Smart meters measure consumption, whether electricity, natural gas or water. What can a smart meter do besides measure consumption?
Correspondence to Melanie Y Bertram email: Bulletin of the World Health Organization ; The main results of a cost—effectiveness analysis — in which the costs and outcomes of alternative policy options are compared — are cost—effectiveness ratios.
In the field of health, a cost—effectiveness ratio usually represents the amount of additional health gained for each additional unit of resources spent.
The makers of health policy initially used cost—effectiveness analyses for priority setting, in their attempts to ensure that the greatest possible health benefits were achieved given the available budget.
Many countries currently use cost—effectiveness analyses and the resultant cost—effectiveness ratios to guide their decisions on resource allocation and to compare the efficiencies of alternative health interventions.
A cost—effectiveness threshold is generally set so that the interventions that appear to be relatively good or very good value for money can be identified. There are several types of Implementation of reliable and cost effective smart home.
There are also supply-side thresholds that take resource allocation into account — e. In considering the choice of the type of cost—effectiveness threshold to use, the concept of opportunity cost may be the one most relevant to providers who are primarily concerned with using the available resources to improve health.
In considering the implementation of a new intervention, decision-makers need estimates of both the health that might be gained elsewhere through the alternative use of the resources needed for the new intervention and the health that is likely to be lost if the new intervention is not used.
Recent claims about the misapplication of cost—effectiveness thresholds 1 are well founded. The commission, in trying to encourage investment in health, has suggested that all countries should map out a path to universal access to essential health services, increase domestic financing for health and include economic considerations in their attempts to identify health priorities.
They can be compared to measures — e. They are simply an indication that, in a given setting, an intervention may represent poor, good or very good value for money.
Although this list was partly based on value for money — in terms of GDP-based cost—effectiveness thresholds — it was also based on affordability, feasibility and other criteria.
In a similar manner, in work carried out on behalf of WHO-CHOICE, GDP-based thresholds were used to categorize interventions as cost—effective or very cost—effective but the intention was only to guide policy-makers on value for money. Other related programmes for priority setting — e.
Where the primary goal of a health system is the optimization of population health, it can be important to use an approach such as that followed by WHO-CHOICE — and its generalized cost—effectiveness analysis — to decide which set of interventions, out of a larger group of feasible options, offer the best value for money.
The addition of single interventions one at a time, based on incremental analyses, may not result in the optimal use of resources.
However, given that many systems already have an existing package of interventions, in some settings there is clearly still a role for incremental analysis.
Misuse of thresholds Many factors influence the results of cost—effectiveness analyses — e. Variations in the inputs can have substantial effects on the estimate of a cost—effectiveness ratio.
If the analyses do not reflect the policy context accurately, overreliance on cost—effectiveness ratios and a fixed cost—effectiveness threshold, to guide decision-making, may result in the wrong decisions being made. At a technical level, it is important to note that cost—effectiveness ratios derived from economic modelling are simply estimates — generally based on several assumptions — produced to indicate the potential value for money of one or more interventions.
The construction of economic models is prone to problems and errors, 10 — 15 but such models can still be a valuable input for decision-making if well-constructed and validated.
However, even well-constructed models can produce a range of estimates depending on the assumptions adopted and the formulation of the policy question being evaluated.
Use of a rigid cost—effectiveness threshold to determine funding decisions may simply encourage the interested parties to tailor their estimates so that they trigger funding. Even if estimated accurately, generic GDP-based cost—effectiveness ratios — or other estimates of willingness to pay — do not provide information on affordability, budget impact or the feasibility of implementation.
Such an increase is probably unaffordable and more cost—effective interventions would probably be crowded out if sofosbuvir were to be offered on such a large scale.
In the detection of tuberculosis, the use of GeneXpert Cepheid, Sunnyvale, United States of America — a molecular test for the deoxyribonucleic acid of Mycobacterium tuberculosis — is considered to be a cost—effective intervention that has already been implemented in South Africa.
From evidence to decision-making The use of cost—effectiveness ratios in decision-making remains an area without consensus. Above all, the indiscriminate sole use of the most common threshold — of three times the per-capita GDP per DALY averted — in national funding decisions or for setting the price or reimbursement value of a new drug or other intervention must be avoided.
If a single fixed cost—effectiveness threshold is not to be used — at least, not alone — what are the alternatives? In the development of clinical guidelines, evidence-to-decision frameworks have been developed to guide decision-making. While cost—effectiveness ratios are undoubtedly informative in assessing value for money — from either the supply or demand side — they also need to be considered alongside affordability, budget impact, fairness, feasibility and any other criteria considered important in the local context.
The Norwegian Committee on Priority Setting has proposed the use of three criteria — i. To ensure better health outcomes and optimal value for money, decision-makers need to use all the relevant data and estimates wisely. Poland Infor its decisions on reimbursing the costs of new pharmaceuticals, Poland legislated a cost—effectiveness threshold of three times the per-capita gross GDP per QALY gained.
Although the impact of the threshold is not yet clear, the prices paid in Poland for certain products appear to be higher than the mean values for the European Union. Decisions on the benefit package are made by the National Health Assembly, using societal values, and cost—effectiveness thresholds are therefore not the only aspect taken into consideration.
Technologies that appear less cost—effective may still be recommended if they are for end-of-life care or for diseases associated with short life expectancies that would be extended by the technology. This relatively low value probably reflects the displacement of more cost—effective activities by new approvals.Enabling environments for climate-smart agriculture (CSA) are the framework conditions that facilitate and support the adoption of climate-smart technologies and practices.
They include policies, institutional arrangements, stakeholder involvement and gender considerations, infrastructure, insurance schemes, as well as access to weather information and advisory services.
The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the th United States Congress and signed into law by President Barack Obama on March 23, The term "Obamacare" was first used by opponents, then reappropriated by supporters, and eventually used by President Obama .
article published in December Cost–effectiveness thresholds: pros and cons Melanie Y Bertram a, Jeremy A Lauer a, Kees De Joncheere a, Tessa Edejer a, Raymond Hutubessy a, Marie-Paule Kieny a & Suzanne R Hill a. a. World Health Organization, avenue Appia 20, Geneva 27, Switzerland.
The successful implementation of centralized monitoring requires effective planning, process restructuring, cross-functional expertise alignment, and the right technology in place. EISA provided the legislative support for DOE’s smart grid activities and reinforced its role in leading and coordinating national grid modernization efforts.
EISA Section established at DOE the Smart Grid Advisory Committee and Federal Smart Grid Task Force. Since , SAI Systems Auditing has been the premier re-seller of Copitrak, a specialized program of cost recovery and expense management.
We help professional firms .