Telecar 시스템의 경제성 평가에 관한 연구

이은표,이경희 한국보건정보교육학회 1999 보건정보교육학회지 Vol.1 No.1

AbstactThis study is aimed to provide the sources of rational decision making for installing(introducing) Telecar system through the cost effectiveness analysis which the direct effect of introducing Telecar system was analyzed by conversed currency value and the indirect effect was analysed by economics each effect point between users and non users this system.This study was analyzed by conversed up to data value of reduce effect on labor cost which is the direct effect of investment and maintenance cost accomplish by introducing Telecar system and the indirect effect was by comparison analysis of the better quality of medical service effects of which the details are the promptness of chart control, error rate and the extent of communication with the treating medical care, and also by comparing the number of persons in charge of chart control, departing rate, and the extent of satisfaction.According to the result of this study, the not effect of direct effect for the direct cost within limitation period was about 351 million Won and the cost rate for direct effect showed 0.65%But in the aspect of direct effect, there was no economical merit, nevertheless the indirect effect which was not measured by cost showed that the rapidity of the users of this system was 8.3min/6.7min faster in admission/outpatient, and the error case rate 0.63%/0.28% reduced in admission/outpatient. On the contrary, it showed lower extent of communication with medical care team in the user of this system according to the result of the survey using point extent.The users showed 0.1 person decrease in average numbers of employees per average lOOtimes of chart control. And the average satisfaction rate was higher than non-user group even though there was no meaningful difference in the satisfaction rate for the employee in charge of chart control in the user group.The rate of changing occupation of the user group was 4.9% higher than non-user group. Regarding the improvement of efficiency in the chart control part the user group task the recruitment the best way, and the other group took change of the chart control instrument.Although we can see the lack of the total analysis of the cost effectiveness according to use of data Telecar in this study, it could be a help in a development of the work in the medical record room by the cost-effectiveness analysis of the instrument and equipment widely used medical record room. This study is aimed to provide the sources of rational decision making for installing(introducing) Telecar system through the cost effectiveness analysis which the direct effect of introducing Telecar system was analyzed by conversed currency value and the indirect effect was analysed by economics each effect point between users and non users this system. This study was analyzed by conversed up to data value of reduce effect on labor cost which is the direct effect of investment and maintenance cost accomplish by introducing Telecar system and the indirect effect was by comparison analysis of the better quality of medical service effects of which the details are the promptness of chart control, error rate and the extent of communication with the treating medical care, and also by comparing the number of persons in charge of chart control, departing rate, and the extent of satisfaction. According to the result of this study, the not effect of direct effect for the direct cost within limitation period was about 351 million Won and the cost rate for direct effect showed 0.65% But in the aspect of direct effect, there was no economical merit, nevertheless the indirect effect which was not measured by cost showed that the rapidity of the users of this system was 8.3min/6.7min faster in admission/outpatient, and the error case rate 0.63%/0.28% reduced in admission/outpatient. On the contrary, it showed lower extent of communication with medical care team in the user of this system according to the result of the survey using point extent. The users showed 0.1 person decrease in average numbers of employees per average 1001imes of chart control. And the average satisfaction rate was higher than non-user group even though there was no meaningful difference in the satisfaction rate for the employee in charge of chart control in the user group. The rate of changing occupation of the user group was 4.9% higher than non-user group. Regarding the improvement of efficiency in the chart control part the user group task the recruitment the best way, and the other group took change of the chart control instrument. Although we can see the lack of the total analysis of the cost effectiveness according to use of data Telecar in this study, it could be a help in a development of the work in the medical record room by the cost-effectiveness analysis of the instrument and equipment widely used medical record room.

자아조절자원 및 해석수준이 공짜대안 선택에 미치는 영향

이진용,임승아 한국마케팅학회 2012 ASIA MARKETING JOURNAL Vol.13 No.4

Most people prefer to choose zero-cost products they may get without paying any money. The ‘zero-cost effect’ can be explained with a ‘zero-cost model’ where consumers attach special values to zero-cost products in a different way from general economic models (Shampanier, Mazar and Ariely 2007). If 2 different products at the regular prices of ￦200 and ￦400 simultaneously offer ￦200 discounts, the prices will be changed to ￦0 and ￦200, respectively. In spite of the same price gap of the two products after the ￦200 discounts, people are much more likely to select the free alternative than the same product at the price of ￦200. Although prior studies have focused on the ‘zero-cost effect’ in isolation of other factors, this study investigates the moderating effects of a self- regulatory resource and a construal level on the selection of free products. Self-regulatory resources induce people to control or regulate their behavior. However, since self- regulatory resources are limited, they are to be easily depleted when exerted (Muraven, Tice, and Baumeister 1998). Without the resources, consumers tend to become less sensitive to price changes and to spend money more extravagantly (Vohs and Faber 2007). Under this condition, they are also likely to invest less effort on their information processing and to make more intuitive decisions (Pocheptsova, Amir, Dhar, and Baumeister 2009). Therefore, context effects such as price changes and zero cost effects are less likely in the circumstances of resource depletion. In addition, construal levels have profound effects on the ways of information processing (Trope and Liberman 2003, 2010). In a high construal level, people tend to attune their minds to core features and desirability aspects, whereas, in a low construal level, they are more likely to process information based on secondary features and feasibility aspects (Khan, Zhu, and Kalra 2010). A perceived value of a product is more related to desirability whereas a zero cost or a price level is more associated with feasibility. Thus, context effects or reliance on feasibility (for instance, the zero cost effect) will be diminished in a high level construal while those effects may remain in a low level construal. When people make decisions, these 2 factors can influence the magnitude of the ‘zero-cost effect’. This study ran two experiments to investigate the effects of self-regulatory resources and construal levels on the selection of a free product. Kisses and Ferrero-Rocher, which were adopted in the prior study (Shampanier et al. 2007) were also used as alternatives in Experiments 1 and 2. We designed Experiment 1 in order to test whether self-regulatory resource depletion will moderate the zero-cost effect. The level of self-regulatory resources was manipulated with two different tasks, a Sudoku task in the depletion condition and a task of drawing diagrams in the non-depletion condition. Upon completion of the manipulation task, subjects were randomly assigned to one of a decision set with a zero-cost option (i.e., Kisses ￦0, and Ferrero-Rocher ￦200) or a set without a zero-cost option (i.e., Kisses ￦200, and Ferrero-Rocher ￦400). A pair of alternatives in the two decision sets have the same price gap of ￦200 between a low-priced Kisses and a high-priced Ferrero-Rocher. Subjects in the no-depletion condition selected Kisses more often (71.88%) over Ferrero-Rocher when Kisses was free than when it was priced at ￦200 (34.88%). However, the zero-cost effect disappeared when people do not have self-regulatory resources. Experiment 2 was conducted to investigate whether constual levels influence the magnitude of the ‘zero-cost effect’. To manipulate construal levels, 4 different ‘why (in the high construal level condition)’ or ‘how (in the low construal level condition)’ questions about health management were asked. They were presented with 4 boxes connected with downward arrow... 사람들이 돈을 지불하지 않고 무료로 얻을 수 있는 공짜제품을 과다하게 선호하는 현상을 ‘공짜효과’라 한다. 기존 연구들에 의하면 공짜제품에 주어지는 특별한 가치 때문에 이와 같은 효과가 발생한다. 본 연구는 공짜효과가 항상 나타나는 것이 아니라 심리적 변수에 의하여 조절될 수 있다는 것을 보이기 위하여 자아조절자원과 해석수준의 조절효과를 살펴보았다. 자아조절자원이 고갈되면 통제의 힘이 약해져서 가격에 대한 민감도가 감소할 뿐만 아니라 직관적이고 노력을 별로 기울이지 않는 정보처리과정을 통해 의사결정을 수행한다. 또한, 주어진 정보를 어떤 해석수준에서 처리하는가에 따라 선택이 달라진다. 고차원 해석수준에서 중심기능을 바탕으로 대안의 바람직성에 따라서 선택하는 반면, 저차원 해석수준에서 부가기능을 바탕으로 대안의 실행가능성에 초점을 두어 선택한다. 이와 같은 특성이 공짜효과의 크기에 미치는 영향을 살펴보는 것이 본 연구의 가장 중요한 목적이다. 자아조절자원과 해석수준에 의해서 공짜효과의 크기가 조절될 수 있다는 사실을 검증하기 위해 2개의 실험설계를 채용하였다. 두 실험 모두에서 기존연구에서 사용한 실험재(키세스와 페레로로쉐 초콜릿)를 이용했다. 실험 1은 자아조절자원 고갈 여부가 공짜효과에 미치는 영향을 검증했다. 자아조절자원 고갈과 비고갈 집단으로 나누어 공짜대안이 있는 선택과업과 그렇지 않은 과업에 할당했다. 자아조절자원이 고갈되지 않은 집단에서 공짜효과가 확실하지만, 자아조절자원이 고갈된 집단에서 공짜효과가 약해진다는 것을 밝혔다. 실험 2는 해석수준이 공짜효과에 미치는 영향을 검증했다. 실험 2는 ‘왜(why)’와 ‘어떻게(how)’를 이용해 해석수준을 조작했으며, 실험 1과 유사하게 공짜대안이 존재하는 의사결정과업과 존재하지 않는 과업에 할당한 뒤 공짜대안 선택에 미치는 영향을 확인하였다. 고차원 해석수준의 집단은 저차원 해석수준의 집단에 비하여 공짜제품 선택비율이 낮았다.

Big 4 감사인의 감사품질이 부채조달비용에 미치는 효과 : 유가증권상장과 코스닥상장기업에 대한 실증적 증거

박종일,남혜정 韓國公認會計士會 2013 회계·세무와 감사 연구 Vol.55 No.2

본 연구는 상장기업을 대상으로 Big 4 감사인의 선임이 부채조달비용에 미치는 영향을 분석하였다. 특히 본 연구는 유가증권상장기업(KOSPI)과 코스닥상장기업(KOSDAQ)을 비교하여 살펴보았다. 더 나아가 본 연구에서는 국내 상장기업에서 Big 4 감사인의 선임과 부채조달비용 간에 유의한 음(-)의 관계가 관찰된다면 이와 같은 관계가 채권자들에게 Big 4 감사인의 선임이 보증효과(insurance effect)에 따른 결과인지, 또는 정보효과(information effect)에 따른 결과인지, 아니면 두 가지 모두에 따른 총효과(=보증효과+정보효과)에 기인된 것인지를 Mansi et al.(2004)의 방법에 따라 살펴보았다. 이를 위하여, Big 4 감사인 여부는 선행연구의 방법에 따라 Big 4 회계법인과의 제휴여부로 측정하였고, 부채조달비용은 부채차입이자율 스프레드로 측정하였다. 분석기간은 2001년부터 2011년까지 금융업을 제외한 12월 결산법인으로 분석에 이용가능 했던 최종표본 10,479개 기업/연 자료를, 또한 KOSPI 표본은 5,036개 기업/연 자료이고, KOSDAQ 표본은 5,443개 기업/연 자료가 이용되었다. 본 연구의 실증결과에 따르면. 첫째, 전체 상장기업을 대상으로 한 경우 부채조달비용에 영향을 미치는 일정변수뿐만 아니라, 신용등급(또는 직교된 신용등급)까지 통제한 후에도 Big 4 감사인을 선임한 상장기업이 그렇지 않은 기업보다 1% 수준에서 유의하게 부채조달비용이 더 낮은 것으로 나타났다. 또한 Mansi et al.(2004)의 방법에 따라 Big 4 감사인의 선임 효과를 보증효과와 정보효과로 나누어 살펴본 결과, Big 4 감사인의 선임은 채권자에게 주로 보증효과에 기초해 부채조달비용이 낮은 것으로 나타났다. 이는 채권자들에게는 Big 4 감사인이 딥 포켓(deep pocket)이라는 것에 기초한 결과로 보인다. 둘째, 전체 상장기업을 다시 KOPSI와 KOSDAQ 표본으로 나누어 각각 분석한 결과에 따르면, KOSPI 표본에서는 Big 4 감사인의 선임과 부채조달비용 간에 유의한 음(-)의 관계가 관찰되지 않았다. 이와 달리 KOSDAQ 표본에서는 Big 4 감사인의 선임과 부채조달비용 간에 1% 수준에서 유의한 음(-)의 관계로 나타났다. 즉 앞서 전체 상장기업의 경우 Big 4 감사인과 부채조달비용 간에 유의한 음(-)의 관계와 Big 4 감사인의 선임이 보증효과를 제공한다는 결과는 주로 KOSPI 표본보다는 KOSDAQ 표본에 기인한 결과로 나타났다. 이상의 결과를 종합하면, 본 연구결과는 국내 채권시장의 채권자들은 KOSPI와 KOSDAQ 기업들에서 Big 4 감사인의 선임에 따른 인지된 감사품질 정보에 대해 차별적으로 반응하고 있다는 것을 실증적으로 보여주었다는데 의의가 있다. 또한 KOSDAQ에 속한 상장기업들이 부채차입을 통해 자금을 조달시 Big 4 감사인을 선임하면 채권자들에게 긍정적인 반응으로 나타나는 것은 주로 Big 4 감사인의 보증효과에 대한 인지(perception)에 기초한 것이라는 결과를 보여주었다. 이러한 결과는 KOSPI 보다 기업지배구조가 상대적으로 열악하고, 재무정보의 신뢰성이 낮은 KOSDAQ에 속한 상장기업에서 감사품질이 높은 외부감사인의 선임은 보다 중요한 외부지배구조의 역할을 수행할 것으로 채권자들이 평가한 결과일 수 있다. 따라서 본 연구결과는 학계의 관련연구에 추가적인 공헌을 할 뿐만 아니라, 감사품질에 관심이 있는 실무계 및 정책당국에게도 유익한 시사점을 제공해 줄 것으로 기대된다. This paper examines the effect of audit quality on cost of debt in listed firms. Specifically, this study investigates differences between KOSPI and KOSDAQ listed firms on associations between audit quality and cost of debt. Furthermore, this study tries to identify driving factors of audit quality using Mansi et al. (2004)’s methodology in determining whether the effect comes from insurance effect or information effect, or both. This approach may be differentiated our study from previous study, which only focus on audit quality. The effectiveness of the auditor that reduces information asymmetries is one of the function of audit quality. Prior research suggests that Big 4 auditors in the U.S. provide high quality audits to improve the firm’s brand reputation and to avoid costly litigation. Khurana and Raman (2004) shows that clients of Big 4 auditors have significantly lower ex ante cost of equity capital compared to clients of non-Big 4 auditors in the US but not in other Anglo-American countries. They argue that the perception of Big 4 performing higher quality audits than non-Big 4 is a function of the litigation environment. Their conclusion is that the threat of litigation is a stronger driver than reputation behind perceived audit quality, proxied by cost of capital. This conclusion implies that debt-holders primarily perceive audit quality in terms of the Big 4 auditor’s “deep pockets”. Also, Pitman and Fortin (2004) show that clients of Big 4 auditors have a lower cost of interest immediately after an IPO compared to clients of non-Big 4 auditors. In sum, it is general that big 4 auditors have the financial resources to better fulfill their monitoring, information and insurance roles than non-Big 4 auditors. In the context of this study this better fulfillment of these roles is expected to be reflected in a reduced cost of debt. In other words, to the extent that debt-holders perceive the Big 4 audit as providing a higher quality audits and more credible financial statement, firms audited by the Big 4 (relative to those audited by non-Big 4 auditors) are expected, ceteris paribus, to have a lower cost of debt. Specifically, we investigate whether Big 4 auditors are perceived as providing higher quality audits relative to non-Big 4 auditors in the debt market in Korea. To do this, we use 10,479 observations from 2001 to 2011 for 5,036 firm-year observations in KOSPI and for 5,443 firm-year observations in KOSDAQ. As a main variable, we measure Big4 audit firm dummy variable as proxy for audit quality. And we use the yield spread of interest rates as proxy for cost of debt. According to our analyses, we find that the first, firms audited by the Big 4 audit firm are more likely to associated with low cost of debt after controlling for control variables and corporate credit ratings. And we identify that when audit quality is divided into insurance and information effect using Mansi et al. (2004)’s methodology, this result comes from insurance effect rather than information effect. This implies that debt-holders consider Big 4 audit firm as deep pocket. The second, when we divide samples into KOSPI and KOSDAQ, the negative relationship between audit quality and cost of debt is not significant for KOSPI while the relationship is significant for KOSDAQ. This result demonstrates that the negative relationship between audit quality and cost of debt mainly comes from KOSDAQ listed firms. The finding implies that hiring Big 4 auditors in KOSDAQ listed firms is perceived as sound governance mechanism to debt-holders and improves credibility of financial reporting. The findings of this study provide important contributions in several ways. The first, unfortunately, the research about relationship between audit quality and cost of debt is rare in Korea. We believe that this work provides additional evidences about the effect of audit quality on cost of debt in Korea. The second, our study suggests that perception to insurance of Big 4 audit firms drives a negative relationship between audit quality and cost of debt in KOSDAQ. The findings of this study also suggest that Big 4 auditors provide high-quality audits, which improves financial reporting quality for KOSDAQ listed firms with poor governance compared to KOSPI listed firms. The third, this paper provides the evidence about driving factors of audit quality using Mansi et al. (2004) and find that a negative relationship between audit quality and cost of debt is mainly caused by insurance effect rather than information effect. This result is not consistent with Mansi et al. (2004)’s findings that audit quality comes from both insurance and information effect. This inconsistency provides implications to related study in Korea. Finally, the results present the empirical evidence to support that Big 4 auditor has an important role in alleviating information asymmetry between companies and external interested parties. This study suggests that debt-holders in Korea tend to differently react to Big 4 audit firm and perceived audit quality. In sum, the results of this paper indicate that a differential audit demand still exists in listed firms, and a audit quality significantly influences a level of cost of debt for KOSDAQ listed firms. Based on these results, we can better understand about the decision on auditor selection of listed firms in Korea. The findings in this study have various implications. This result implies that debt-holders in debt market perceive the firm audited from Big 4 auditor more favorable. Specifically, we show that the effect of audit quality attributes on cost of debt of client firms is limited to KOSDAQ listed firms. This suggests that the debt market in Korea perceives audit quality to be more important for smaller listed firms than for bigger ones. Therefore, these findings are very useful and provide a lot of important implications to academic as well as practitioner, investors, creditors, and regul

Strategic Distributional Cost-Effectiveness Analysis for Improving National Cancer Screening Uptake in Cervical Cancer: A Focus on Regional Inequality in South Korea

이태훈,김우림,신재용,박은철,박소희,김태현 대한암학회 2018 Cancer Research and Treatment Vol.50 No.1

Purpose The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities. Materials and Methods Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio. Results All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the ‘strong screening recommendation to target regions’ strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis. Conclusion The ‘strong screening recommendation to target regions’ strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.

의사결정 상황에서 매몰원가효과에 관한 실험연구

정명환(Myunghwan Chung) 대한경영학회 2015 大韓經營學會誌 Vol.28 No.10

규범적 경제이론에 기반한 합리적 의사결정에서 매몰원가는 비관련원가로 의사결정에 영향을 미치지 않는다. 따라서 경제적 의사결정 문제를 다루는 관리회계에서는 의사결정 상황에서 매몰원가를 고려하지 않도록 주의하여야 하는 비관련원가로 가르친다. 그럼에도 불구하고 많은 의사결정자들은 실제 의사결정에서 매몰원가를 고려하여 다른 판단을 한다는 것이 미국을 중심으로 한 외국의 여러 연구들에서 밝혀진 바 있다. 이 연구는 서구와 사회경제적 문화적 배경이 다른 우리나라에서도 마찬가지의 매몰원가효과가 나타나는지를 확인하고, 선행연구를 확장하여 매몰원가 금액과 매몰원가에 대한 교육의 영향을 검증하고자 한 실험연구이다. 구체적 연구문제는 다음과 같은 가설로 설정되었다. 가설 1 의사결정자는 의사결정 상황에서 매몰원가를 고려한다. 가설 2 의사결정자는 의사결정 상황에서 매몰원가 금액이 클수록 매몰원가를 더 강하게 고려한다. 가설 3 매몰원가에 대한 교육은 의사결정 상황에서 매몰원가효과를 감소시킨다. 실험참가자(participants)는 적절한 교육과정을 통해 경영 의사결정의 기본소양은 갖춘 것으로 볼 수 있고, 매몰원가와 관련한 교육(instruction)의 실험처치가 용이한 2015년 4월 현재 K대학교 회계학과 3학년 관리회계 수강자를 대상으로 하여 각 분반을 두 집단 총 76명으로 선정하였다. 실험은 시나리오 설문지를 이용하여 두 집단에 대하여 세 차례에 걸쳐 이루어졌다. 연구목적의 가설을 검증하는 실험을 위하여 3개의 시나리오를 구성하였다. 〈시나리오 1〉과 〈시나리오 2〉는 Arkes and Blumer(1985)의 스키여행 문제를 변형하여 실험참가자들이 익숙하고 쉽게 선택할 수 있는 콘서트선택 문제를 활용하였다. 〈시나리오 3〉은 Arkes and Blumer(1985)의 항공기개발제작 문제를 변형하여 조금은 복잡한 투자의사결정 문제로 구성하였다. 실험연구 결과, 가설 1은 부분적으로 지지되었고 가설 2는 지지되었으나 가설 3은 기각되었다. 즉 매몰원가효과가 언제나 나타나는 것은 아니었고, 비교적 작은 금액의 매몰원가는 무시되었으나 매몰원가 금액이 커지면서 그 효과는 더욱 강하게 나타났다. 그러고 매몰원가에 대한 교육이 매몰원가효과를 감소시키지는 못하였다. 이 연구결과는 의사결정 상황에서 매몰원가효과를 감소시키기 위한 방안을 모색하게 하는 기초자료가 될 것이며, 학문적으로는 우리나라에서 행동회계학의 연구지평을 넓히는 자료를 제공하게 될 것이다. 한편, 이 연구는 매우 제약된 상황을 조작한 실험설계를 이용한 연구이므로 이 연구결과를 일반화하는 데는 매우 제한된다는 본질적 한계를 가진다. 따라서 다양한 설계를 이용한 지속적 연구로 이 연구결과를 확장하고 일반화하는 것이 향후의 연구과제로 남는다. In an uncertain decision making sunk costs are irrelevant costs. So it is instructed in management accounting that sunk costs should be neglected in decision making. Nevertheless in real decision making they are used as if relevant costs. That is called as sunk cost effect. Even the reason of the effect is explained by various theories, the prospect theory of Kahneman and Tversky (1979) gives the most powerful explaining. That is, the sunk cost effect is explained by the value function of the prospect theory. According to the value function, under the situation in which there is some sunk cost that is initial expenditure or investment, since the reduction of the value of additional loss is relatively small but the increase of the value of additional gain is relatively big, additional expenditure or investment is executed. Several experimental studies were conducted on sunk cost effect. Especially Arkes and Blumer (1985) conducted earlier experiment to test the sunk cost effect. They conducted 10 experiments using various scenarios and found the existence of the sunk cost effect. The purpose of this study is that following hypotheses are tested in Korea. Hypotheses are as followings: (1) Sunk cost effect exits in decision making. (2) Sunk cost effect is revealed stronger as the amount of sunk costs gets bigger. (3) The instruction on sunk cost may reduce sunk cost effect. The participants are composed of 76 undergraduate students who are major in accounting. They are assumed to have the ability to make relatively rational decisions. The participants are grouped into two groups, those are control and experimental group. The experiments are conducted three times with scenarios which are a little adjusted from those of Arkes and Blumer (1985). Hypothesis (1) is tested by all the experiments, hypothesis (2) is by the second experiment, and hypothesis (3) is by the third experiment. Scenario (1) used by the first experiment contains the concert ticket choice problem. If he neglects sunk cost, that is the ticket price which he paid, he should choose singer B concert, but he considers sunk cost he may choose singer A concert. Scenario (2) used by the second experiment contains the same problem with scenario (1), but it contains one more context that if the ticket price changes which concert he may choose. This scenario tests the amount sensitivity of sunk cost effect. Scenario (3) used by the third experiment contains continuous investment problem of car development project. The results of the experimental study are followings: Hypothesis (1) is partly supported, hypothesis (2) is supported but hypothesis (3) is not supported. That is, sunk cost effect is not always revealed, but the effect is revealed strongly as the amount of the costs gets bigger. But the instruction on sunk cost could not reduce the effect. This study was done with experimental method. So the generalization of the result is a little limited. Future research with various scenarios and contexts are suggested.

Cost-Utility Analysis of Non-Contrast Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance in Cirrhosis

Decharatanachart Pakanat,Pan-ngum Wirichada,Peeraphatdit Thoetchai,Tanpowpong Natthaporn,Tangkijvanich Pisit,Treeprasertsuk Sombat,Treeprasertsuk Sombat,Chaiteerakij Roongruedee 거트앤리버 소화기연관학회협의회 2024 Gut and Liver Vol.18 No.1

Background/Aims: Ultrasonography has a low sensitivity for detecting early-stage hepatocellular carcinoma (HCC) in cirrhotic patients. Non-contrast abbreviated magnetic resonance imaging (aMRI) demonstrated a comparable performance to that of magnetic resonance imaging without the risk of contrast media exposure and at a lower cost than that of full diagnostic MRI. We aimed to investigate the cost-effectiveness of non-contrast aMRI for HCC surveillance in cirrhotic patients, using ultrasonography with alpha-fetoprotein (AFP) as a reference. Methods: Cost-utility analysis was performed using a Markov model in Thailand and the United States. Incremental cost-effectiveness ratios were calculated using the total costs and quality-adjusted life years (QALYs) gained in each strategy. Surveillance protocols were considered cost-effective based on a willingness-to-pay value of $4,665 (160,000 Thai Baht) in Thailand and $50,000 in the United States. Results: aMRI was cost-effective in both countries with incremental cost-effectiveness ratios of $3,667/QALY in Thailand and $37,062/QALY in the United States. Patient-level microsimulations showed consistent findings that aMRI was cost-effective in both countries. By probabilistic sensitivity analysis, aMRI was found to be more cost-effective than combined ultrasonography and AFP with a probability of 0.77 in Thailand and 0.98 in the United States. By sensitivity analyses, annual HCC incidence was revealed as the most influential factor affecting cost-effectiveness. The cost-effectiveness of aMRI increased in settings with a higher HCC incidence. At a higher HCC incidence, aMRI would remain cost-effective at a higher aMRI-to-ultrasonography with AFP cost ratio. Conclusions: Compared to ultrasonography with AFP, non-contrast aMRI is a cost-effective strategy for HCC surveillance and may be useful for such surveillance in cirrhotic patients, especially in those with high HCC risks.

Cost-Effectiveness Analysis of Different Management Strategies for Detection CIN2+ of Women with Atypical Squamous Cells of Undetermined Significance (ASC-US) Pap Smear in Thailand

Tantitamit, Tanitra,Termrungruanglert, Wichai,Oranratanaphan, Shina,Niruthisard, Somchai,Tanbirojn, Patuou,Havanond, Piyalamporn Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.16

Background: To identify the optimal cost effective strategy for the management of women having ASC-US who attended at King Chulalongkorn Memorial Hospital (KMCH). Design: An Economical Analysis based on a retrospective study. Subject: The women who were referred to the gynecological department due to screening result of ASC-US at King Chulalongkorn Memorial Hospital, a general and tertiary referral center in Bangkok Thailand, from Jan 2008 - Dec 2012. Materials and Methods: A decision tree-based was constructed to evaluate the cost effectiveness of three follow up strategies in the management of ASC-US results: repeat cytology, triage with HPV testing and immediate colposcopy. Each ASC-US woman made the decision of each strategy after receiving all details about this algorithm, advantages and disadvantages of each strategy from a doctor. The model compared the incremental costs per case of high-grade cervical intraepithelial neoplasia (CIN2+) detected as measured by incremental cost-effectiveness ratio (ICER). Results: From the provider's perspective, immediate colposcopy is the least costly strategy and also the most effective option among the three follow up strategies. Compared with HPV triage, repeat cytology triage is less costly than HPV triage, whereas the latter provides a more effective option at an incremental cost-effectiveness ratio (ICER) of 56,048 Baht per additional case of CIN 2+ detected. From the patient's perspective, the least costly and least effective is repeat cytology triage. Repeat colposcopy has an incremental cost-effectiveness (ICER) of 2,500 Baht per additional case of CIN2+ detected when compared to colposcopy. From the sensitivity analysis, immediate colposcopy triage is no longer cost effective when the cost exceeds 2,250 Baht or the cost of cytology is less than 50 Baht (1USD = 31.58 THB). Conclusions: In women with ASC-US cytology, colposcopy is more cost-effective than repeat cytology or triage with HPV testing for both provider and patient perspectives.

The analysis of cost-effectiveness of implant and conventional fixed dental prosthesis

June Sang Chun,Alix Har,Hyun-Pil Lim,Hoi-Jeong Lim 대한치과보철학회 2016 The Journal of Advanced Prosthodontics Vol.8 No.1

PURPOSE This study conducted an analysis of cost-effectiveness of the implant and conventional fixed dental prosthesis (CFDP) from a single treatment perspective. MATERIALS AND METHODS The Markov model for cost-effectiveness analysis of the implant and CFDP was carried out over maximum 50 years. The probabilistic sensitivity analysis was performed by the 10,000 Monte-Carlo simulations, and cost-effectiveness acceptability curves (CEAC) were also presented. The results from meta-analysis studies were used to determine the survival rates and complication rates of the implant and CFDP. Data regarding the cost of each treatment method were collected from University Dental Hospital and Statistics Korea for 2013. Using the results of the patient satisfaction survey study, quality-adjusted prosthesis year (QAPY) of the implant and CFDP strategy was evaluated with annual discount rate. RESULTS When only the direct cost was considered, implants were more cost-effective when the willingness to pay (WTP) was more than 10,000 won at 10th year after the treatment, and more cost-effective regardless of the WTP from 20th year after the prosthodontic treatment. When the indirect cost was added to the direct cost, implants were more cost-effective only when the WTP was more than 75,000 won at the 10th year after the prosthodontic treatment, more than 35,000 won at the 20th year after prosthodontic treatment. CONCLUSION The CFDP was more cost-effective unless the WTP was more than 75,000 won at the 10th year after prosthodontic treatment. But the cost-effectivenss tendency changed from CFDP to implant as time passed.

Cost-Effectiveness of Anti-Viral Treatment in Patients with Immune-Tolerant Phase Chronic Hepatitis B

( Hye-lin Kim ),( Gi-ae Kim ),( Jae-a Park ),( Hye-rim Kang ),( Eui- Kyung Lee ),( Young-suk Lim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Currently, antiviral therapy for chronic hepatitis B (CHB) patients in immune tolerant (IT) phase is generally not recommended. There has been a need for studies assessing benefits of antiviral therapy in IT-phase. A recent study showed that untreated IT-phase patients had higher risk of hepatocellular carcinoma (HCC) than treated immune active (IA) phase patients. We aimed to evaluate the cost-effectiveness of starting antiviral treatment from IT-phase (IT-Tx) compared to delaying the treatment to IA-phase (IA-Tx). Methods: We designed a Markov model to compare expected costs and quality-adjusted life-years (QALYs) between IT-Tx group and IA-Tx group from healthcare system and societal perspectives. Transition probabilities and costs were obtained from a cohort of 4,965 HBeAg-positive, treatment-naive CHB patients at Asan Medical Center. Literature review was conducted for other parameters. Cost and effectiveness were discounted at a 5% annual rate, and incremental cost-effectiveness ratio (ICER) was calculated for 10-year horizon and evaluated with various HCC risks. Results: The cost-effectiveness analysis showed that IT-Tx group had ₩6,996,562 incremental costs and additional 0.294 QALY per patient compared to IA-Tx group with 10-year cumulative HCC risk of 10% (base-case). ICER was ₩23,819,529/QALY, which was borderline high of the cost-effectiveness threshold (₩20,000,000/QALY) in Korea. As HCC risk increased, IT-Tx became acceptable in cost-effectiveness. When the HCC risk increased over 11.8%, ICER went below the threshold. The analysis including the cost of lost productivity showed that IT-Tx was dominant with HCC risk greater than 4.6% (ICER<0). Conclusions: To start antiviral therapy for CHB patients in IT-phase was borderline high cost-effective from healthcare system perspective dealing with the only medical costs, however, it was a dominant strategy in view of societal perspective covering also the costs for lost productivity.

한국 비판막성 심방세동 환자의 뇌졸중 위험 감소에 대한 리바록사반의 경제성평가

이경아,박한라,Thomas Evers,Yumi Asukai 한국보건의료기술평가학회 2014 보건의료기술평가 Vol.2 No.2

Objectives: To evaluate the cost-effectiveness of new oral anticoagulant rivaroxaban compared to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation in the Korea healthcare setting. Methods: A cost-effectiveness analysis of rivaroxaban versus warfarin was performed in Korea from a restricted societal perspective. A Markov model was developed and adapted to the Korean healthcare setting to evaluate the clinical and economic consequences of rivaroxaban versus warfarin. Baseline event rates and efficacy data were obtained from the results of a large double-blind, randomized controlled clinical trial. The population evaluated was patients with non-valvular atrial fibrillation at a moderate to high risk of stroke. The model consists of health states covering the management and outcome of atrial fibrillation. Costs and utilities were assigned to each state to reflect the burden of therapy. Utility values for events were based on literature. Local cost data estimation was based on published price lists, healthcare statistics and local market research data. The cycle length was 3 months and the time horizon of analysis was over a patient life time (30 years). An incremental cost effectiveness ratio (ICER) was evaluated using cost and quality-adjusted life years gained (QALY). Both costs and outcomes were discounted at 5%. One-way sensitivity analyses were conducted on key variables to deal with uncertainty. Results: Rivaroxaban was cost-effective compared to warfarin with an ICER of KRW 12,550,023 (incremental QALYs of 0.26 and incremental costs of KRW 3,270,756). Sensitivity analysis with nursing cost indicated rivaroxaban was a dominant alternative. Also the one-way sensitivity analyses ranging from KRW 1,057,895/QALY to KRW/QALY 19,021,292 indicated that rivaroxaban was cost-effective. Conclusion: Prevention of stroke with rivaroxaban in the population of non-valvular atrial fibrillation patients at a moderate to high risk of stroke is cost-effective compared to warfarin in the Korean healthcare setting.