Dissertations / Theses on the topic 'Cost-effectiveness model'

The purpose of this thesis is to develop a model for assessing cost effectiveness of applying lean tools. The

model consists of eight phases: it starts by understanding customers' requirements using Voice of Customer

(VOC) and Quality Function Deployment (QFD) tools. In phase 2, the current state of plant is assessed

using lean profile charts based on Balanced Scorecard (BSC) measures. In phase 3 and phase 4,

identification of critical problem(s) and generating of improvement suggestion(s) are performed. Phase 5

provide evaluation of the cost effectiveness of implementing the suggested lean methods based on life cycle

cost analysis (LCCA) and phase 6 prefers the right alternative based on multiple criteria decision making

(MCDM). In phase 7 the selected alternative is supposed to be implemented and finally the user should

monitor and control the process to make sure that the improvement is going as planned. The model was

verified successfully using a case study methodology at one Swedish sawmill called Södra Timber in

Ramkvilla, one part of Södra group. Results obtained from the study showed that the production and human

resources perspectives are the most critical problem areas that need to be improved. They got the lowest

scores in the lean profile, 63% and 68%, respectively. Using value stream mapping (VSM) it was found that

the non value added (NVA) ratios for the core and side products are 87.4% and 90.4%, respectively. Using

the model, three improvement alternatives were suggested and evaluated using LCCA and MCDM.

Consequently, implementing 5S got the highest score, second came redesigning the facility layout.

However, it was estimated that 4.7 % of NVA for the side product would be reduced by redesigning the

facility layout. The recommendations were suggested for the company to improve their performance. The

novelty of the thesis is based on the fact that it addresses two main issues related to lean manufacturing:

firstly, suggesting lean techniques based on assessment of lean profile that is based on BSC and QFD, and

secondly assessing the cost effectiveness of the suggested lean methods based on LCCA and MCDM. This

thesis provides a generalized model that enables the decision-maker to know and measure, holistically, the

company performance with respect to customer requirements. This will enable the company to analyze the

critical problems, suggest solutions, evaluate them and make a cost effective decision. Thus, the company

can improve its competitiveness.

Several studies have shown that the work environment affects company performance. The managers are seldom aware to which extent work environment problems affect productivity, quality of delivery and sick-leave in their organisation. The present literature study showed that improvements regarding physical ergonomics generally are shown to be cost-effective. The most beneficial way of working is through proactive measures interactively with employees. An efficient, systematic way of performing risk assessments and interventions reduce the need for a calculation method. This study identified propositions for properties of calculation methods. These propositions were : “Simplicity, high usability”, “Right content for the target group”, “High ability to measure risk”, “Focus on staff”, “Correct standardised values”, “Right focus” and “Optimal design”. Scania CV, a producer of trucks and buses, has developed a calculation model for cost-effectiveness of ergonomic interventions. Evaluation of this model with semi-structured interviews showed agreement regarding the need of a simplified calculation method, based on systematic risk assessments.
Ett flertal studier har visat att arbetsmiljön påverkar företags effektivitet. Företagsledningen är sällan medveten om till vilken grad arbetsmiljö-problem påverkar produktivitet, kvalitet och sjukfrånvaro. Litteraturstudien i detta projekt visade att förbättringar inom ergonomi generellt sett är kostnadseffektiva. Det är mest gynnsamt att arbeta proaktivt samt participativt, det vill säga i samarbete med medarbetarna på den lokala avdelningen. Ett effektivt, systematiskt arbete med riskbedömningar och interventioner minskar behovet av att göra en beräkning av lönsamheten. Propositioner för egenskaper hos kostnadseffektiva beräkningsmetoder togs fram i denna studie. Dessa propositioner var; ” Enkelhet och god användbarhet”, ”rätt innehåll för målgruppen”, ”hög förmåga att bedöma risk”, ”personalfokus”, ”korrekta standardiserade värden”, ”rätt fokus” och ”optimal design”. Scania CV, producent av lastbilar och bussar, har tagit fram en beräkningsmodell för kostnadseffektivitet hos ergonomiska interventioner. Utvärderingen av denna modell med semistrukturerade intervjuer visar god samstämmighet i att det behövs enkla kalkylmetoder som grundar sig på systematiska riskbedömningar.

Thesis (M.S. in Computer Science)--Naval Postgraduate School, December 2009.
Thesis Advisor(s): Michael, James Bret ; Shing, Man-Tak. "December 2009." Description based on title screen as viewed on February 01, 2010. Author(s) subject terms: Acquisition process, concept-refinement phase, GQM Method, use case analysis, activity diagram, workflow process, StateChart Assertions, runtime execution monitoring. Includes bibliographical references (p. 45-47). Also available in print.

Thesis (M.S. in Operations Research)--Naval Postgraduate School, September 1990.
Thesis Advisor(s): McMasters, Alan W. ; Henderson, David R. "September 1990." Description based on title screen as viewed on December 21, 2009. DTIC Descriptor(s): Naval Procurement, Mathematical Models, Parameters, Navy, Theses, Costs, Precision, Procurement, Inventory, Value, Supplies, Naval Logistics, Models, Contracts, Decision Making. DTIC Identifier(s): Navy Inventory Control Points, Navy Procurement Contract Termination Model, Forecasts. Author(s) subject terms: Procurement, Contract, Termination. Includes bibliographical references (p. 57-58). Also available in print.

With 7 000 new cases in Sweden each year, breast cancer represents 30 percent of all female malignancies and is therefore the most commonly diagnosed cancer among women. There are limitations as to what can be done to prevent the disease but with the use of mammography screening the chances of finding and treating the disease at an early stage are increasing. Unfortunately, mammography screening is associated with radiation, which is an established risk factor for developing breast cancer. However, the newest screening technologies come with a reduced dose which decreases the risk of developing breast cancer due to the radiation.

 

The effects of this lower dose compared to that of traditional technologies have not yet been studied and the purpose of this paper is therefore to assess the cost-effectiveness of the use of this new technology, with a focus on the number of radiation-induced cancers. A cost-utility analysis was performed where three different mammography technologies (one analogue and two digital) were compared. The total costs and QALYs of breast cancer generated by the use of these three technologies were calculated with the use of a Markov decision-analytic model, where a cohort of hypothetical 40 year-old women was followed throughout life.

 

The results of the analysis showed that with the new digital technology (the PC-DR), one in 14 100 screened women develops breast cancer due to radiation while with the traditional mammography systems (SFM and the CR) this number is one in 3 500 and 4 300 screened women, respectively. Consequently, the number of induced cancers is decreased with up to 75 percent with the use of the PC-DR. Assuming that only the radiation dose differs between the three units, the analysis resulted in an incremental effect of 0.000269 QALYs over a life-time for the PC-DR when compared to SFM(0.000210 QALYs compared to the CR). The PC-DR was also associated with a 33 SEK (26 SEK) lower cost. Thus, if the only difference can be found in radiation dose, the PC-DR is the dominating technology to use since it is both more effective and costs less. However, it is possible that the PC-DR is more expensive per screening occasion than the other technologies and if so, the PC-DR would no longer be less costly. The study found that the scope for the possibility of excessive pricing is very small and under these circumstances, the willingness to pay for a QALY has to be considered when deciding what technology to invest in.

The purpose of this master thesis is to develop a model for assessing cost effectiveness of facility layouts. A critical literature review of the available relevant models as well as theories was performed in accordance to this purpose. After this a model was developed in order to cover lacks in existing theories. The aim of the model is to evaluate different facility layouts, from both economical and working environmental aspects. The model as a whole is about evaluating, creating and selecting the most preferable facility layout. In this thesis a case study has been performed for testing the developed model. The case company for this testing was the Mail Terminal in Alvesta, which is a part of Posten Sweden AB. The mail terminal receives, sorts and distributes the mail further. The result of this thesis is that, by following the model the authors were able to evaluate all the layouts and also to create the most preferable one. This thesis provides a general model in a structured way, primary aimed to be used for manufacturing companies. Further researches could be to test the model on service producing companies and to define to what extent the model can be generalised.

Syftet med denna magisteruppsats är att utveckla en modell för att utvärdera kostnadseffektiviteten av anläggningslayouter. En kritisk litteraturundersökning av tillgängliga relevanta modeller samt teorier genomfördes i enlighet med syftet. Därefter utvecklades en modell för att täcka brister i existerande teorier. Syftet med modellen är att utvärdera olika layouter, från både ett ekonomiskt- och arbetsmiljös- perspektiv. Modellen i sin helhet handlar om att utvärdera, skapa och välja den mest fördelaktiga layouten. En fallstudie har genomförts i denna uppsats för att testa den skapade modellen. Fallföretaget för att testa modellen var Postterminalen i Alvesta, som är en del av Posten Sverige AB. Postterminal tar emot, sorterar och distribuerar posten vidare. Resultatet av denna uppsats är att genom att använda modellen lyckades författarna utvärdera alla layouter och även skapa den mest fördelaktiga layouten. Denna uppsats bidrar med en strukturerad generell model, som främst riktar sig till producerande företag. Fortsatt forskning skulle kunna vara att testa modellen på service baserade företag och att definiera till vilken omfattning man kan generalisera modellen.

Thesis (M.S. in Management) Naval Postgraduate School, September 1996.
Thesis advisor(s): Paul J. Fields, William R. Gates. "September 1996." Includes bibliographical references (p. 285). Also available online.

Sepsis is a life-threatening organ dysfunction that is caused by a dysregulated host response to infection. Sepsis is a substantial health care and economic burden worldwide and is one of the most common reasons for admission to the hospital and intensive care unit. Early diagnosis and targeted treatment of sepsis are the bases to reduce the mortality and morbidity. Conventional blood culturing is the gold standard method for sepsis diagnostics. However, blood culturing is a time consuming method, requiring at least 48 to 72 hours to get the first results with very low sensitivity and specificity. The aim of this study was to determine and assess the direct sepsis-related costs for PCR-based diagnostic strategies (SeptiFast and POC/LAB). A mathematical model was constructed to compare PCR-based diagnostic strategies with the conventional blood culturing. Three case scenarios were investigated based on data from the United Kingdom, Spain and the Czech Republic. It was found that, POC/LAB was the most cost effective strategy in all countries if it could reduce the hospitalization length of stay with at least 3 days in the normal hospital ward and 1 day in the intensive care unit. Reducing the hospitalization length of stay had the greatest impact on the economic outcomes. While, reducing the costs of the diagnostic strategies did not show a remarkable effect on the economic results. In conclusion, the findings suggest that PCR-rapid diagnostic methods could be cost-effective for the diagnosis of patients with sepsis if they could reduce the hospitalization length of stay.

How to allocate resources in the health care sector is academically dealt with within the subject of health economics. Economic evaluations are within this area used to compare the costs and effects of medical interventions with the purpose to help decision makers decide how to allocate resources.

Oxygen deficiency in the foetus during birth can lead to severe life long injuries in the child. In high-risk deliveries, it is therefore considered necessary to use foetal surveillance with a scalp electrode and the choice is between surveillance with internal cardiotocography (CTG) and surveillance with ST analysis. The standard procedure is in most hospitals currently CTG, which records the foetal heart rate and the uterine contractions. The second strategy, in this thesis referred to as ST analysis, complements CTG with foetal electrocardiography(ECG) and ST analysis.

The objective of this report is to from a societal perspective determine the cost-effectiveness of using ST analysis in complicated deliveries, compared to the use of CTG alone. A cost-utility analysis was performed based on a probabilistic decision model incorporating the relevant strategies and outcomes. The costs and effects of the two different treatment strategies were compared in a decision tree. Discounted costs and quality-adjusted life-years (QALYs) were measured and simulated over a life-time perspective.

The analysis resulted in an incremental effect of 0.005 QALYs for the ST analysis strategy, when compared to the CTG strategy. ST analysis was also associated with a €30 lower cost. Thus, CTG is dominated by the ST analysis strategy. The probability that ST analysis is the cost-effective alternative is high for all values of willingness-to-pay for a QALY, which means that a decision to implement the ST analysis strategy based on the results of this thesis would be surrounded by a low degree of uncertainty.

The purpose of this thesis is to develop a model for assessing cost effectiveness of applying lean tools. The model consists of eight phases: it starts by understanding customers' requirements using Voice of Customer (VOC) and Quality Function Deployment (QFD) tools. In phase 2, the current state of plant is assessed using lean profile charts based on Balanced Scorecard (BSC) measures. In phase 3 and phase 4, identification of critical problem(s) and generating of improvement suggestion(s) are performed. Phase 5 provide evaluation of the cost effectiveness of implementing the suggested lean methods based on life cycle cost analysis (LCCA) and phase 6 prefers the right alternative based on multiple criteria decision making (MCDM). In phase 7 the selected alternative is supposed to be implemented and finally the user should monitor and control the process to make sure that the improvement is going as planned. The model was verified successfully using a case study methodology at one Swedish sawmill called Södra Timber in Ramkvilla, one part of Södra group. Results obtained from the study showed that the production and human resources perspectives are the most critical problem areas that need to be improved. They got the lowest scores in the lean profile, 63% and 68%, respectively. Using value stream mapping (VSM) it was found that the non value added (NVA) ratios for the core and side products are 87.4% and 90.4%, respectively. Using the model, three improvement alternatives were suggested and evaluated using LCCA and MCDM. Consequently, implementing 5S got the highest score, second came redesigning the facility layout. However, it was estimated that 4.7 % of NVA for the side product would be reduced by redesigning the facility layout. The recommendations were suggested for the company to improve their performance. The novelty of the thesis is based on the fact that it addresses two main issues related to lean manufacturing: firstly, suggesting lean techniques based on assessment of lean profile that is based on BSC and QFD, and secondly assessing the cost effectiveness of the suggested lean methods based on LCCA and MCDM. This thesis provides a generalized model that enables the decision-maker to know and measure, holistically, the company performance with respect to customer requirements. This will enable the company to analyze the critical problems, suggest solutions, evaluate them and make a cost effective decision. Thus, the company can improve its competitiveness.

"Submitted in partial fulfillment of the requirements for the degree of Master of Business Administration from the Naval Postgraduate School, March 2010."
Advisor(s): Ferrer, Geraldo. ; Kang, Keebom. "March 2010." "MBA Professional report"--Cover. Description based on title screen as viewed on April 20, 2010. Author(s) subject terms: Radio Frequency Identification, RFID, Cost of Ownership, COO, Military Logistics System, Life Cycle Cost, LCC, Supply Chain, Cost Benefit Analysis, Turkey Includes bibliographical references (p. 115-117). Also available in print.

(Thesis: M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
INTRODUCTION: The ever-changing landscape of the US health care system is characterized by innovation and high-level care, yet it remains in a state of crisis. With the system seemingly locked in this dire state of rising costs, it becomes increasingly important to take costs into account when deciding between multiple treatments for a particular disease by undertaking cost-effectiveness analysis (CEA) studies. In the present study, a model for mitral regurgitation (MR)—a cardiac valvular disease for which multiple treatment options exist with varying degrees of effectiveness, making it a suitable candidate for CEA —was developed to determine the cost-effectiveness of the four main treatments of medical therapy (MT), mitral valve repair (MVR), mitral valve replacement with a mechanical valve (MVPm) and mitral valve replacement with a bioprosthetic valve (MVPb). The goal of the present undertaking was to determine the most cost-effective treatment option for a reference patient given patient-specific inputs to test the functionality of the developed model. METHODS: Input values for costs, probabilities of event’s occurrences and quality-adjusted life-year (QALY) estimates for each treatment option were first obtained from databases and relevant literature. These values were then standardized to account for source variability and input into a decision tree (DT) model created specifically for the present analysis that included branches for each of the four potential interventions, from each of which were three potential outcome arms representing the potential endpoints of each treatment: death, alive with complications and alive without complications. The costs, probabilities and QALY –values of each of the four complications of interest in the study—atrial fibrillation (AFib), stroke, congestive heart failure (CHF) and reoperation—were combined and averaged to create a unified endpoint for the alive with complications branches of the DT. Following the development of the model, the relevant cost, probability and utility values were used to run a simulation to test the functionality of the model using values associated with a fictional 65-year-old Medicare-covered patient with chronic MR to act as a representative of a sizable real-life population. The model results were then used to calculate the incremental cost-effectiveness ratio (ICER)—the standard comparison used in CEA—between treatment options to determine the most cost-effective among them. Following this simulation, one-way sensitivity analyses (SA) were conducted to determine the susceptibility of the result to variations in select input values. RESULTS: The probability-weighted costs of MT, MVR, MVPm and MVPb were found to be $40,387, $60,249, $76,293 and $74,320, respectively, with respective probability-weighted QALYs of 4.298, 4.740, 4.428 and 5.119. The calculation of ICERs from these values led to the conclusion that MVPb dominated all other treatments and had an ICER of $41,370/QALY gained over MT, which was treated as the baseline treatment option. The societal willingness-to-pay (WTP) threshold used in the present study ($62,000/QALY gained) was greater than the ICER, indicating that MVPb is a cost-effective solution to society. The results of the SA indicated that variations in mortality rate within the ranges in the relevant literature have significant effect on the cost-effectiveness of the interventions, with roughly a 4.74% increase in mortality for MVPb or a 5.09% decrease in the rate of MT leading MVPb to be considered cost-ineffective. CONCLUSIONS: The simulation study concluded that for the 65-year-old reference case, MVPb was the most cost-effective option and the additional cost to society was deemed less than society’s WTP for the additional health benefit. The successful simulation of the model indicates it may hold real-world potential and be applicable to numerous other situations with varying input values. Further research into more accurate input values for a larger number of variables need to be determined in order to increase the accuracy and maximize the applicability of the present model. In addition, the model will require further complication via the inclusion of an increasing number of variables to allow for a more accurate determination of cost-effectiveness in a wider range of health scenarios. Thus, the current model described here and a further evolved future model hold great potential for use all across health care in order to help contain rising costs plaguing the current health care system in the United States.
2031-01-01

Public and private concern over the decline of Virginia's oyster industry prompted the General Assembly (GA) in 1977 and 1983 to commission its Joint Legislative Audit and Review Commission (JLARC) to examine the State's oyster grounds management policies. In response to JLARC's findings the GA directed Virginia Marine Resources Commission (VMRC) to construct and implement an oyster fisheries management plan. The GA set as the plan's objective to achieve the greatest production level possible subject to limits of physical resource availability and technical feasibility. That the plan should be attentive to cost-effectiveness was also expressed by the GA. In developing its management plan VMRC must consider a variety of environmental, economic and political factors affecting the production and harvest of market oysters. A linear programming model developed for VMRC's use in evaluating alternative oyster grounds management strategies is described. The objective of the programming model is to minimize the public plus private cost of producing a prespecified level of market oyster harvest over a ten year planning horizon. The model includes as its activities the different aquacultural techniques used by private planters and VMRC in its repletion program. The many environmental, economic and political factors are incorporated into the model's constraints and technical coefficients. Several management alternatives are evaluated with the model. The results of these analyses indicate that without a fundamental in the oyster repletion program, even if new oyster grounds management policies are considered, there would be little change in public grounds market oyster harvest over current levels. Under revised repletion program practices, however, marked increases in public grounds harvest could be effected for relatively small increases in repletion program budget allocations over current levels.
Master of Science

Context. Cloud computing is getting more and more interest with every year. It is an approach that allows Internet based applications to work in distributed and virtualized cloud environment. It is characterized by on-demand resources and payper-use pricing. Software-as-a-Service (SaaS) is a software distribution paradigm in cloud computing and represents the highest, software layer in the cloud stack. Since most cloud services providers charge for the resource use it is important to create resource efficient applications. One of the way to achieve that is multi-tenant architecture of SaaS applications. It allows the application for efficient self-managing of the resources Objectives. In this study I investigate the influence of tenant-based resource allocation model on cost-effectiveness of SaaS systems. I try to find out weather that model can decrease the system's actual costs in commercial public cloud environment. Methods. I am implementing two authorial SaaS systems: first tenant-unaware and then using tenant-based resource allocation model. Then they are deployed into Amazon public cloud environment. Tests focused on measuring over- and underutilization are conducted in order to compare cost-effectiveness of the solutions. Public cloud provider's billing service is used as a final cost measure. Results. The tenant-based resource allocation model proved to decrease my system's running costs. It also reduced the system's resources underutilization. Similar research was done, but the model was tested in private cloud. In this work the systems were deployed into commercial public cloud. Conclusions. The tenant-based resource allocation model is one of the method to tackle under-optimal resource utilization. When compared to traditional resource scaling it can reduce the costs of running SaaS systems in cloud environments. The more tenant-oriented the SaaS systems are the more benefits that model can provide.

Thesis (M.S. in Management) Naval Postgraduate School, December 1993.
Thesis advisor(s): Alan W. McMasters ; Katsuaki L. Terasawa. "December 1993." Includes bibliographical references. Also available online.

Thesis (M.S. in Management) Naval Postgraduate School, December 1993.
Thesis advisor(s): Alan W. McMasters ; Katsuaki L. Terasawa. "December 1993." Includes bibliographical references. Also available online.

A simulation model analyzes cost effectiveness of remote facility monitoring for risk reduction in rural water supply systems by performing a break-even analysis that compares operating costs with manual and remote monitoring.

Water system operating cost includes the value of water loss (i.e., realized risk) resulting from operating excursions which are inversely related to mechanical reliability. Reliability is controlled by facility monitoring that identifies excursions enabling operators to implement mitigating measures.

Cost effectiveness refers to the cost relationship among operating alternatives that reveals changed economic conditions at different operating rates inherent in the inverse relationship between fixed and variable costs. Break-even analysis describes cost effectiveness by identifying the operating rate above which the more capital intensive alternative will result in lower operating cost.

Evidence indicates that increased monitoring frequency associated with remote monitoring can reduce water system operating cost by improving reliability, but whether remote monitoring is cost effective depends upon system-specific factors. The lack of a documented tool for evaluating this type of cost effectiveness led to the project objective of developing a model that performs break-even analysis by simulating water system operating costs as functions of system size (delivery rate).

When the spreadsheet-based static deterministic parametric simulation model is run for the Tazewell County, Virginia water system based upon 1998 data, break even is predicted at approximately fifty-five percent of annual capacity (116,338,000 gallons) with operating cost of $1,043,400. Maximum annual operating cost reduction from a $317,600 investment provides payback in nine years.
Master of Science

Using geotextiles in secondary roads to stabilize weak subgrades has been a well accepted practice over the past thirty years. However, from an economical point of view, a complete life cycle cost analysis (LCCA), which includes not only costs to agencies but also costs to users, is urgently needed to assess the benefits of using geotextile in secondary road flexible pavement. In this study, a comprehensive life cycle cost analysis framework was developed and used to quantify the initial and the future cost of 25 representative design alternatives. A 50 year analysis cycle was used to compute the cost-effectiveness ratio for the design methods. Four flexible pavement design features were selected to test the degree of influence of the frameâ s variables. The analysis evaluated these variables and examined their impact on the results. The study concludes that the cost effectiveness ratio from the two design methods shows that the lowest cost-effectiveness ratio using Al-Qadiâ s design method is 1.7 and the highest is 3.2. The average is 2.6. For Perkinsâ design method, the lowest value is 1.01 and the highest value is 5.7. The average is 2.1. The study also shows when user costs are considered, the greater TBR value may not result in the most effective life-cycle cost. Hence, for an optimum secondary road flexible pavement design with geotextile incorporated in the system, a life cycle cost analysis that includes user cost must be performed.
Master of Science

Objective: The primary objective of this study was to estimate the long-term cost-effectiveness of stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the United States using new anticoagulant therapies - dabigatran 150 mg, apixaban 5 mg, and rivaroxaban 20 mg - as well as the standard treatment, warfarin. Methods: A Markov decision-analysis model was constructed using data from clinical trials that evaluated the new oral anticoagulants relative to warfarin (apixaban 5 mg & ARISTOTLE, dabigatran 150 mg & RE-LY, and rivaroxaban 20 mg & ROCKET-AF) to compare the lifetime cost and quality-adjusted life expectancy. The Markov model target population was a hypothetical cohort of 70-year old patients with nonvalvular atrial fibrillation, an increased risk for stroke (CHADS₂ ≥ 1, or equivalent), a renal creatinine clearance (CrCl) of 50 or above, and no contraindication to anticoagulant therapy. Using pair-wise comparisons of each therapy, analyses were conducted to evaluate incremental cost-effectiveness ratios (ICERs), net monetary benefits (NMBs), lifetime costs, life-years, and quality-adjusted life-years (QALYs). Results: In the base case, warfarin had the lowest cost of $71,857 (95% confidence interval [CI]: $68,730, $77,452), followed by rivaroxaban 20 mg ($74,023; 95% CI: $70,943, $77,307), dabigatran 150 mg ($78,584; 95% CI: $75,277, $81,968), and apixaban 5 mg ($81,180; 95% CI: $78,642, $83,756). Apixaban 5 mg also yielded the highest QALY estimate, 8.63 (95% CI: 8.52, 8.72), followed by dabigatran 150 mg (8.55; 95% CI: 8.43, 8.67), rivaroxaban 20 mg (8.42; 95% CI: 8.31, 8.54), and warfarin (8.17; 95% CI: 8.1, 8.24). In a Monte Carlo probabilistic sensitivity analysis, apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg, and warfarin were cost effective in 45%, 37%, 19%, 0%, respectively, of the simulations using a willingness-to pay threshold of $50,000 per QALY gained. From the one-way sensitivity analyses, new anticoagulant (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) costs and probabilities associated with intracranial hemorrhage and stroke for patients receiving rivaroxaban 20 mg were identified as significant influential variables impacting model results. Conclusion: In patients with NVAF and an increased risk of stroke prophylaxis, apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg may all be cost-effective alternatives to warfarin depending on pricing in the United States and neurologic events for rivaroxaban 20 mg.

The thesis describes the development, research and evaluation of the applicability of a new model of care that involves GPs being employed on a sessional basis in A&E departments to treat patients attending with primary care needs. The main aim of the study was to research its cost and clinical effectiveness. A multi-faceted approach was taken to include consideration of patients' needs and preferences, professional concerns, organisational and structural issues within the health service, and planning and policy issues. Clinical, sociological, epidemiological, and economic perspectives are drawn upon, reflecting the context of the service development and to provide a firm base for discussion about the generalisability and applicability of the findings. The first two chapters provide a detailed review of the epidemiological, sociological, clinical, and organisational literature relating to the primary care/A&E interface. The incentives and disincentives that may act to increase or reduce demand and supply are explored, in addition to issues relating to the 'appropriateness' of demand, the organisational culture of A&E departments, and strategies used to curtail or cope with demand. The demand for primary care at A&E departments appears to cross national boundaries and hence, literature from other countries (particularly the USA) is included and its applicability to the UK considered. Relevant literature relating to the quality of A&E care, patient satisfaction, and the costing of care is also discussed. The main study was a prospective controlled trial that was conducted at King's College Hospital. This compared process variables, clinical outcome and costs of 'primary care' consultations performed by senior house officers (SHOs), registrars, and general practitioners working three-hour sessions in A&E. A new system of nurse triage was implemented to allow the prospective identification of patients presenting with primary care needs. A total of 27 SHOs, three registrars and one senior registrar were included, and the patient sample comprised 1702 patients seen by GPs, 2382 by SHOs, and 557 by registrars or the senior registrar. GPs were found to practice considerably less interventionist care than A&E medical staff, and the resource implications were substantial. The findings are discussed critically, and their applicability is considered drawing on empirical data from recent evaluations of A&E Primary Care Service developments in other parts of London. The policy and service implications of the study are considered and further research needs identified.

In today’s dynamic technological landscape, wireless communication networks have become an important part of economic development. The emergence of wireless technologies raises hopes to extend communication to remote areas that have not seen any tangible deployment to date. As developing nations pin their hopes to wireless technologies, cost models for wireless communication networks are becoming vital to support the emerging technologies. However, varying cost changes raise critical challenges to the estimation of both capital expenditure and operational expenditure. The network deployment process has numerous events that may cause adjustments to initially estimated project costs. These adjustments are necessary for a cost management plan and this plan includes monitoring cost performance and ensuring that only appropriate changes are made to the network project. The incidents that may cause cost changes can not be entirely predicted as their distribution tend to change dynamically from time to time. Estimating network deployment costs in such a dynamic environment necessitates cost models that can adapt to random occurrence of cost changes. Widely used cost models are usually performed by experienced personnel whose engineering experience is derived from deploying similar networks. In this approach experienced personnel add a certain percentage to the cost estimate to cater for contingency costs. Certainly such an approach depends on individual opinion, making it subjective and void of mathematical estimating relationships which are of paramount importance in ensuring that estimated deployment costs are sufficient to deal with cost uncertainties. We observe that existing approaches can only explore a limited solution space and hence can lead to cost overruns if implemented in dynamically cost changing environments. This thesis presents a wireless communication network deployment cost model that incorporates uncertainties into the final cost estimate. The model is adaptive to unpredictable cost changes since it allows adjustments of confidence levels when calculating contingency costs. This allows dynamically updating the cost changes without the cost model being reconstructed from scratch. We make use of the Poisson process in modeling the occurrence of incidents that are responsible for causing cost changes during network deployment. We also show that the occurrence of the incidents causing cost change are random and tend to follow the Poisson distribution. Using different levels of confidence we model various cost contingencies and make sensitivity analyses to identify the probability of cost overrun when given different contingencies. The dynamic adaptive cost model can be used either at the strategic level to understand the cost of a particular technique or at the operational level, as a way to show how Poisson process in network deployment can compare with engineering experience and other estimating techniques. We believe that the model is useful for remote areas where deployment costs are volatile and the distribution of incidents causing cost change to original cost estimates are diverse and dynamically changing. Further we expect that our research improves the knowledge base of information about the costs for rural communities to connect to the Internet, consequently providing useful input to future policy debates. This work is further poised to be a utility function to help those planning internet infrastructure deployments in least developed regions.

Immunotherapy is a potent new treatment for non-small cell lung cancer. However, immunotherapy is much more expensive than many treatment alternatives. Previous cost-effectiveness analyses determined that nivolumab would be cost effective if it elicits a response rate greater than 20% (Sullivan et al., 2016), is given to all non-squamous and all PD-L1 positive squamous stage IV non-small cell lung cancer patients (Aguiar et al., 2016), or is 33% cheaper for PD-L1 positive patients or 45% cheaper for all patients (Matter-Walstra et al., 2017). This thesis analyzes these three studies and accounts for the effect that many responders survive much longer than those who respond to other treatments by modeling overall survival for patients on nivolumab with two regressions. These regressions estimate, that after 150 months, the value (in terms of life-years saved) of nivolumab is about four times greater than that of docetaxel. Depending on pricing strategy, nivolumab was found to cost either $1,000 less or $16,000 more per month of survival than docetaxel. These estimates differ considerably due to imprecision in price estimates. Because of this high degree of uncertainty, it is impossible to say whether or not nivolumab is cost effective. Due to the considerably longer average survival which results from nivolumab treatment and the ambiguous cost-effectiveness results, immunotherapy should be treated as a possibly cost-effective treatment. Further cost-effectiveness analyses will be necessary once future costs of immunotherapy can be better estimated.

Thesis (M.S. in Management) Naval Postgraduate School, December 1994.
"December 1994." Thesis advisor(s): Keebom Kang, Katsuaki L. Terasawa. Includes bibliographical references. Also available online.

Introdução: A malária humana apresenta sintomas inespecíficos e exige diagnóstico laboratorial e identificação da espécie para o seu manejo. O diagnóstico baseia-se na microscopia, exame barato, que exige profissionais experientes. Nos últimos anos surgiram testes imunocromatográficos de execução rápida e custo mais elevado em comparação à microscopia. Estudos de validação demonstraram sensibilidade e especificidade comparáveis à microscopia, podendo ser alternativa confiável em áreas sem laboratório. Objetivo: Realizar análise de custo-efetividade do uso do OptiMAL® - teste rápido (TR) registrado no Brasil e validado em áreas endêmicas - comparado à microscopia. Métodos: A perspectiva da análise foi a do sistema público de saúde brasileiro SUS, o horizonte analítico de seis meses e o ano de 2006, a referência temporal. Doze municípios do Estado do Pará constituíram a área de estudo. Foi construído modelo de decisão considerando dois desfechos: casos diagnosticados adequadamente e casos conduzidos adequadamente em três cenários: o cenário 1 corresponde a 100% dos exames realizados, o cenário 2 considera somente os exames feitos nas áreas com laboratório e o cenário 3 corresponde a 30% dos exames, realizados em áreas isoladas. Os parâmetros epidemiológicos principais foram prevalência da malária entre indivíduos sintomáticos e acurácia - sensibilidade e especificidade - dos métodos diagnósticos, cujas estimativas foram obtidas a partir do Sistema de Informação de Vigilância Epidemiológica da Malária e literatura científica. Foram estimados custos diretos médicos e não-médicos, considerando diretrizes nacionais e dados municipais. Fontes de dados de custos incluíram o Sistema de Informação de Insumos Estratégicos, a Tabela de Procedimentos do SUS e o Sistema de Informação Hospitalar do SUS. Foram estimadas as razões média e adicional de custo-efetividade (RCEA) e realizada análise de sensibilidade. O software utilizado foi o TreeAge Pro 2005. Resultados: O TR foi dominado pela microscopia nos cenários 1 e 2. Em áreas isoladas a estratégia microscopia apresentou RCEA de R$1.193,00 por caso diagnosticado adequadamente e de R$1.016,67 por caso conduzido adequadamente quando comparada com o OptiMAL®. O TR tornou-se mais custo-efetivo nos dois desfechos dos três cenários com a redução da acurácia da gota espessa, na análise de sensibilidade. Conclusões: o TR foi menos custo-efetivo em todos os cenários, quando a acurácia da microscopia manteve-se elevada.
Introduction: Diagnosis of malaria is based on blood microscopy, a lowcost procedure that requires experienced technicians. Rapid immunochromatography tests (RDT) were developed with the advantage of being easy-to-use tools but with higher costs. RDT validation showed similar accuracy compared to microscopy suggesting that the RDT could be a reliable alternative in areas without lab facilities. Objective: To perform costeffectiveness analysis for the use of OptiMAL® in comparison with the thick blood smear microscopy. Methods: The study was conducted from the perspective of the Brazilian Public Health System, the analytic horizon was of six months, and the time frame was 2006. The analysis was performed through a decision tree with two outcomes: properly diagnosed cases and properly conducted cases. There were defined three scenarios in 12 municipalities of the State of Pará: the scenario 1 considered the whole malaria tests performed in 2006; the scenario 2 considered the malaria tests performed in the endemic areas with access to lab facilities; and the scenario 3 considered the 30% malaria tests performed in areas without lab facilities. The main epidemiological measures were the prevalence of malaria and the accuracy of the diagnostic methods. Epidemiological estimates were obtained from the Brazilian Malaria Surveillance Information System and the scientific literature. Direct medical and non-medical costs were estimated taking into consideration the national guidelines and the data obtained from the municipalities. Cost data sources were the Information System for Strategic Resources from the Health Surveillance Secretariat, the Reimbursement Values Table and the Hospital Information System of the Brazilian Public Health System. The average and the incremental costeffectiveness ratio (ICER) were estimated and it was conducted a sensitivity analysis. Data were analyzed with the TreeAge Pro 2005 software. Results: RDT strategy was dominated by the microscopy strategy in the scenarios 1 and 2. The ICER for the microscopy strategy in the scenario 3 was R$1,193.00 per properly diagnosed case and it was R$1,016.67 per properly conducted case compared with the OptiMAL® strategy. The sensitivity analysis showed that the RDT was cost-effective for both outcomes in all the scenarios when the thick blood smear accuracy was reduced. Conclusions: The RDT is the least cost effective strategy, providing that microscopy accuracy is high.

Thesis (M.S. in Management) Naval Postgraduate School, December 1994.
Thesis advisor(s): Alan W. McMasters and Keebom Kang. "December 1994." Includes bibliographical references. Also available online.

Introduction: This research evaluated the implementation of a novel public-private partnership (PPP) between the provincial department of health, an NGO, and a local private sector general practitioner (GP) network, which provides routine HIV care and treatment to public sector patients in order to alleviate the patient burden at public sector primary care clinics. Methods: This was a retrospective cohort study that compared the PPP model to the status quo public primary healthcare clinic (PHC) model in terms of patient outcomes, costs and cost-effectiveness. Outcomes data (viral suppression, patient retention and other clinical outcomes) were collected from clinic records and patient files. Cost data included HIV and TB treatment, laboratory tests, down-referral care, and hospital-based outpatient and inpatient care. In addition, a new program performance metric proposed a cost associated with premature treatment attrition. Total and average costs for each model were based on resource utilization. Average cost and incremental cost per patient retained, cost per suppressed patient, and cost per suppressed patient remaining in down-referral care were calculated. Finally, a survey was conducted with a sub-set of study patients in order to incorporate patient experience and perceptions of each care model into the analysis. Results: The proportion of patients who remained in care at the down-referral site with suppressed viral loads was 83 and 55 percent in the PPP and PHC cohorts respectively. Eighty-eight percent of PPP patients had suppressed viral loads compared to 67 percent of PHC patients. Retention on treatment was 94 percent among PPP subjects and 75 percent among PHC subjects. Total model cost was higher in the PPP model (R2,153,233) compared to the PHC model (R1,556,591) during the study period. The average cost per suppressed patient in down-referral care was R646.41 per month in the PPP model and R724.00 per month in the PHC model, and the cost per patient retained was R570.85 in the PPP model and R516.45 in the PHC model. The incremental cost-effectiveness ratio (ICER) was R724.00 for the PHC model and R505.20 for the PPP model compared to a 'do nothing' alternative. The PHC model was dominated (extended dominance), and the ICER for the PPP model compared to a 'do nothing' alternative was R638.97. Discussion: Despite recent progress in scaling-up HIV services in South Africa, an intensified effort will be required to meet the rapidly growing demand for treatment over ii the next decade. A lack of human resources has been identified by experts as one of the biggest constraints to achieving further scale-up of ART. The PPP model evaluated here was designed to help alleviate some of the pressure on the public health system by utilizing local private sector GPs to provide routine care for treatment experienced patients in Matlosana, North West Province. Clinical outcomes in the PPP model were significantly better than in the PHC model, it was more cost-effective at producing virally suppressed patients in down-referral care, and PPP patients were equally as happy as PHC patients with the quality of care and the level of convenience that the model offered. Innovative partnerships like the one evaluated here may offer a strategy for boosting public health sector capacity by leveraging existing private sector health resources.

To stay competitive on today’s market and satisfy the constantly increasing customer requirements, working with continuous and cost-effective improvement is a requirement. The purpose of this thesis is to develop a model to continuously and cost-effectively improve the quality of a management system within trading business, taking the environmental aspect and impact of organizational changes up on personnel in consideration. The model has been developed based on theoretical management strategies and improvement methodologies: Process management, Change management, TQM, Lean, Continuous and cost-effective improvement, PDCA and Kaizen. The developed model should result in a high-qualitative management system that continuously should be improved and maintained, to streamline the supply chain and in turn be profitable. In order to enhance the sustainability of the model, it has been tested at a case company. From the results, conclusions can be drawn that concrete outcomes of the model implementation takes time, but it serve its purpose and generates in great results.

Background Several studies have shown that the Individual Placement and Support (IPS) model of supported employment is an effective approach to help many people with severe mental illness to find and maintain competitive employment. These studies include a randomized trial conducted in Montreal, Canada. Very few studies, however, have evaluated the cost-effectiveness of IPS compared to traditional services. Objective To evaluate the cost-effectiveness of IPS model compared to usual vocational services, using data from the Montreal trial. Methods A total of 149 unemployed adult with severe mental illness were randomly assigned to receive either IPS or usual vocational services and were followed for 12 months. Costs were estimated from the perspectives of the health and social care system, the government, and the society. Competitive employment hours and wages were taken as measures of effectiveness. A cost-effectiveness analysis was conducted, using the net benefit framework. A sensitivity analysis was carried out to take into account baseline differences of inpatient days between the two groups. Results IPS dominated usual services with significantly better competitive employment outcomes and less average costs, regardless of the economic perspective. IPS is likely to be more cost-effective than usual services even if the decision maker is only willing to pay a small amount of money per unit improvement in employment outcomes. If only clients without inpatient days during the year before the baseline are considered, IPS costs more than usual services but still with significantly better competitive employment outcomes: $155.73 per additional competitive employment hour and $20.12 per additional dollar of competitive employment earnings from the health and social care services perspective. Conclusions In this study, IPS proved cost-effective compared to usual services, although the baseline difference in inpatient days attenuates the strength of this finding.
IntroductionPlusieurs études ont démontré que le modèle de soutien à l'emploi « Individual Placement and Support » (IPS - Placement et soutien individuels) constitue une méthode efficace pour aider un grand nombre de personnes qui ont des troubles graves de santé mentale à obtenir et conserver un emploi régulier. Ces études incluent une étude expérimentale menée à Montréal, Canada. Très peu d'études, toutefois, ont évalué la coût-efficacité de IPS en comparaison avec des services traditionnels. Objectif Évaluer la coût-efficacité du modèle IPS en comparaison avec des services d'insertion socio-professionnelle habituels, en utilisant des données de l'étude montréalaise. Méthodes Au total, 149 adultes sans emploi et ayant des troubles mentaux graves furent répartis de façon aléatoire entre un programme IPS et des services habituels, et suivis pendant 12 mois. Les coûts furent estimés à partir des perspectives du système de santé et de services sociaux, du gouvernement et de la société. L'efficacité a été évaluée au moyen de deux variables: les heures en emploi régulier et les revenus de ces emplois. Une analyse coût-efficacité fut menée, en utilisant le cadre bénéfice net (net benefit framework). Une analyse de sensibilité fut effectuée pour tenir compte de la différence entre les deux groupes entre leurs jours d'hospitalisation au cours de l'année précédant leur entrée dans l'étude. Résultats IPS domine les services habituels avec de bien meilleurs résultats au niveau de l'emploi compétifi et des coûts moyens moindres, qu'importe la perspective économique. IPS semble plus coût-efficace que les services habituels même si le décideur n'est prêt qu'à payer un faible montant pour une amélioration dans les résultats au niveau de l'emploi. Si on ne retient que les clients qui n'avaient aucun jour d'hospitalisation pendant l'année précédant l'entrée dans l'étude, les sujets du groupe IPS coûtent nettement plus cher en moyenne que ceux des services habituels, mais toujours avec des résultats meilleurs au niveau de l'emploi compétitif. Du point de vue du systèeme de santé et services sociaux, les ratios coût-efficacité incrémentaux qui en résultent sont de 155,73 $ par heure d'emploi compétitif additionnelle et 20,12 $ par dollar additionnel de revenus compétitifs. Conclusions Dans cette étude, IPS s'est révélé coût-efficace en comparaison avec les services habituels, quoique la différences entre les groupes au niveau des jours d'hospitalisation à l'entrée atténue la force de cette conclusion.

To stay competitive, companies are forced to improve their products continuously. Field data is a source of information that shows the actual performance of products during operation, and that information can be used to clarify the items in need of improvements. This master thesis aims at identifying the set of field data that is required for dependability improvements and to develop a working procedure that enables increased utilization of the field data in order to make cost-effective design improvements. To achieve this, a 12-step model called the Design Improvement Cycle (DIC) was developed and tested in a single case study. The field data need was identified using a top-down method and was included as a part of the DIC.

Testing of the model showed that it was practicable and each step could be carried through, even though the last steps only could be tested hypothetically during discussions with concerned personnel. The model implied a working procedure that should be aimed at, according to personnel with competence within the subject. As the DIC appeared to be very flexible it should be possible to use within several areas. It was discovered that field data was not a sufficient source of information to support design improvements but it could be used to indicate which items that should be focused on during further investigations. The quality of the field data had a big impact on the analysis possibilities and to point out which data quality issues that had to be amended to make the data more useful, the data need for dependability improvements could be used.

The growing use of decision analytic modelling (DAM) to aid decision making in healthcare has triggered the need for increased scrutiny of the methods used and the assessment of compliance with these methods. The assessment of structural uncertainty surrounding the choice of model structure and model external validity represent some of most frequent challenges faced by researchers. This thesis used systematic reviews and two case studies focused on the self-management of hypertension in patients at high risk and thrombolysis in acute stroke to critically examine all available guidelines and statements of good practice and the adherence of current research to good practice guidelines. Two case studies were developed to assess structural uncertainty surrounding the choice of model structure and the impact of the exclusion of secondary events. The results here indicate that DAM guidelines lack practicality due to the extensive amount of information available and their complexity; furthermore, researchers are failing to identifY and correctly assess model structural uncertainty. This thesis makes an important contribution to current knowledge by developing and proposing the use of a practical five-dimension framework to improve the current standards of reporting results of DAM and by illustrating, through case studies, the assessment of structural uncertainty arising from the choice of model structure via scenario analysis and the use of extensive sensitivity analysis.

BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.

El trabajo de investigación nace de un análisis sobre la problemática ambiental y social que afecta la vida de los seres vivos y de las comunidades peruanas. En ese sentido, uno de los principales problemas ambientales está relacionado con los residuos contaminantes que se necesitan para producir carteras de cuero y sintéticos. El uso indiscriminado de este tipo de materiales en la industria de la moda genera inestabilidad en el ecosistema. Frente a esta problemática, se propone un modelo de negocio relacionado a la comercialización de carteras de fibra vegetal por redes sociales para un nicho ecológico de mujeres que se preocupan por tener accesorios eco amigables en Lima Metropolitana. La elaboración de las carteras de fibra vegetal será de responsabilidad de la Asociación de Tejedoras Ñari Walac Arte, las cuales, son representadas por un grupo de tejedoras de la provincia de Piura, Catacaos. Punto fundamental de nuestro modelo de negocio es la exposición del talento de las tejedoras del norte del Perú. El proyecto contempla la evaluación financiera para los próximos 3 años, la cual inicia a mediados del 2020. Para el inicio de operaciones se necesita una inversión de S/44,193, y se espera una rentabilidad de S/57,421 a finales del tercer año en el Flujo de Caja Económico y una rentabilidad de S/59,716 en el Flujo de Caja Financiero. La tasa interna de retorno representa el 26.4% recuperándose la inversión en 2.5 años considerando un crecimiento económico moderado debido a la pandemia por el COVID-19. La estructura financiera está conformada por 65% de capital propio y 35% financiado a través de una Fintech. El proyecto presenta una perspectiva financiera positiva para los inversionistas, así como permite el desarrollo de las comunidades y promueve el consumo responsable de productos ecológicos.
The research work stems from an analysis of the environmental and social problems that affect the lives of living beings and of Peruvian communities. In this sense, one of the main environmental problems is related to the polluting residues that are needed to produce leather and synthetic wallets. The indiscriminate use of this type of material in the fashion industry generates instability in the ecosystem. Faced with this problem, a business model related to the commercialization of vegetable fiber handbag through social networks is proposed for an ecological niche of women who worry about having ecofriendly accessories in Metropolitan Lima. The production of vegetable fiber handbags will be the responsibility of the Ñari Walac Arte Weavers Association, which are represented by a group of weavers from the Piura province, Catacaos. Fundamental point of our business model is the exhibition of the talent of weavers in northern Peru. The project contemplates the financial evaluation for the next 3 years, which begins in mid-2020. An investment of S / 44,193 is required for the start of operations, and a profitability of S / 57,421 is expected at the end of the third year in Economic Cash Flow and a profitability of S / 59,716 in Financial Cash Flow. The internal rate of return represents 26.4%, recovering the investment in 2.5 years considering a moderate economic growth due to the pandemic by COVID-19. The financial structure is made up of 65% of its own capital and 35% financed through a Fintech. The project presents a positive financial perspective for investors, as well as allows the development of communities and promotes the responsible consumption of organic products.
Trabajo de investigación

Thesis (MEng)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: The demand for rail travel has increased over the years. As a result, it is becoming mandatory for railway industries to maintain very high availability of their assets to ensure that service levels are high. Railway industries require both their infrastructure and rolling stock assets maintained efficiently to sustain reliability. There has been on-going research on how maintenance can be carried out in a cost effective manner. However, the majority of this research has been done for infrastructure and the rolling stock maintenance has not been properly covered. The purpose of this research is to contribute to the maintenance sector of rolling stock for railway industries by developing a decision support model for rolling stock based on reliability and cost. The model is developed as an optimization problem of a system containing several components dependent on each other with different reliability characteristics. In this model, a mixed integer nonlinear problem is developed and solved using an exact method and metaheuristics methods. The Metrorail facility in Cape Town was chosen as a case study. Failure history and cost data were gathered from the facility and the information was applied to the model developed. The case study was investigated and different results were achieved using both exact and metaheuristics methods. The final result from the study is an optimal maintenance schedule based on reliability and cost. The developed model serves as a practical tool railway companies can adopt to schedule rolling stock maintenance to achieve a high level of reliability and at the same time maintaining minimum cost expenditure.
AFRIKAANSE OPSOMMING: Die vraag na spoorvervoer het oor die jare toegeneem. Dus het dit belangrik geword dat die spoorweg se bates hoogs toeganklik moet wees om te verseker dat die vlak van dienslewering hoog bly. Die spoorweg industrie besef dat hulle infrastruktuur, lokomotiewe, waens ens. effektief in stand gehou moet word sodat dit betroubaar kan wees. Navorsing word nog steeds gedoen oor hoe instandhouding op ’n koste-effektiewe wyse gedoen kan word. Die meeste van hierdie navorsing gaan egter oor infrastruktuur en instandhouding word nie ordentlik gedek nie. Die doel met hierdie navorsing is om by te dra tot die instandhoudingsektor van die spoorweg deur om ’n besluit-ondersteunende model vir lokomotiewe, waens, ens wat op betroubaarheid en koste gegrond is, te ontwikkel. Die model is ontwikkel as ’n optimasie probleem van ’n sisteem wat verskillende komponente wat van mekaar afhanklik is maar oor verskillende betroubaarheidskenmerke beskik, inluit. In hierdie model word ’n gemengde, heeltal nie-lineêre probleem ontwikkel en met ’n eksakte metode en metaheuristiese metodes opgelos. Die Metrorail fasiliteit in Kaapstad is vir die gevalle studie gekies. Die geskiedenis van mislukkings en koste data is by die fasiliteit versamel en die inligting is op die model wat ontwikkel is, toegepas. Die gevalle studie is ondersoek, en verskillende resultate is met eksakte en metaheuristiese metodes bereik. Die finale uitkomste van die studie is ’n optimale instandhoudingskedule wat op betroubaarheid en koste gegrond is. Die model wat ontwikkel is dien as ’n praktiese instrument wat spoormaatskappye kan gebruik om die instandhouding van lokomotiewe, waens ens. te reël sodat ’n hoë vlak van betroubaarheid bereik kan word en kostes terselfdertyd tot ’n minimum beperk kan word.

Inledning: En stor del av den svenska ekonomin vilar på den svenska banksektorn. I och med den ökande digitaliseringen som blivit än mer påtaglig på senare tid har konkurrenssituationen bidragit till ett nytt utgångsläge än tidigare. Idag talas det om nya konkurrenter i banksektorn, som FinTech bolag, internationella banker och andra aktörer som börjar utmana svenska storbanker om fler marknadsandelar. Syfte och problemformulering: Syftet med arbetet är att identifiera, beskriva och förklara hur svenska storbanker och FinTech bolag uppfattar möjligheterna och hoten i samband med den ökande digitaliseringen inom banksektorn. Detta är för att försöka skapa en förståelse för förändringen av banksektorn i samband med digitaliseringen. Hur uppfattar svenska storbanker och FinTech bolag de möjligheter och hot som uppkommer i samband med den ökande digitaliseringen? Teoretisk referensram: De teorier som har använts under studien är isomorfismen med underbegreppen tvingande, imiterande och normativ isomorfism samt Porters strategiteori, femkraftsmodellen. En SWOT analys har använts för att enklare kunna identifiera bankernas styrkor, svagheter, möjligheter och hot i samband med digitaliseringen. Studien har även använt sig av tidigare forskning och tagit hänsyn till strävan efter legitimitet och krav på kostnadseffektivisering. Detta har använts som stöd till det empiriska resultat som samlats in för att enklare kunna analysera och därmed få problemformuleringen besvarad. Metod: Det empiriska materialet har samlats in med en kvalitativ metod. 5 informanter har medverkat i semistrukturerade intervjuer. Slutsats: Författarna till studien har identifierat och beskrivit flera faktorer till hur de uppfattar de möjligheter och de hot som finns i samband med den ökande digitaliseringen. Informanterna belyste både möjligheter och hot, exempelvis att regelverket PSD2 ökar konkurrensen och förbättrar situationen för mindre aktörer att konkurrera mot de större bankerna. Studien har även begränsats till svenska storbanker och FinTech bolag.
Introduction: A big part of the Swedish economy rests on the shoulders of the Swedish bank sector. Because of the increasing digitalization in recent times, the difference in competition has become substantially more evident and it has received a completely new starting point compared to before. The newest and most recent additions to the competition within the banking sector are examples such as FinTech companies, international banks and other parties that are also starting to compete with the big Swedish banks for market shares. Purpose and problem formulation: The purpose of this study is to describe the way the big Swedish banks and FinTech companies perceive the different opportunities and threats related to the increased digitalization that we see today. This will allow us to try and create an understanding of what the future might look like and what has already changed within the banking sector ever since the introduction of digitalization. How do the big Swedish banks and FinTech companies perceive the different opportunities and threats related to the increased digitalization? Theoretical frame of reference: The theories that have been used during the study are isomorphism with the notion of compelling, imitating and normative isomorphism as well as Porter's strategy theory, the five force model. A SWOT analysis has been used to more easily identify the banks' strengths, weaknesses, opportunities and threats during the digitization. The study has also used previous research and taken into account the quest for legitimacy and demands for cost efficiency. This has become a support for the empirical results that have been collected in order to be able to analyze more easily, reach a conclusion and thus get the problem formulation answered. Method: The empirical material has been collected with a qualitative method. 5 informants have participated in semi-structured interviews. Conclusion: The authors of the study have identified, described and explained several factors as to how they perceive opportunities and threats during the increasing digitization. The informants shared both opportunities and threats, such as the fact that the PSD2 regulations increase competition and improve the situation for smaller players to compete against the big banks. The study has also been limited to big Swedish banks and FinTech companies.

Overwhelming evidence throughout the literature has shown that bus overhead and maintenance (O&M) costs increase as buses age. This has implications toward a fleet manager's decision of when one should buy, use, or sell buses to minimize total fleet costs. Unfortunately, there are uncertain market conditions associated with bus fleets that cloud the manager's ability to make appropriate decisions. Using integer programming (IP), O&M trends and changing market conditions are integrated into a model to better analyze bus fleets. Due to recent budget constraints of transit agencies, needs for a bus fleet replacement model have arisen. King County in Washington State has supplied cost aggregated data of their New Flyer (NF) and NF hybrid buses. These data have been analyzed to create statistical relationships based on rising O&M costs per mile with age, which are then integrated with the IP model to determine the impact of changing diesel prices, potential carbon dioxide (CO2) emissions costs, uncertain maintenance costs, and bus purchase cost subsidies. The goal is to aid fleet managers to determine the costs of early or delayed suboptimal bus replacement timing and the impacts of market variability on fleet costs and optimal replacement timing. The optimal replacement age for NF and NF hybrid buses based on King County data and current fuel prices of $3.99/gal are 16.7 and 18.3 years, respectively. It has been consistently observed that greater expense is incurred when buses are replaced earlier rather than later from optimal. To minimize total CO2 emissions (including operation and construction emissions), buses should be replaced slightly before the optimal replacement time without considering CO2 emissions. High diesel prices and CO2 emissions had little or no effect, on when buses should be replaced. However, higher maintenance costs reduced the optimal replacement time by almost two years. Although NF hybrid buses have been found to have no economic advantage over conventional buses, this finding may be a consequence of the different costs associated to the different routes operated by hybrid and conventional buses. Due to the lack of detailed King County's route level historical data, a study of the economic competitiveness of NF hybrids against conventional buses is outside the scope of this thesis. If buses are used less with age, the optimal replacement age is reduced. The optimal replacement age also dropped significantly when the Federal Transit Agency's procurement assistance is applied into the model. The procurement assistance can be up to 80% of the capital costs and can be considered a purchase subsidy from the transit agency viewpoint. If purchase subsidies decrease bus purchase prices by 1%, the optimal replacement age drops approximately 1.5%. When the bus purchase price is reduced by 80%, the optimal bus replacement age is less than 12 years, the FTA's minimum replacement age.

The purpose of this thesis is to develop a model that is going to be used when wanting to cost-effectively improve the productivity of material supply to assembly with consideration to improve ergonomics and quality of semi-finished products. For this approach a case company’s material supply and assembly station have been studied. By utilising interviews, observations, time measurements and the company’s archival records relevant data have been gathered to review the company’s current materials supply method and assembly station in order to compare it with new possible materials supply methods. A cost break down structure was made in order to identify the different cost drivers for the different materials supply methods. This facilitated the time measurements since they pointed out which operations/activities that should be studied. There were two main types of materials supply methods used in the comparisons, which were line stocking and materials kitting. Line stocking was the first alternative since it was their current material supply method. In materials kitting, the new material supply method, there was two sub types examined, kit carriers and kits in pallets. The conclusion was that that the kit carriers made it possible to improve the labour productivity of one assembly station and at the same time being cost-effective. The kit carriers did also improve the ergonomics for the assembler, but on the contrary worsened the ergonomics for the material handlers. It was also perceived by the assemblers and materials handlers that the quality of the materials was improved when using the kit carriers.
Syftet med det här examensarbetet är att utveckla en modell som kommer att användas när man kostnadseffektivt vill förbättra produktiviteten av materialförsörjningen till montering med hänsyn till att förbättra ergonomin och kvaliteten på halvfabrikats produkter. För denna uppgift har ett fallföretags materialförsörjning och en monteringsstation blivit studerade. Genom att använda intervjuer, observationer, tidmätningar och företagsdokument så har relevant data samlats in for att undersöka företagets nuvarande materialförsörjningsmetod och monteringsstation för att kunna jämföra de mot nya möjliga materialförsörjningsmetoder. Ett kostnadsstrukturträd gjordes för att kunna identifiera de kostnadsdrivare för de olika materialförsörjningsmetoderna. Detta underlättade tidmätningarna eftersom de pekade ut vilka operationer/aktiviteter som borde bli studerade. Det var två huvudsakliga materialförsörjningsmetoder som användes i jämförelserna, vilka var linje lagring och kittning av material. Linje lagring var det första alternativet eftersom det var deras nuvarande materialförsörjningsmetod. I kittningen av material, som var det nya alternativet, så var det två subtyper undersökta, kitvagnar och kit i pall. Slutsatsen var att kitvagnarna gjorde det möjligt att förbättra arbetsproduktiviteten i en monteringsstation samtidigt som den var kostnadseffektiv. Kitvagnarna förbättrade även ergonomin för montören men däremot försämrade den ergonomin för materialhanterarna. Det upplevdes också av montörerna och materialhanterarna att kvalitén av materialen förbättrades när kitvagnarna användes.

El part ha passat de ser un procés fisiològic a rebre la consideració d'un procediment controlat amb moltes intervencions mèdiques. Davant la multitud de factors que poden influir en la variabilitat en l'atenció al part, aquest estudi es centra en un dels factors claus que és la titularitat de l'hospital. OBJECTIU: Comparar el procés assistencial que reben les dones en l’atenció al part hospitalari, a la Fundació Althaia, segons el model assistencial públic o privat durant els anys 2012-2013. ÀMBIT D’ESTUDI: Les 2 àrees de parts i les 2 unitats maternoinfantils que ofereix la Fundació Althaia. DISSENY: Estudi observacional, longitudinal, prospectiu i analític de Cohorts SUBJECTES D’ESTUDI: Es van estudiar les dones de baix i mitjà risc ateses a la Fundació Althaia durant els anys 2012-2013. 140 subjectes per el grup de dones amb assistència pública i 140 subjectes per al grup de dones amb assistència privada. INSTRUMENTS: En una graella de dades d’elaboració pròpia, les llevadores van recollir a la sala de parts les variables de les pràctiques realitzades i els resultats perinatals obtinguts i en el postpart es va recollir la satisfacció de la dona, el tipus d’alletament i el tipus d’alta. Al mes de l’alta es va recollir el cost del procés del part hospitalari. PRINCIPALS MESURES DE RESULTAT: Diferències entre les pràctiques basades en l’evidència científica, la satisfacció i el cost en l’atenció al part normal hospitalari depenent si les dones varen ser ateses en el model d’atenció públic o privat. RESULTATS: Es van trobar diferències estadísticament significatives amb p <0,001 en les característiques sociodemogràfiques. La mitjana d'edat de les dones del model públic, 30,7 anys (DE= 5,2), va ser inferior a la mitjana d'edat de les dones del model privat, 33,7 anys (DE= 4,1). El nivell d'estudis que tenien les dones de la privada va ser superior i la variabilitat en els país de procedència va ser més elevat en el model públic on només un 69,1% eren autòctones en front a un 98,6% en el model privat. Es van analitzar 39 pràctiques obstètriques que la dona pot rebre en el transcurs del part i els resultats obtinguts ens mostren que hi va haver variabilitat entre els dos models en un 61,53% de les pràctiques. No es van observar diferències estadísticament significatives en el grau de satisfacció que van expressar les dones, trobant pels dos models un elevat grau de satisfacció, amb una mitjana de 9,1 (DE= 0,9) en el model públic i de 8,7 (DE= 1,3) en el model privat. Només es van observar diferències estadísticament significatives entre els dos models en el cost del part normal, trobant un cost de 1.298,1€ (DE= 943,4) pel model públic i de 1.307,5€ (DE= 304,1) pel model privat. CONCLUSIONS: La variabilitat en les pràctiques obstètriques que existeix entre el model públic i privat no influeix en la satisfacció de les dones. El cost del part pels dos models assistencials és igual en tots dos centres exceptuant el cost del part normal que és superior en el model assistencial privat.
El parto ha pasado de ser un proceso fisiológico a recibir la consideración de un procedimiento controlado con muchas intervenciones médicas. Ante la multitud de factores que pueden influir en la variabilidad en la atención al parto, este estudio centra su atención en uno de los factores clave que es la titularidad del hospital. OBJETIVO: Comparar el proceso asistencial que reciben las mujeres en la atención al parto hospitalario, en la "Fundació Althaia", según el modelo asistencial público o privado durante los años 2012-2013. ÁMBITO DE ESTUDIO: Las 2 áreas de parto y las 2 unidades maternoinfantiles que ofrece la "Fundació Althaia". DISEÑO: Estudio observacional, longitudinal, prospectivo y analítico de Cohortes. SUJETOS DE ESTUDIO: Se estudiaron las mujeres de bajo y medio riesgo atendidas en la "Fundació Althaia" durante los años 2012-2013. 140 sujetos para el grupo de mujeres con asistencia pública y 140 sujetos para el grupo de mujeres con asistencia privada. INSTRUMENTOS: En una parrilla de datos de elaboración propia, las comadronas recogieron en la sala de partos las variables de las prácticas clínicas realizadas y los resultados perinatales obtenidos y en el postparto se recogió la satisfacción de la mujer, el tipo de lactancia y el tipo de alta. Al mes del alta se recogió el coste del proceso del parto hospitalario. PRINCIPALES MEDIDAS DE RESULTADO: Diferencias entre las prácticas basadas en la evidencia científica, la satisfacción y el coste en la atención al parto hospitalario en función de si las mujeres fueron atendidas en el modelo de atención público o privado. RESULTADOS: Se encontraron diferencias estadísticamente significativas con p<0,001 en las características sociodemográficas. La media de edad de las mujeres del modelo público 30,7 años (DE= 5,2), fue inferior a la media de edad de las mujeres del modelo privado 33,7 años (DE= 4,1). El nivel de estudios que tenían las mujeres de la privada fue superior y la variabilidad en el país de procedencia fue más elevado en el modelo público donde sólo un 69,1% eran autóctonas frente a un 98,6% en el modelo privado. Se analizaron 39 prácticas obstétricas que la mujer puede recibir en el transcurso del parto y los resultados obtenidos muestran que hubo variabilidad entre los dos modelos en un 61,5% de las prácticas. No se observaron diferencias estadísticamente significativas en el grado de satisfacción que expresaron las mujeres, encontrando para los dos modelos un elevado grado de satisfacción, con una media de 9,1 (DE= 0,9) en el modelo público y de 8,7 (DE= 1,3) en el modelo privado. Sólo se hallaron diferencias estadísticamente significativas entre los dos modelos en el coste del parto normal, resultando un coste de 1.298,1€ (DE= 943,4) para el modelo público y de 1.307,5€ (DE= 304,1) para el modelo privado. CONCLUSIONES: La variabilidad en las prácticas obstétricas que existe entre el modelo público y privado no influye en la satisfacción de las mujeres. El coste del parto para los dos modelos es igual en los dos centros exceptuando el coste del parto normal que es superior en el modelo asistencial privado.
Childbirth assistance has gone from being a physiological process to the status of a controlled process with many medical interventions. Given the multitude of factors that can influence the variability in delivery care, this study focuses on one of the key factors wich is the type of hospital. OBJECTIVE: Compare care process in women receiving attention, at “Fundació Althaia”, according to public or private healthcare model during the years 2012-2013. SETTING: The two areas of childbirth and two maternity units offering “Fundació Althaia”. DESIGN: Observational, longitudinal, prospective analytic cohort. Subjects: We studied women with low or medium risk attended at “Fundació Althaia” during the years 2012-2013. INSTRUMENTS: In a data sheet of own elaboration, midwives were collected in the delivery room variables of practices and results obtained perinatal and postpartum picked up the satisfaction of the woman, the kind of breastfeeding and the kind of discharge. To the month of discharge picked up the cost of hospital delivery process.. RESULTS: We found statistically significant differences with p <0.001 sociodemographic characteristics. The average age of women in the public model, 30.7 years (SD= 5.2) was lower than the average age of women in the private model 33.7 years (SD= 4,1). The education level of women in the private sector was higher. Variability in the country of origin was higher in the public model, where 69.1% were native versus 98.6% in the private model. We analyzed 39 obstetric practices that women can receive during childbirth and the results show that there was variability between the two models in 61.53% of the placement. There were no statistically significant differences in the degree of satisfaction women expressed, finding a high level of satisfaction in the two models, with an average of 9.1 (SD= 0.9) in the public model and 8.7 (SD= 1.3) in the private model. Only statistically significant differences were observed between the two models in the cost of normal childbirth, finding an average cost of €1,298.1 (SD= 943.4) in the public model and €1,307.5 (SD= 304.1) in the private model. CONCLUSIONS: The variability in the obstetric practices between the public and private model does not affect satisfaction of women. The cost of delivery care for both models is the same in both centers excepting the cost of normal labor that is higher in the private healthcare model.

Grundskolan, som är en obligatorisk och viktig kommunal verksamhet, utgör ett exempel på då det är svårt att uppskatta reella resultatmått för att mäta och jämföra effektivitet, t ex till följd av reformer. Denna avhandling belyser utvecklingen av modeller för effektivitetsmätning inom ramen för en reform inom den offentliga sektorn, den s k stads-delsnämndsreformen (SDN-reformen) i Stockholms stad 1997. En grundläggande fråga för de ekonomiska vetenskaperna gäller utveck-ling av metoder för att bedöma effektivitet i olika verksamheter. I denna avhandling är effektivitetsbegreppet centralt. För att mäta effekter krävs mått som anger värdet av det som presterats i förhållande till värdet av de förbrukade resurserna. Möjligheterna att göra effektivitetsmätningar varierar mellan olika verksamheter. Det är svårt att mäta effektivitet hos många offentliga verksamheter och därmed att göra bra bedömningar av deras utveckling. Främst ligger svårigheten i att få goda och jämförbara mått på resultaten av en viss verksamhet. Mot bakgrund av de senare decenniernas reformering av den offentliga sektorn finns ett stort behov av modeller för att bedöma i vilken utsträckning dessa reformer lett till en ökad effektivitet. I studien undersöks effektivitetsförändringar i Stockholms stads grund-skolor i samband med SDN-reformen genom att mäta och beskriva effektivitet med hjälp av flera olika metoder. Tillvägagångssättet innebär att jämföra resultaten från metoderna och studera i vilken grad de pekar åt samma håll. Motivet är att belysa i vilken utsträckning resultaten ger samstämmighet. Då resultaten inte pekar åt samma håll analyseras tänkbara orsaker. En slutsats gällande den troliga effektivitetsför-ändringen ges. Avslutningsvis görs ett försök att med hjälp av SDN-reformen förklara denna utveckling.

Sammanfattning på engelska med titeln: Effectiveness in compulsory school education following a district council reform. Diss. Stockholm : Handelshögskolan, 2003

Thesis (M. Tech. (Information Technology)) -- Central University of technology, Free State, 2013
The aim of this study was to create a dynamic software system that captures all information related to a student and delivers it to the educators, principal, higher authorities and parents. In order to achieve this aim, an investigation was launched as to the development of a cost-effective school management system for disadvantaged schools in the Free State Province using the Software as a Service (SaaS) delivery model. Although a variety of other school management systems exist in the market, they are often expensive and difficult to maintain. Details such as previous academic performances, disciplinary actions taken against a student in the current school, ailments the student suffers from and parental details are some of the information that will help an educator to better understand a student. The software that is currently in use fails to deliver this information. Designing the software as a multitenant system, helps accommodate different schools under the same database, while the shared database, shared schema reduces back-end costs. Database design was carried out in such a way that tenant data is logically isolated and that data integrity is maintained throughout. What makes the software explained in this study cost effective is the method of delivery that was employed, which is SaaS. Here, software is not purchased, there is no upfront capital and the yearly license fee is eliminated, as schools need only pay a monthly rental fee for the services they use. Since all services are provided through the Internet, there is no need for system space; the only requirement is a high-speed Internet network.

Thesis (MBA (Business Management))--University of Stellenbosch, 2006.
ENGLISH ABSTRACT: Since packaging materials comprise a substantial percentage, namely 35% of the entire input cost on a fruit farm, the four largest fruit producers in the Western Cape decided in 1988 to erect their own corrugated cardboard plant at Worcester, namely A P L Cartons. The driving force of the company is to minimise the longterm input cost of packaging material in a sustainable manner. Therefore cost effectiveness and competitiveness had to be a distinct characteristic of the company. The company's corporate strategy is aimed at strong growth by means of a best value strategy that adds to the value of clients' products and production processes. Despite a well formulated strategy, it has been found that key targets are not met according to expected standards. While profitability, productivity, cost effectiveness and the workers' moral are on the decline, there is a constant rising in downtime, quality rejections and waste at the plant. The problem is further complicated when one takes into account that the company still succeeds in maintaining its specific growth performances. Yet, this take place at the expense of effectiveness in the plant. A literature study will be conducted to establish the general causes for strategic gaps at companies. Against this background the reasons for the gap between the strategic direction and the company results at A P L Cartons will be identified. A literature study will also be conducted to determine the project management and strategic management approach to goal achievement. This will be developed into a management model for bridging the strategic gap at A P L Cartons. An investigation into companies that have experienced project failures revealed two main causes, namely that such companies: a) Don't have a framework for projects; or b) Don't have a distinct strategic direction. Therefore strategic, as well as project managers must act as facilitators who rely on delegating and co-ordinating in order to create conditions for performance instead of failure. From the study it appeared that the main reasons for strategic gaps at A P L Cartons are the following, namely : a) Although a definite strategic direction has been formulated, the company does not have a proper framework for the implementation of its strategy, projects and initiatives. b) Functional managers do not contribute on a cross-functional basis to the training and development of skills lacking in other departments. c) The development of functional and competitive strategies don't go further merely than their formulation. Therefore they can't support the implementation of corporate strategy. d) Senior management is too intent on operational detail, so much so that a helicopter like vision of a strategic direction and its implementation mostly is lacking. e) There doesn't exist a procedure for the identification, handling and managing of critical issues for strategy implementation. The study suggests two related tools for the handling of critical matters, namely a critical issue management form and a critical issue register. This forms part of a management tool that can be utilised alongside a management model and management framework, especially developed for A P L Cartons to strive for reaching strategic goals. The framework was developed after discovering that both strategy and projects can be managed within the same framework of reference since both share the same origin and substructure. The origin is found in corporate objectives, while a directional value system provides its substructure.
AFRIKAANSE OPSOMMING: Aangesien pakmateriaal 'n wesenlike gedeelte, naam1ik 35 persent van totale boerdery insetkoste in die vrugtebedryf beslaan, het die vier grootste vrugteprodusente in die Wes-Kaap in 1988 besluit om hul eie riffelkarton vervaardigingsaanleg, naamlik A P L Cartons te Worcester op te rig. Die dryfkrag van die maatskappy is om pakmateriaal insetkoste oor die langtermyn handhaafbaar te minimiseer. Daarom moes kostedoeltreffendheid en mededingendheid 'n onderskeidende kenmerk van die maatskappy wees. Die korporatiewe strategie van die maatskappy is ingestel op versnelde groei by wyse van 'n waarde-strategie wat waardetoevoegend tot kliente se produkte en produksieprosesse is. Ondanks 'n goed geformuleerde strategie, word gevind dat sleuteldoelstellings nie teen verwagte standaarde bereik word nie. Terwyl winsgewendheid, produktiwiteit, kostedoeltreffendheid en werknemermoraal afneem, styg staantye, kwaliteitsafkeurings en afval in die aanleg. Die probleemstelling word verder gekompliseer indien in ag geneem word dat die maatskappy steeds daarin slaag om sy reele groeiprestasie voort te sit. Dit vind egter plaas ten koste van doelmatigheid in die aanleg. Daar sal op 'n literatuurstudie staatgemaak word om die algemene oorsake van strategiese gapings by ondernemings vas te stel. Teen die agtergrond sal die oorsake vir die gaping tussen die strategiese rigting en maatskappyresultate van A P L Cartons identifiseer word. 'n Verdere literatuurstudie sal onderneem word om vas te stel wat onderskeidelik die projekbestuursbenadering en strategiese bestuursbenadering tot doelwitbereiking is. Daaruit sal 'n bestuursmodel vir die oorbrugging van die strategiese gaping by A P L Cartons ontwikkel word. 'n Ondersoek na projekmislukkings by maatskappye identifiseer twee hoof-oorsake daarvoor, naamlik dat sulke maatskappye : a) Nie oor 'n raamwerk vir projekte beskik nie; of b) Nie oor 'n duidelike strategiese rigting beskik nie. Daarom moet strategiese en projekbestuurders optree as fasiliteerders wat staatmaak op delegering en koordinering om die omstandighede te skep vir prestasie pleks van mislukking. Uit die ondersoek is vasgestel dat die hoof-oorsake vir strategiese gapings by A P L Cartons die volgende is, naamlik : a) Alhoewel 'n duidelike strategiese rigting geformuleer is, beskik die maatskappy nie oor 'n raamweek vir die implementering van strategie, projekte en inisiatiewe nie. b) Funksionele bestuurders dra nie kruisfunksioneel by tot die opleiding en ontwikkeling van vaardighede wat in ander departemente ontbreek nie. c) Funksionele en mededingende strategiee word nie verder as die formulering daarvan ontwikkel nie. Gevolglik rugsteun dit nie die korporatiewe strategie tot implementering nie. d) Senior bestuur is te ingegrawe in operasionele detail, sodat 'n helikoptervisie oor strategiese rigting en implementering meestal ontbreek. e) Daar bestaan nie 'n werkswyse vir die identifisering, hantering en bestuur van kritiese kwessies vir strategie-implementering nie. Die ondersoek stel twee instrumente wat met mekaar verband hou voor vir die hantering van kritieke kwessies naamlik 'n kritieke kwessie bestuursvorm en 'n kritieke kwessie register. Dit vorm 'n bestuursinstrument wat saam met 'n bestuursmodel en -raamwerk, wat vir A P L Cartons ontwikkel is, gebruik kan word om strategiese doelwitbereiking na te streef. Die raamwerk is ontwikkel nadat vasgestel is dat strategie en projekte binne dieselfde verwysingsraamwerk bestuur kan word, omdat beide dieselfde oorsprong en onderbou deel. Die oorsprong word gevind by korporatiewe doelstellings, terwyl 'n rigtinggewende waardestelsel die onderbou daarvoor verleen.

Très peu de travaux ont été publiés sur l’évaluation du fardeau des patients atteints de la maladie de Huntington (MH) et de leur famille. Les objectifs de cette thèse étaient: 1/le développement d’un instrument mesurant les caractéristiques de la MH; 2/la validation de cet instrument; 3/la mise en place d’une étude observationnelle; 4/le développement d’un modèle d’évaluation de la trajectoire des patients. Un instrument auto-administré de qualité de vie liée à la santé (QVLS) et un instrument auto-administré clinique spécifiques aux patients ont été développé. Ils présentaient de bonnes propriétés psychométriques et ont été validés dans plusieurs langues. Les coûts de la MH dans cinq pays (France, Italie, Espagne, Etats Unis, Pologne) ont été évalués. La QVLS des patients et des aidants et ses déterminants ont été décrites. Aussi, un modèle mathématique qui modélise l’évolution des patients a été développé pour pouvoir évaluer l’efficience de nouvelles thérapies dans la prise en charge de la MH. Une comparaison entre un traitement fictif et les soins standards actuels a été faite qui a permis de démontrer qu’une thérapie qui améliore le score total TMS de l’instrument d’autoévaluation H-CSRI de 3,3 points ne sera pas coût efficace. Aussi des travaux sur la QVLS chez des patients atteints de troubles de la consommation d’alcool, et des patients ayant des symptômes associées à l'hyperplasie bénigne de la prostate ont été réalisés ainsi que des travaux sur les trajectoires des patients atteints d’AVC. Ces travaux apportent des informations originales qui répondent à des besoins pour l’évaluation des interventions thérapeutiques dans chacun des domaines considérés
Few studies have been done on the evaluation of the burden of patients suffering from Huntington’s disease (HD) and their family. The objectives of this thesis were: 1/development of an instrument evaluating HD characteristics; 2/validation of this instrument; 3/implementation of an observational study; 4/development of a model evaluating patients’ pathways. A self-administered instrument of quality of life related to health (HRQoL) and a self-administered clinical instrument specific for patients were developed. Both instruments showed good psychometric properties and were validated in several languages. The costs of HD in five countries (France, Italy, Spain, USA, Poland) were assessed. HRQoL of patients and caregivers and their determinants have been described. Also, a mathematical model that models the evolution of patients was developed to assess the cost-effectiveness of new therapies in HD. A comparison between a mock treatment and current standard care showed that a therapy that improves the total score of the self-assessment TMS (H-CSRI) by 3.3 points would not be cost effective. Also, studies on HRQoL in patients with alcohol use disorders, and in patients with lower urinary tract symptoms were made as well as studies on stroke patients pathways. These studies bring original information that meets needs for evaluation of therapeutic interventions in each of the considered areas