The farms sell milk (product income), other milk products and some farm produced fodder (other income), but they also buy and sell animals (trading income), so these are the three components of the output variable. The variable product income is the net income for all milk sold, including cash sales (milk sold informally), after deducting transport charges, all levies and monthly shares deductions. The price that farmers normally receive from processors depends on a number of milk characteristics and these include butterfat and protein content and somatic cell count. Price differences between farmers are, therefore, the result of milk quality and component composition. Thus, using revenues for total output provides additional information. Other income includes bags sold; levies repaid; dividend and bonus received; surplus grain sales; grazing let; land lease income: Lease charges for cattle must be deducted from cost centre. Trading income, by definition, is gross income (inclusive of levies, transport etc) for the sale of cull cows, breeding cows, heifers, bull calves and oxen. Cattle purchases and hire purchase (charges for purchase) redemption for cattle purchases are entered in parenthesis (as a negative value) next to the cattle sales figures.
The use of the ULC in deflating NEER has the disadvantage, as Nielson (1999) points out, that in this way the capital-labor force ratio is neglected, as it is known that a part of the growth in productivity is due to an increase in the capital intensity, so that only if the decrease in the unit labor costs is higher than the total decrease of the unitcost, the former has a direct impact on the competitiveness. Some other problems related to this indicator are derived from the measurement errors and the large delay in the publication of the data.
3. Level 3 – It is an estimate prepared upon completion of the final design and the accuracy of which falls between +10 and ‐3 percent.
The conceptual estimate is generally prepared by the owner as part of economic feasibility analysis or by the designer during the design phase for selecting the design alternatives or by the contractor for negotiated work between owner and a contractor. The preparation of conceptual cost estimates requires knowledge and experience with the work required to complete the project. Cost information from previous projects of similar type and size is essential. From the cost records of previous projects, the estimator can develop unit costs to forecast the cost of future projects. The unitcost is developed from weighting of the data that emphasizes the average value, yet it accounts for the extreme maximum and minimum values. The following equation is used for weighting cost data from previous projects:
that of the services considered, most support was provided in-school; very little was provided by educational psychologists and community paediatricians so these costs will be low.
These detailed data on how additional support is provided to children in schools are an ideal vehicle for cost estimation. Unit costs can be estimated for each professional using the approach outlined in work undertaken for the BCRP and then multiplied by the number of hours received by each child. It would also be possible to take a wider perspective, taking into account all possible resources that a children may use that may have an impact on their speech, language and communication needs, for example: occupational or behaviour therapists, audiology appointments, help to improve their home environment, etc. Whereas parents using a version of the Client Service Receipt Inventory found it difficult to identify any additional supports, other studies have found a wide range of services reported by parents across groups of children; GPs, paediatricians, social workers, occupational therapists and voluntary sector organisations (Barratt et al., 2012). However, unless the child had complex problems, only a few services are used by each child. The approach taken here, collecting service use from within school and from parents (who have a wide view across many services) could provide the most comprehensive picture (see Section 4.4.4).
Cost-effectiveness studies of services for SLCN 9 meta-analysis. Drummond’s Referee’s Checklist goes
some way to addressing this issue by highlighting the types of information that all such studies should include. Clearly the first step is good, comprehensive data on all the services that children receive. This is particularly important when it comes to services that could be offered through a number of routes. SLCNinterventions can be offered at nurseries and schools both mainstream and specialist, through parent-led training programmes, through direct or indirect speech and language therapy, and even through computer- or internet-based programmes. Although the adoption of a single perspective, such as recording input from the intervention provider, is common, it is rarely sufficient to identify the true cost. As these studies show, if SLCNinterventions include parents in an active role providing instruction to the child on a regular basis outside the context of the therapy received from the specialist, parental input costs should be costed. If researchers do not include the cost of that parental input, whether functional costs (transport and the like) or the costs of time spent reinforcing the aims of the interven- tion, the overall cost of the programme is likely to be misrepresented. It is also possible that minimizing the cost of one service simply shifts the costs of SLCN onto another agency. For example, a cheaper and less effective intervention provided by the health sector may mean that the education services must pick up additional costs of supporting pupils with SLCN. While this is clearly true of targeted intervention studies of the type described in the present review it is especially important to take this into consideration as the number of universal or preventative studies increases.
to support interventions that reduce ICU admissions and LOS, especially in the short term when the majority of costs are fixed. However, our changing reimbursement systems provide a greater sense of urgency to reduce unwanted ICU utilization. Under bundled payment or episode-based pay- ment systems, hospitals and physicians are reimbursed from the same pool of funds based on the health condition of the patient. 22 This type of reimbursement policy provides stronger financial incentives for both administrators and physicians to decrease ICU usage since both bear some fi- nancial risk for costly episodes. However, both the size of the budget and the sharing of financial risk between physicians and hospitals will depend on contract negotiations. Under value-based performance, reimbursement is linked to im- proving quality and reducing costs. Thus, even in the short term when most ICU costs are fixed, but prevention of un- wanted ICU stays is a quality measure, hospital administra- tors may be incentivized to integrate ACP and palliative care interventions to decrease ICU LOS, prevent unwanted ICU stays, and match care with patient wishes. In fact, ICU LOS has been proposed as a quality measure by the Joint Com- mission, strengthening the incentive for adoption within quality-based payment systems. 23 Capitated payment sys- tems and fixed global budgets, as recently passed in Mary- land, provide a fixed budget per patient regardless of care required, providing even more financial incentives for hos- pitals to reduce overall costs with hospitals bearing more of the financial burden for costly patients.
Direct labor wages can vary from location to location by 10 to 15 percent, and sometimes as much as 50 percent. Once wages are considered, labor productivity drives the cost of installation. High productivity results in lower installation cost, while low productivity increases installation cost. However, it is not uncommon for productivity to be very low when direct labor rates are very low, resulting in a relatively high in-place cost per unit despite low wages. Taxes and insurance affect labor costs. Certain trades, such as demoli- tion, carry very high insurance premiums because of the risks associated with the work and the relative safety record of the contractor. Conditions of the work, particularly with renovation, affect productivity relative to access and egress, lay-down/staging areas, and dust, dirt, and general job cleanup requirements, as well as the space available to conduct business. Scheduling and work hour requirements may restrict access to the work or may force multiple work activities to be scheduled at the same place or at the same time. How efficiently shared equipment and services are managed will also affect productivity.
4.1.2 Direct Job Costs
Each activity within the standard work breakdown structure (WBS) is sub-divided into sub-activities or tasks according to the processes needed to complete the work. These work activities are usually detailed in the project specification (and as per detailed scope definition). For example, concrete in a bridge deck is typically subdivided into formwork, reinforcement steel, concrete supply and placement, finishing and curing. To determine the direct cost of the activity, resources such as plant, labour and materials are then allocated to the scheduled quantity of work according to their capacity to meet the requirements of the project, resource availability, production rates and unit costs The sum of the activity direct costs gives the Direct Job Costs (DJC) of the project.
Secondly, the model shares those limitations inherent in SAPM; for example it does not account for heterogeneity in response to SBI, either within subgroups of the population of a country or between countries. If the effectiveness of SBIs were to vary according to the drinking patterns of the recipient this may bias the results presented here, although there is some evidence that SBIs work equally well across a range of countries and contexts (44). It is also important to note that the uncertainty estimates presented here are likely to be under-estimates of the true level of uncertainty associated with the cost-effectiveness results, as they can only incorporate the statistical uncertainty within the meta-model regression and are unable to take account of either parameter uncertainty or structural uncertainty. An additional consideration is our use of a single cost-effectiveness threshold applied to all countries. The true value of any intervention depends on the absolute scale of the problem it seeks to address as well as the benefit associated with the available alternative investment options, both of which will vary between countries. Policy makers are therefore advised to consider these factors alongside the disaggregated costs and benefits and the overall cost-effectiveness figure.
Unit IV - Module 12 14
• Cost Drivers are used to create a CostEstimating Relationship (CER) between the drivers and the cost
– Although it is generally agreed that these are the main cost drivers of software, the CERs based on the drivers differ – The COCOMO II CER is commonly used
J.1. General items
Contractors incur an array of general costs to engage labour, facilities, and machinery in efforts to fulfil contractual requirements. Such costs include insurance, security, and the provision of accommodations and services for contracting and engineering staff. General costs also include temporary works, such as detours; testing of works, contractor supervision, and the installation and removal of all items necessary to maintain reasonable traffic flow and safety throughout the construction project. Items such as temporary pavement, signs, signals, barriers, striping, traffic control, and traffic management planning are part of general costs. If projects for freeways, interchanges, or major arteries require significant detours or construction staging, an estimate may need to include additional costs for these general items. If any of the items and activities listed above are included in global and unit rates or used in calculations of other construction elements, estimators should make suitable adjustments to the guidelines in this appendix.
The ABC-types may be based on templates in MS Excel or Access as also used in dedicated environments. In general the ABC-type programs are very flexible in the type of manufacturing operations and complexity of products they can provide PCE for. The software operator can add machine types and assign investment levels as well as figures for the consumption of energy, consumables, required space and maintenance. The software automatically derives a tariff for use of the particular equipment per unit of time. The operator configures a calculation by selecting the type and amount of material used, the equipment to be used and then provides all the process parameters (such as cycle time, batch-volumes, set-up time, amount of operators, scrap level etc.) as input as well as levels of overhead associated with a particular type of manufacturer. This enables the costs to be modelled of virtually any (manufacturing) process and is as accurate as the input provided. In general, the ABC approach is known to be time-consuming and requires a significant level of expertise to use.
• unit costs, such as cost per email sent. Current costs should be readily available. Estimate future costs from marketing automation pricing.
• set-up costs, such as labor to create a Web form or place external media. These can usually be calculated on a per unit basis, although the actual unit will be different for each program type. You’ll need to assess the current cost and estimate the cost with the new system.
• reduced waste, such as mailing to fewer duplicate names or printing fewer unused pieces of marketing collateral.
Adam D. M. Briggs 1* , Linda J. Cobiac 1 , Jane Wolstenholme 2 and Peter Scarborough 1
Background: Non-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors. In the context of increasingly constrained financial resources, decision makers in England need to be able to compare the potential costs and health outcomes of different public health policies aimed at improving these risk factors in order to know where to invest so that they can maximise population health. This paper describes PRIMEtime CE, a multistate life table cost-effectiveness model that can directly compare interventions affecting multiple disease outcomes.
Longitudinal data sources offer new opportunities for the evaluation of sequential interventions. To adjust for time- dependent confounding in these settings, longitudinal targeted maximum likelihood based estimation (TMLE), a dou- bly robust method that can be coupled with machine learning, has been proposed. This paper provides a tutorial in applying longitudinal TMLE, in contrast to inverse probability of treatment weighting and g-computation based on iter- ative conditional expectations. We apply these methods to estimate the causal effect of nutritional interventions on clinical outcomes among critically ill children in a United Kingdom study (Control of Hyperglycemia in Paediatric Inten- sive Care, 2008 –2011). We estimate the probability of a child’s being discharged alive from the pediatric intensive care unit by a given day, under a range of static and dynamic feeding regimes. We ﬁnd that before adjustment, pa- tients who follow the static regime “never feed” are discharged by the end of the ﬁfth day with a probability of 0.88 (95% con ﬁdence interval: 0.87, 0.90), while for the patients who follow the regime “feed from day 3,” the probability of discharge is 0.64 (95% con ﬁdence interval: 0.62, 0.66). After adjustment for time-dependent confounding, most of this difference disappears, and the statistical methods produce similar results. TMLE offers a ﬂexible estimation approach; hence, we provide practical guidance on implementation to encourage its wider use.
For Peer Review
Longitudinal data sources offer new opportunities for the evaluation of sequential interventions. To adjust for time-dependent confounding in these settings, longitudinal targeted maximum likelihood based estimation (TMLE), a double-robust method that can be coupled with machine learning, has been proposed. This paper provides a tutorial in applying longitudinal TMLE, in contrast to inverse probability of treatment weighting and g-computation based on iterative conditional expectations. We apply these methods to estimate the causal effect of nutritional interventions on clinical outcomes of critically ill children. We estimate the risk of being discharged alive from the pediatric intensive care unit by a given day, under a range of static and dynamic regimes. We find that before adjustment, patients who follow the static regime ’never feed’, are discharged by the end of the 5th day with a probability of 0.88 (95 % CI: 0.87 - 0.90), while for the patients who follow the regime ’feed from day 3’, the probability of discharge is 0.64 (95% CI: 0.62 0.66). After adjusting for time-dependent confounding, most of this difference disappears, and the statistical methods provide similar results. TMLE offers a flexible estimation approach, hence we provide a practical guidance in implementation to encourage its wider uptake.
AAC can aid communication, relieve frustration and help to reduce anxiety in social situations.
SLTs can advise on AAC usage as a component of the interventions offered.
Individuals who use English as their second language and have a mental health problem, along with their families may need help to access services. An interpreter may be required to assist with conducting the SLT assessment to ensure it is both accurate and reliable and to facilitate understanding of therapy and implementation of treatment strategies. There are time and cost implications when working with interpreters/co-workers for example, in taking a case history, completing a full assessment in all languages spoken by the individual and their family. SLTs working with people with mental health problems need to be aware of cultural and religious factors which may impact on ability to access services, e.g. timings of services need to be culturally sensitive, for example, not offering appointment times which coincide with religious observations (Communicating Quality 3 2006).
DOCUMENTING/APPROVING SCOPE OF WORK AND COST ESTIMATES
• Develop a statewide Estimates Tracking System that extracts data from existing Department systems. This system will be used to document scope of work and cost estimate changes from project inception to contract award.