjusted comparison of baseline to post trends in health care expenditures and productivity costs for program participants and nonparticipants (i.e., difference in difference) relative to programmatic investment. Results. The Well at Dell program achieved an overall return on investment of 2.48 in 2011. Most of the savings were realized from the HRA/wellness component of the program. Cost savings were supported with high participation and significant health risk improvement. Conclusion. An incentive-driven, well-managed comprehensive corporate health management program can continue to achieve significant health improvement while promoting health care and productivity cost savings in an employee population. [ABSTRACT FROM AUTHOR]

Background Clinical guidelines are an integral part of healthcare. Whilst much progress has been made in ensuring that guidelines are well developed and disseminated, the gap between routine clinical practice and current guidelines often remains wide. A key reason for this gap is that implementation of guidelines typically requires a change in the behaviour of healthcare professionals - but the behaviour change component is often overlooked. We adopted the Theoretical Domains Framework Implementation (TDFI) approach for supporting behaviour change required for the uptake of a national patient safety guideline to reduce the risk of feeding through misplaced nasogastric tubes. Methods The TDFI approach was used in a pre-post study in three NHS hospitals with a fourth acting as a control (with usual care and no TDFI). The target behavior identified for change was to increase the use of pH testing as the first line method for checking the position of a nasogastric tube. Repeat audits were undertaken in each hospital following intervention implementation. We used Zou's modified Poisson regression approach with robust standard errors to estimate risk ratios for the use of pH testing. The projected return on investment (ROI) was also calculated. Results Following intervention implementation, the use of pH first line increased significantly across intervention hospitals [risk ratio (95%CI) ranged from 3.1 (1.14 to8.43) p < .05, to 8.14 (3.06 to21.67) p < .001] compared to the control hospital, which remained unchanged [risk ratio (CI) = .77 (.47-1.26) p = .296]. The estimated savings and costs in the first year were £2.56 million and £1.41 respectively, giving an ROI of 82%, and this was projected to increase to 270% over five years. Conclusion The TDFI approach improved the uptake of a patient safety guideline across three hospitals. The TDFI approach is clinically and cost effective in comparison to the usual practice. [ABSTRACT FROM AUTHOR]

Ecological rehabilitation is subject to a variety of risks affecting the likely return on investment. We propose an options approach to allocating scarce conservation funds that explicitly allows for the irreversibility of investment and risks to investment payoffs. The approach captures ecosystem dynamics from extinction debt, as well as ecological and climatic risks at the project scale. Climatic risks are introduced through three channels: the effects of climate change on species loss, future rehabilitation benefits and frequency of catastrophic events. Our results suggest that allocating voluntary rehabilitation contracts on the basis of real options criteria increases cost-efficiency and delivers greater value for money for the Government when compared with the conventional cost-effectiveness criterion as it is illustrated for the case of Box Gum Grassy Woodland rehabilitation in Australia. [ABSTRACT FROM AUTHOR]

Aims: METHODS: RESULTS: We identified nine articles (conducted in Australia (n = 5), Europe (n = 3) and China (n = 1)); three reported healthcare costs associated with excessive sedentary time, whilst six were economic evaluations of interventions targeting sedentary behaviour. Healthcare costs associated with excessive sedentary time as reported in cost of illness studies were substantial; however, none explored non-health sector costs. In contrast, all full economics evaluations adopted a societal perspective; however, costs included differed depending on the intervention context. One sedentary behaviour intervention in children was cost-saving. The five interventions targeting occupational sitting time of adults in office workplaces were cost-effective. Physical environmental changes such as sit-stand desks, active workstations etc., were the key cost driver.Conclusions: Sedentary behaviour is likely associated with excess healthcare costs, although future research should also explore costs across other sectors. Cost-effectiveness evidence of sedentary behaviour reduction interventions in workplaces is limited but consistent. Key gaps relate to the economic credentials of interventions targeting children, and modelling of long-term health benefits of interventions. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the cost savings attributable to the implementation of a continuous monitoring system in a medical-surgical unit and to determine the return on investment associated with its implementation. Design: Return on investment analysis. Setting: A 316-bed community hospital. Patients: Medicine, surgery, or trauma patients admitted or transferred to a 33-bed medical-surgical unit. Interventions: Each bed was equipped with a monitoring unit, with data collected and compared in a 9-month preimplementation period to a 9-month postimplementation period. Measurements and Main Results: Two models were constructed: a base case model (A) in which we estimated the total cost savings of intervention effects and a conservative model (B) in which we only included the direct variable cost component for the final day of length of stay and treatment of pressure ulcers. In the 5-year return on investment model, the monitoring system saved between $3,268,000 (conservative model B) and $9,089,000 (base model A), given an 80% prospective reimbursement rate. A net benefit of between $2,687,000 ($658,000 annualized) and $8,508,000 ($2,085,000 annualized) was reported, with the hospital breaking even on the investment after 0.5 and 0.75 of a year, respectively. The average net benefit of implementing the system ranged from $224 per patient (model B) to $710 per patient (model A) per year. A multiway sensitivity analyses was performed using the most and least favorable conditions for all variables. In the case of the most favorable conditions, the analysis yielded a net benefit of $3,823,000 (model B) and $10,599,000 (model A), and for the least favorable conditions, a net benefit of $715,000 (model B) and $3,386,000 (model A). The return on investment for the sensitivity analysis ranged from 127.1% (25.4% annualized) (model B) to 601.7% (120.3% annualized) (model A) for the least favorable conditions and from 627.5% (125.5% annualized) (model B) to 1739.7% (347.9% annualized) (model A) for the most favorable conditions. Conclusions: Implementation of this monitoring system was associated with a highly positive return on investment. The magnitude and timing of these expected gains to the investment costs may justify the accelerated adoption of this system across remaining inpatient non-ICU wards of the community hospital. [ABSTRACT FROM AUTHOR]

Habitat restoration is a key strategy for recovering imperiled species, and planning habitat restoration activities cost effectively can help advance recovery objectives. Habitat restoration planning involves decisions about where and when to undertake restoration, and what type of restoration to undertake. This article focuses on decisions about the amount of restoration to undertake for a given type, location, and time, termed intervention intensity. A return on investment framework is developed for incorporating intervention intensity into habitat restoration planning. The framework is then applied in the context of planning habitat restoration for Pacific salmon recovery as a case study. Results showed that no single intervention type or location dominated, and several returns to scale relationships emerged across the candidate interventions. Scenarios that considered interventions across multiple intensities outperformed single-intensity scenarios in terms of total benefits and cost effectiveness. These findings highlight the usefulness of exploratory return on investment analysis for prioritizing habitat restoration interventions, and underscore the importance of systematically considering how much restoration to undertake, in addition to what to do and where. • Systematically considering the amount of restoration to undertake at a given location and time promotes effective habitat restoration planning. • A return on investment framework is developed for considering intervention intensity when planning habitat restoration. • The framework is applied to prioritizing habitat restoration for endangered Pacific salmon using coupled models of salmon habitat and salmon survival. • The case study results illustrate that considering intervention intensity can promote cost-effective habitat restoration planning. [ABSTRACT FROM AUTHOR]

El artículo discurre sobre los aspectos económicos del desarrollo e implementación de proyectos de innovación tecnológica. Los autores comentan sobre la importancia de un análisis costo-beneficio, con un enfoque en la asignación de recursos. También se considera el uso del retorno sobre la inversión para evaluar los proyectos.