Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method: In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n=90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results: Total costs per participant at 12-month follow-up were e 12,886 in BPR and e 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to e190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
DOCUMENT
By use of a literature review and an environmental scan four plausible future scenarios will be created, based on the research question: How could the future of backpack tourism look like in 2030, and how could tourism businesses anticipate on the changing demand. The scenarios, which allow one to ‘think out of the box’, will eventually be translated into recommendations towards the tourism sector and therefore can create a future proof company strategy.
DOCUMENT
Climate change has been described as the greatest environmental challenge of our time, not only for mankind (UN, 2011), but also for tourism (OECD-UNEP, 2011). Severe impacts of climate change, generally linked to exceeding 2°C global temperature rise, can only be prevented to some extent by drastically reducing the use of fossil fuels and thereby greenhouse gas (GHG) emissions within the next few decades. In this respect, an 80-95 per cent reduction of CO2 emissions by 2050 compared to 1990/2000 levels is recognised as the minimum required effort (Allison et al., 2009; Rogelj et al., 2011). Even with a full implementation of these goals, an increase above 2°C is not unlikely (World Bank, 2012). The contribution of global tourism to anthropogenic CO2 emissions has been estimated at around 5 per cent for 2005, corresponding to 1,302 Mt CO2, 75 per cent of which were from transport and 40 per cent from aviation alone. Tourism’s CO2 emissions are estimated to increase 135 per cent (to 3,000 Mt CO2) by 2035, which includes the high efficiency gains forecasted for air transport (Peeters and Dubois, 2010; UNWTO-UNEP-WMO, 2008). The share of aviation will increase as air travel is expected to grow faster than overall tourism trips (ICAO, 2010; UNWTO, 2011). Emission scenarios for civil aviation vary from 1,034 to 3,105 Mt CO2 for 2050 (Lee et al., 2013). The further development of tourism CO2 emissions is in stark contrast to the aforementioned global emission reduction needs. In fact, when assuming this business-as-usual growth path, tourism would exceed the global economy’s reduced emission budget by midcentury on its own (Scott et al., 2010). Given these developments it is not surprising that some regard the (mainstream) tourism industry as becoming less sustainable (Bramwell and Lane, 2012; Buckley, 2012; Gössling et al., 2012). In acknowledgement of the limited short-term energy reduction potential of technological improvements in aviation and the absence of short-term structural changes in travel behaviour, carbon offsetting has been accepted as an intermediate, albeit less effective solution for mitigating tourism emissions. This research aims to register the motives for buying offsets, but more particularly the effect of offsetting, as well as not offsetting, on the travel behaviour of Dutch tourists.
LINK
