Zoekresultaten

On the cost elasticity of inter-regional distribution structures: a case study for the Netherlands

Several studies show that logistics facilities have spread spatially from relatively concentrated clusters in the 1970s to geographically more decentralized patterns away from urban areas. The literature indicates that logistics costs are one of the major influences on changes in distribution structures, or locations and usage of logistics facilities. Quantitative modelling studies that aim to describe or predict these phenomena in relation to logistics costs are lacking, however. This is relevant to design more effective policies concerning spatial development, transport and infrastructure investments as well as for understanding environmental consequences of freight transport. The objective of this paper is to gain an understanding of the responsiveness of spatial logistics patterns to changes in these costs, using a quantitative model that links production and consumption points via distribution centers. The model is estimated to reproduce observed use of logistics facilities as well as related transport flows, for the case of the Netherlands. We apply the model to estimate the impacts of a number of scenarios on the spatial spreading of regional distribution activity, interregional vehicle movements and commodity flows. We estimate new cost elasticities, of the demand for trade and transport together, as well as specifically for the demand for the distribution facility services. The relatively low cost elasticity of transport services and high cost elasticity for the distribution services provide new insights for policy makers, relevant to understand the possible impacts of their policies on land use and freight flows.

Cost-effectiveness of a lifestyle intervention for people with a serious mental illness (SMILE)

Abstract Background: Cardiovascular disease is the leading cause of the estimated 11–25 years reduced life expectancy for persons with serious mental illness (SMI). This excess cardiovascular mortality is primarily attributable to obesity, diabetes, hypertension, and dyslipidaemia. Obesity is associated with a sedentary lifestyle, limited physical activity and an unhealthy diet. Lifestyle interventions for persons with SMI seem promising in reducing weight and cardiovascular risk. The aim of this study is to evaluate the effectiveness and cost-effectiveness of a lifestyle intervention among persons with SMI in an outpatient treatment setting. Methods: The Serious Mental Illness Lifestyle Evaluation (SMILE) study is a cluster-randomized controlled trial including an economic evaluation in approximately 18 Flexible Assertive Community Treatment (FACT) teams in the Netherlands. The intervention aims at a healthy diet and increased physical activity. Randomisation takes place at the level of participating FACT-teams. We aim to include 260 outpatients with SMI and a body mass index of 27 or higher who will either receive the lifestyle intervention or usual care. The intervention will last 12 months and consists of weekly 2-h group meetings delivered over the first 6 months. The next 6 months will include monthly group meetings, supplemented with regular individual contacts. Primary outcome is weight loss. Secondary outcomes are metabolic parameters (waist circumference, lipids, blood pressure, glucose), quality of life and health related self-efficacy. Costs will be measured from a societal perspective and include costs of the lifestyle program, health care utilization, medication and lost productivity. Measurements will be performed at baseline and 3, 6 and 12 months. Discussion: The SMILE intervention for persons with SMI will provide important information on the effectiveness, cost-effectiveness, feasibility and delivery of a group-based lifestyle intervention in a Dutch outpatient treatment setting. Trial registration: Dutch Trial Registration NL6660, registration date: 16 November 2017.

Cost minimisation of hydrogen

Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function

Background: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. Objective: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-)effectiveness compared with care as usual. Methods: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n = 48) receiving care as usual and of an intervention group (optimized provision process) (n = 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up.

Cost Effectiveness of Endovascular Revascularisation <i>vs.</i> Exercise Therapy for Intermittent Claudication Due to Iliac Artery Obstruction

ObjectiveTo compare cost effectiveness of endovascular revascularisation (ER) and supervised exercise therapy (SET) as primary treatment for patients with intermittent claudication (IC) due to iliac artery obstruction.MethodsCost utility analysis from a restricted societal perspective and time horizon of 12 months. Patients were included in a multicentre randomised controlled trial (SUPER study, NCT01385774, NTR2648) which compared effectiveness of ER and SET. Health status and health related quality of life (HRQOL) were measured using the Euroqol 5 dimensions 3 levels (EQ5D-3L) and VascuQol-25-NL. Incremental costs were determined per allocated treatment and use of healthcare during follow up. Effectiveness of treatment was determined in quality adjusted life years (QALYs). The difference between treatment groups was calculated by an incremental cost utility ratio (ICER).ResultsSome 240 patients were included, and complete follow up was available for 206 patients (ER 111 , SET 95). The mean costs for patients allocated to ER were €4 031 and €2 179 for SET, a mean difference of €1 852 (95% bias corrected and accelerated [bca] bootstrap confidence interval 1 185 – 2 646). The difference in QALYs during follow up was 0.09 (95% bcaCI 0.04 – 0.13) in favour of ER. The ICER per QALY was €20 805 (95% bcaCI 11 053 – 45 561). The difference in VascuQol sumscore was 0.64 (95% bcaCI 0.39 – 0.91), again in favour of ER.ConclusionER as a primary treatment, results in slightly better health outcome and higher QALYs and HRQOL during 12 months of follow up. Although these differences are statistically significant, clinical relevance must be discussed due to the small differences and relatively high cost of ER as primary treatment.

Thermodynamics, environmental damage cost, exergoeconomic, life cycle, and exergoenvironmental analyses of a JP-8 fueled turbodiesel aviation engine at take-off phase

The objective of this study is to evaluate the energetic, exergetic, sustainability, economic and environmental performances of a 4-cylinder turbodiesel aviation engine (TdAE) used on unmanned aerial vehicles for the take-off operation mode to assess the system with large aspects. Energy efficiency of the system is found as 43.158%, while exergy efficiency 40.655%. Thermoeconomic analysis gives information about the costs of the inlet and outlet energy and exergy flows of the engine. Hourly levelized total cost flow of the TdAE is found as 21.036 $/h, when the hourly fuel cost flow of the engine is found as 30.328 $/h. The waste exergy cost parameter is determined as 0.0144 MJ/h/$ from exergy cost-energy-mass (EXCEM) analysis, while it is estimated as 14.043 MJ/$ from modified-EXCEM analysis. Environmental damage cost analysis evaluates the cost formation of the exhaust emissions. The total environmental damage cost of the TdAE is computed as 12.895 $/h whilst specific environmental damage cost is determined as 0.054 $/MJ for 494.145 MJ/h TdAE power production. It is assessed that the main contributors to the environmental impact rate of the TdAE are the fuel consumption and the formation pollutants of combustion reaction.