Absolute Cost Research Articles

Ferric derisomaltose versus usual care in patients with heart failure, reduced ejection fraction, and iron deficiency: a short-term UK cost-utility analysis based on the IRONMAN RCT

Abstract Background In the IRONMAN trial, patients with heart failure (HF), a reduced ejection fraction and iron deficiency who were randomly assigned to ferric derisomaltose (FDI), rather than usual care, had a lower rate of the composite of hospitalization for heart failure (HHF) and cardiovascular (CV) death (rate ratio, RR, 0.82; 95% CI 0.66 to 1.02; p=0.07). A COVID-19 sensitivity analysis, censoring data at 1 year of follow-up showed a greater magnitude of treatment effect (RR 0.66; 95% CI 0.48 to 0.91; p=0.011). Purpose Patient-level data from IRONMAN were used to evaluate the effectiveness and cost-utility of FDI compared to usual care for patients with a current or recent HHF, or raised plasma natriuretic peptide concentrations, from a UK National Health Service (NHS) perspective. Methods A cost-utility analysis (CUA) was conducted covering the first year after randomization. Numbers-needed-to-treat (NNTs) were calculated for the primary endpoint censored at 1 year. In the CUA model, patient survival and rates of (re)hospitalization due to HF, other CV events, infections, respiratory conditions, and other non-CV events were modeled based directly on data from the IRONMAN RCT. UK-specific costs were obtained from the national schedule of NHS costs. Quality of life was estimated based on EQ-5D-5L data collected from patients included in the IRONMAN RCT. Results were undiscounted and reported as absolute and incremental costs in 2023 pounds sterling, and quality-adjusted life expectancy in quality-adjusted life years (QALYs). A willingness-to-pay threshold of £20,000 per QALY was adopted to allow calculation of a net monetary benefit (NMB), a summary measure of the overall value of FDI in monetary terms, capturing changes in both cost and QALY outcomes. Results The NNT analysis showed that 9 patients would need to be treated with FDI to avoid one composite primary endpoint event (CV death and HHF) over 1 year. Relative to usual care, FDI was associated with an improvement of 0.01 QALYs per patient over 1 year (0.58 versus 0.57 QALYs). Total average costs per-patient were £1,672 for FDI, versus £1,975 for usual care, leading to a saving of £302 per patient with FDI. The cost of iron procurement was more than offset by reductions in costs of (re)hospitalizations (Figure). FDI was therefore dominant over usual care, yielding an NMB of £483 over 1 year. Conclusions This short-term, within-trial CUA suggests that FDI both improves QALYs and reduces healthcare expenditure versus usual care when administered to patients with HF and iron deficiency in the UK. Iron repletion with FDI may be a prudent allocation of healthcare resources in this patient population.Breakdown of costs

Metabolic profile in elite badminton match play and training drills.

Aim of the study was to analyze the metabolic profile of badminton matches and training drills. Therefore, 11 male (23.2±3.8years, 182±7cm, 74.4±8.4kg) and five female (19.3±1.5years, 170±6cm, 62.6±9.2kg) elite badminton players participated in either a training match (TM; n=7) and/or three protocols of multifeeding drills (T10, T30, T50; n=13), that varied in interval and rest durations (10s/10s, 30s/30s, 50s/50s). Absolute and relative energetic costs (Wtot and Etot) and contribution to oxidative (WOxid), phosphagen (WPCr), and anaerobic glycolytic (WLa) metabolism were calculated by the three-component PCr-La-O2-method based on an indirect calorimetric approach from oxygen consumption during exercise, post exercise, and net blood lactate concentration. A novel intermittent approach was used to consider replenishment of phosphocreatine during each resting phase. Results show that during TM, Etot was 676±98J·kg-1min-1, while metabolic pathways contributed by 56.9±8.6% (WOxid), 42.7±8.7% (WPCr), and 0.4±0.6% (WLa). In the multifeeding drills Etot was comparable between T10 (1020±160J·kg-1min-1) and T30 (985±173J·kg-1min-1) but higher in T50 (1266±194J·kg-1min-1) (p<0.001). Relative contribution of WOxid was lower in T10 (47.3±7.7%) but similar in T30 (56.5±6.2%) and T50 (57.3±6.0%) (p<0.001). WPCr was highest in T10 (51.1±8.3%) followed by T30 (42.2±6.9%) and lowest in T50 (31.2±7.7%) (p<0.001). WLa was similar between T10 (1.6±1.0%) and T30 (2.1±1.0%) but higher in T50 (11.6±4.8%) (p<0.001). Concludingly, metabolic costs in badminton are predominantly covered by oxidative and phosphagen energetic pathways. Metabolic profiles of the multifeeding drills differ depending on rally/interval duration, with increasing contribution of anaerobic glycolysis and decreasing phosphagen contribution in case of longer intervals.

Barriers to Entry in China’s Consumer Goods E-Commerce Market

ABSTRACT Purpose Although economists and strategy theorists have extensively researched market entry barriers in the Western industrial market and post-entry barriers in the e-commerce market, few studies have focused on entry barriers in the context of the unique challenges in China’s business landscape. In this study, a survey was conducted with 139 Chinese marketing executives of consumer goods e-commerce firms to elucidate the dimensions and relative importance of market entry barriers in China. Specifically, this study aims to explore the barriers to entry that exist in the Chinese consumer goods e-commerce market, determine their importance, and identify potential dimensions through factor analysis. Methodology/approach This study employed an in-depth interview with nine marketing executives from China consumer goods e-commerce firms, and the instrument was revised accordingly. Then questionnaire adopted a simple random sampling method to select 300 enterprises as survey respondents. In total, 195 firms completed and returned the questionnaires by the deadline, resulting in 139 valid responses being collected. Findings This study explores 33 entry barriers and reveals seven dimensions of China’s consumer goods e-commerce market, highlighting incumbents with an absolute cost advantage barrier as the most significant barrier, and the cost of establishing a branch office as the least significant barrier, as perceived by Chinese business executives. Research implications Extant literature has mostly confirmed the value and practical significance of market entry barriers in Western markets or industrial markets. However, there are few studies on entry barriers in China’s e-commerce market, particularly in the consumer goods e-commerce market. Our research attempts to provide a theoretical basis for China’s consumer goods e-commerce market entry barriers. Practical implications Studying market entry barriers can help firms better adapt to market changes, optimize their operational modes according to market demands and norms, and enhance their competitiveness. The exploration of this research could be utilized by e-commerce businesses to become more successful or avoid failure. Originality/value/contribution This study complements the existing research on market entry barriers in China and the West. It complements barriers to entry into the consumer e-commerce market based on the Chinese economic context.

Synthesis of activity-based costing and deep learning to support cost management: A case study in the automotive industry

Activity based costing (ABC) models for cost management and big data analytics are deeply rooted in academia and practice to efficiently manage operational costs. Inspired by cost management and deep learning (DL) theories we develop a multilayer perceptron (MLP) using a nested particle swarm optimized (PSO) neural network algorithm for self-controlled architecture and weight optimization. This innovative approach enables to mimic ABC while increasing prediction accuracy. In a real-world case study we use wheel manufacturing data provided by a large original equipment manufacturer (OEM) and follow a full factorial experimental design. Furthermore, we benchmark our novel DL approach with results derived from a traditional ABC analysis. We demonstrate that this intelligent cost estimation model can mimic ABC using few cost drivers contributing to efficient and transparent interorganizational cost management. Major quantitative findings within a conducted field experiment demonstrate a high forecast accuracy with low absolute cost percentage error (CPE) deviation of the novel cost estimation approach in industry. The results extend the scope of PSO for the simultaneous optimization of the architecture and weights of neural networks. Additionally, we prove that the PSO algorithm is a suitable alternative to traditional optimization methods in DL.

Estimating the cost of young stock mortality in livestock systems-An application to sheep farming in Ethiopia.

In sub-Saharan Africa, pre-weaning young stock mortality (YSM) is in the order of 20 to 30% across most livestock species and production systems. High YSM has significant economic implications for livestock keepers, but few studies provide estimates of the "cost of YSM." This study explores a bio-economic herd modeling approach to estimate the "cost of YSM" at farming/livestock system level. The static zero-growth version of DYNMOD was used to calculate the annual physical and monetary output of a sheep flock consisting of 100 breeding females at different levels of lamb mortality. Production parameter values and prices were taken from recently published research. Calculations were carried out for values of lamb mortality decreasing from 30% to 0% in 5% intervals, with 20% representing the "baseline" YSM. Calculations were repeated for a "high" fertility scenario (100% vs. 59% parturition rate) to gauge the sensitivity of the cost of YSM to another parameter determining flock productivity. The relation of revenue per head and YSM is close to linear over the range of analyzed YSM with 1% decrease in YSM resulting in an increase in revenue per animal of approximately 1%. At the higher fertility rate, the absolute cost of YSM to sheep farmers is higher while the relative increase in revenue per animal resulting from YSM reduction is lower. The estimated difference in revenue of the 100-ewe flock between the 20% and 0% lamb mortality scenarios (at baseline fertility) amounts to approximately USD 90 per additionally surviving lamb, which is far above its market value. Reduced lamb mortality ultimately impacts flock revenue through increased sales of "mature" animals, which embody the value of a lamb plus the revenue/profit from raising it to marketable age/weight. The modeling results suggest that foregone profit is an important component of the systemic "cost of YSM." Consequently, expected profit per animal, in addition to its current market value, is essential for estimating the absolute cost of YSM at farming system level.

Cost Evaluation of the Ontario Virtual Urgent Care Pilot Program: Population-Based, Matched Cohort Study.

In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns. This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable). We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts. This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions.

Cost trends in standard-of-care cancer treatments, 2017-2021.

11073 Background: Financial burden of cancer care in the United States is substantial. Prior studies have explored price trends at the level of individual cancer drugs but not that of clinical indications, which can be impacted not only by changes in drug prices but also changes in standard-of-care. This study evaluates temporal trends in the cost of providing the contemporary best guideline-concordant therapy for each cancer indication. Methods: We analyzed trends in the cost of the standard-of-care treatments for the 20 most prevalent cancer types, using NCCN Guidelines to identify the standard-of-care (SOC) treatment for each indication. Our primary comparison of interest was the cost of providing the SOC treatment regimen for each indication in 2021 vs. 2017. All solid tumor treatment indications present in the NCCN Guidelines at both study time points, 7/1/2017 and 7/1/2021, were included. Indications that involved radiotherapy or stem cell transplant among the treatment options were excluded. Costs of all recommended treatment options for each included indication were calculated using Medicare reimbursement rates. We included costs of the antineoplastic agents themselves as well as necessary supportive medications. Costs were inflation-adjusted to 2021 USD. We identified the SOC treatment for every indication at both time points by referring to NCCN Evidence Blocks and identifying the regimen(s) with the highest scores (prioritizing Efficacy, then Safety, then Quality, then Consistency, in that order). If multiple SOC treatments for a single indication had identical scores, we chose the least-costly treatment. Results: 83 clinical indications across 16 solid tumor cancer types (bladder, brain, breast, colon, kidney, liver, lung, melanoma, oropharyngeal, ovary, pancreas, prostate, rectal, soft tissue, stomach, and uterus) were included. Median SOC cost was $8,364 (IQR = $3,838, $15,783) in 2017, compared to a median of $4,290 (IQR = $1,438, $14,947) in 2021. 57 indications (68.7%) had lower SOC costs in 2021 vs 2017, with median change of -$935 (IQR = -$4,432, +$452), representing a 31% decrease (IQR = -50%, 8%). Gastric cancer perioperative chemotherapy had the biggest absolute cost decrease at $65,612 (-90%), while extensive stage small cell lung cancer had the biggest absolute increase at $37,213 (706%). 45 indications (54.2%) had the same SOC regimen across this study period, of which 75.6% saw price drops. Of the 38 indications with new SOCs, 60.5% had lower costs. Conclusions: Majority of the best SOC treatments decreased in cost over a 4 year period. Although introduction of newly approved drugs can cause large price increases for some indications, more commonly the financial cost of delivering the standard-of-care treatment for a given cancer trended down due to slower-than-inflation price increases and new generic entrants.

5-year multicenter analysis of clinical trial participation and total cost of care for older adults with cancer.

11013 Background: Clinical trial access particularly for older adults aged 65 years and above with cancer is impacted by multilevel barriers, including cost concerns to payers in the usual models of cancer care delivery. Alternative models recently studied include the Centers for Medicare and Medicaid Innovation’s Oncology Care Model (OCM), a value-based care pilot to enhance quality &amp; reduce costs. Here, we investigated the association between clinical trial participation (CTP) and the total cost of care (TCOC) within this non-traditional model. Methods: We identified prospective longitudinal observational cohort of patients cared for in 11 states within 323 clinics in 14 multi-site community practices participating in OCM, in The US Oncology Network and extracted data (episode claims, medical records, episodes) from OCM performance periods (PP) 3-11 between 7/1/17 and 6/30/22. Propensity score matching by PP, age, gender, date of death, cancer type identified the analysis cohort of matched episodes, then stratified by trial participation (CTP vs usual care) to compare TCOC and drug expenditures. Results: Over 5 years, 121,717 unique patients (94% of whom were aged 65y+) received 282,604 episodes of cancer care in the community, most common cancers being breast, lung, multiple myeloma. Propensity score matching identified 13,260 matched episodes (6630 usual care, 6630 CTP). The actual expenditure differed by $2,341 per episode between CTP &amp; usual care (CTP $43,890 vs usual care $41,548; p &lt; 0.0001), while trial participation had significant savings against the OCM CTP benchmark ($4816 saved per CTP episode), compared to usual care vs its benchmark ($826 saved per usual care episode, p &lt; 0.0001). Drug costs per episode did not differ between the two groups (CTP $29,516 vs usual care $30,553; p 0.54). Further breakdown shows that drug spending on anticancer agents (CTP $28,008 vs usual care $29,139) and other drugs including supportive care meds (CTP $1,511 vs usual care $1,414) did not differ significantly. Conclusions: Clinical trial participation saw relative cost savings against the benchmark compared to usual care, owing largely to the higher benchmark prices for CTP episodes in OCM’s risk-adjusted price prediction model, rather than an absolute cost savings to payers. Drug expenditures remain the largest contributor to total cost of care in this alternative model. The contributors to both drug expenditures as well as the absence of absolute cost savings between the two cohorts represent key areas for further investigation. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Inpatient Infliximab Biosimilar Cost-Savings: Cost Analysis of Inpatient Treatment with Originator Infliximab (Remicade™) versus Biosimilar Infliximab (Renflexis™) for Acute Severe Ulcerative Colitis

Introduction: Infliximab (IFX) is a standard, inpatient salvage therapy for the treatment of refractory acute severe ulcerative colitis (ASUC). Remicade™ is the originator IFX. Its biosimilar Renflexis™ offers a reduced cost structure. We performed a cost-minimization analysis to compare costs with Remicade™ and Renflexis™ for the inpatient treatment of ASUC. Methods: Retrospective clinical and financial data were obtained from 34 inpatients with refractory ASUC who received Renflexis™ (n = 17) or Remicade™ (n = 17) between 2019 and 2021. Clinical data included admission and discharge laboratory values. Financial data included a decision support drug cost (DSDC), constituting the total cost associated with inpatient IFX administration, and total inpatient cost of care. The following equation generated a ratio (rDSDC) representing the percentage of drug cost (or DSDC) of the total inpatient cost of care, after controlling for IFX dose and length of stay: [DSDC of IFX/Number of Units of IFX] ÷ [Total Inpatient Cost of Care/Length of Stay in Days]. Median and non-parametric Wilcoxon ranked sum test were used for analyzing patient demographics, clinical, and financial data. Results: No differences were found in baseline or discharge clinical parameters. The median unadjusted ratio of DSDC to total inpatient cost of care was 0.387 versus 0.241 in the Remicade™ versus Renflexis™ groups (p = 0.0025), respectively, representing an absolute difference of ∼14%. Median adjusted rDSDC were 0.04 versus 0.024 in the Remicade™ versus Renflexis™ groups, respectively, representing a relative cost reduction of ∼40% (p = 0.0001). Discussion: The unadjusted absolute cost reduction and adjusted relative cost reduction were, respectively, 14% and 40% in the Renflexis™ group as compared to Remicade™, when treating inpatient ASUC. Our calculation included median DSDC as a percentage of the total inpatient cost of care, controlling for IFX dose and length of stay. This reduced cost structure promotes use of Renflexis™ for ASUC inpatients and may reduce costs systemically.

Uncertainty propagation in stereo matching using copulas

This contribution presents a concrete example of uncertainty propagation in a stereo matching pipeline. It considers the problem of matching pixels between pairs of images whose radiometry is uncertain and modeled by possibility distributions. Copulas serve as dependency models between variables and are used to propagate the imprecise models. The propagation steps are detailed in the simple case of the Sum of Absolute Difference cost function for didactic purposes. The method results in an imprecise matching cost curve. To reduce computation time, a sufficient condition for conserving possibility distributions after the propagation is also presented. Finally, results are compared with Monte Carlo simulations, indicating that the method produces envelopes capable of correctly estimating the matching cost.

A fully scalable homogenization method to upscale 3-D elastic media

SUMMARY Modelling seismic wavefields in complex 3-D elastic media is the key in many fields of Earth Science: seismology, seismic imaging, seismic hazard assessment and earthquake source mechanism reconstruction. This modelling operation can incur significant computational cost, and its accuracy depends on the ability to take into account the scales of the subsurface heterogeneities varying. The theory of homogenization describes how the small-scale heterogeneities interact with the seismic waves and allows to upscale elastic media consistently with the wave equation. In this study, an efficient and scalable numerical homogenization tool is developed, relying on the similarity between the equations describing the propagation of elastic waves and the homogenization process. By exploiting the optimized implementation of an elastic modelling kernel based on a spectral-element discretization and domain decomposition, a fully scalable homogenization process, working directly on the spectral-element mesh, is presented. Numerical experiments on the entire SEAM II foothill model and a 3-D version of the Marmousi II model illustrate the efficiency and flexibility of this approach. A reduction of two orders of magnitude in terms of absolute computational cost is observed on the elastic wave modelling of the entire SEAM II model at a controlled accuracy.

A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use.

The COVID-19 pandemic stressed global health care systems' acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England's National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system. The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use. There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists. In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US $504,197 in net financial savings across the 2 key groups of patients-those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US $1850 and US $1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9%, which was below comparative data. The mean cost of the intervention was US $223.53 per patient, 12.1% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4% in the sensitivity analysis that the intervention was no longer cost saving. The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost.

A Material Allocation Model for Public Health Emergency under a Multimodal Transportation Network by Considering the Demand Priority and Psychological Pain

In a public health emergency, residents urgently require a large number of rescue materials for treatment or protection. These rescue materials are usually located far from the emergency area. The government must organize rescue materials transportation by selecting suitable transport modes. Thus, we propose a material allocation model for public health emergencies under a multimodal transportation network to determine the best rescue material supply route. In this model, we set the demand priorities according to the emergency degrees to decide the transportation sequence. Meanwhile, we introduce the psychological pain cost brought by the rescue material shortage into the proposed model to trade off the priority and fairness of demand. Having compared it to the research literature, this is the first study that considers multiple categories of materials, absolute pain costs, relative pain costs and demand priority under multimodal transportation. The research problem is formulated into an integer programming model, and we develop a modified genetic algorithm to solve it. A set of numerical examples are conducted to test the performance of the proposed algorithm, and to investigate features and applications of the proposed model. The results indicate that the modified genetic algorithm performs better in the calculation examples at different scales. For small-scale instances, the algorithm produces consistent results with Gurobi. As the instance size increases, Gurobi fails to find the optimal solution within 1800 s, while this algorithm is able to find the optimal solution within an acceptable time frame. Additionally, when dealing with large-scale instances, the algorithm exhibits a significant advantage in terms of runtime. Sensitivity analysis of key factors indicate that (1) Adjusting the relative pain cost coefficient can make the best trade-off between fairness, economy and timeliness; (2) Compared with a single mode of transport, multimodal transport can reduce the psychological pain cost and the logistics cost; (3) Improving the loading and unloading capacity of nodes can reduce the delivery time of materials and the psychological pain cost of residents, but the influence of other factors and cost-effectiveness need to be considered.

Plant choice between arbuscular mycorrhizal fungal species results in increased plant P acquisition.

Arbuscular mycorrhizal fungi (AMF) are plant root symbionts that provide phosphorus (P) to plants in exchange for photosynthetically fixed carbon (C). Previous research has shown that plants-given a choice among AMF species-may preferentially allocate C to AMF species that provide more P. However, these investigations rested on a limited set of plant and AMF species, and it therefore remains unclear how general this phenomenon is. Here, we combined 4 plant and 6 AMF species in 24 distinct plant-AMF species compositions in split-root microcosms, manipulating the species identity of AMF in either side of the root system. Using 14C and 32P/33P radioisotope tracers, we tracked the transfer of C and P between plants and AMF, respectively. We found that when plants had a choice of AMF species, AMF species which transferred more P acquired more C. Evidence for preferential C allocation to more beneficial AMF species within individual plant roots was equivocal. However, AMF species which transferred more P to plants did so at lower C-to-P ratios, highlighting the importance both of absolute and relative costs of P acquisition from AMF. When plants had a choice of AMF species, their shoots contained a larger total amount of P at higher concentrations. Our results thus highlight the benefits of plant C choice among AMF for plant P acquisition.

RELATIVE AND ABSOLUTE METABOLIC COST OF DAILY PHYSICAL ACTIVITIES ACROSS THE LIFESPAN

Abstract Americans spend over 90% of their activity related energy expenditure performing common daily activities. However, there is a gap in knowledge pertaining to potential age-related differences in the metabolic cost of performing these activities which diminishes proper physical activity prescription. We hypothesized age differences in both the absolute and relative metabolic cost of performing common daily physical. Participants (n=248, age: 20-94 yrs) performed 33 activities (e.g. dressing, walking, making a bed, gardening, computer work) in a standardized setting. A portable indirect calorimeter was worn for approximately 6-10 minutes to achieve steady-state metabolic rate. A graded exercise treadmill test was performed to quantify peak metabolic rate. A metabolic equivalent (MET as a function of 3.5 milliliter•min-1•kg-1) and percentage of peak were used to express absolute and relative metabolic rate, respectively. Watching television (1.0+/-0.36 METs; 15.6+/-5.7% of peak) produced the lowest and climbing stairs (6.2+/-2.2 METs; 84.8+/-17.0% of peak) elicited the highest metabolic rate. Results from mixed effect regression models adjusting for health conditions, demographics and anthropometry showed no association between absolute MET and age. However, when expressed relative to peak, adjusted models showed a strong association with age (0.66+/-0.33% per year, p=0.006). As an example, adults &amp;lt; 40 yrs old worked at 34.1+/-14.8% of peak during a leisurely walk while those 80+ years old worked at 64.2+/-16.3%. Aging is associated with a substantial increase in the relative metabolic cost of performing common daily physical activities. These results could have implications on prescribing physical activity older adults to achieve higher fitness.

Calculation of wheat production costs in Lalapaşa district, Edirne province

&lt;p&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;This study aims to determine the quantities of inputs used in wheat production activities in agricultural enterprises in Lalapaşa district, Edirne province, and calculate the absolute production costs. Lalapaşa is a district that exhibits richness in terms of location, land structure, and productivity. In the villages located on the Balkans side of our country, wheat cultivation shows relatively low productivity (300–350 kg/ha), whereas in the villages close to Edirne city, wheat yield exceeds the country’s average (500 kg/ha). Since the expenses for wheat production do not differ significantly in the villages where wheat is cultivated in Lalapaşa district, an income/cost calculation has been made based on three different yield groups, considering the yield criterion. The average yield of these groups in terms of wheat cultivation is rounded to 350 kg/ha, 400 kg/ha, and 500 kg/ha, respectively. The purpose of this grouping is to calculate the income that can be obtained from 1 hectare of land in the villages by fixing the wheat yield averages in 3 different groups in the most transparent way possible. A survey was conducted in the district’s 28 villages using stratified sampling method. The villages selected for the sample and the grouping of the enterprises in these villages according to yield criteria were used to calculate the wheat cost for 1 hectare of wheat production area for the 2022–2023 production year. According to the results obtained from the research, the average production costs of wheat yield groups were calculated as 1018.92 TL, 1441.42 TL, and 2276.42 TL, respectively.&lt;/p&gt;

Carbon inequality and support for carbon taxation

AbstractStringent policies that significantly increase the cost of greenhouse gas emissions, such as CO2, are increasingly necessary for mitigating climate change. Yet while richer individuals in society generate the most CO2 emissions and thus will face the largest absolute cost burden, they also tend to be more supportive of stringent environmental policies. In this paper, we examine how information about the distribution of carbon emissions by income affects support for carbon taxation. While carbon taxation is widely advocated as the most efficient policy for mitigating climate change, it faces significant political hurdles due to its distributional costs. Using original survey data, with an embedded experiment, we find that providing information about the actual distribution of household CO2 emissions by income significantly changes individuals' support for carbon taxation. These effects are particularly pronounced at the bottom of the household income distribution, leading to increased support for costly climate policies. However, individuals who believe that carbon taxes will reduce their income continue to hold their level of support for carbon taxation. Our findings have significant implications for understanding the public's response to the distributional consequences of the green transitions and ultimately their political feasibility.

Cost-utility analysis of robotic arm-assisted medial compartment knee arthroplasty.

To perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA). This was a five-year follow-up study of patients who were randomized to rUKA (n = 64) or mUKA (n = 65). Patients completed the EuroQol five-dimension questionnaire (EQ-5D) preoperatively, and at three months and one, two, and five years postoperatively, which was used to calculate quality-adjusted life years (QALYs) gained. Costs for the primary and additional surgery and healthcare costs were calculated. rUKA was associated with a relative 0.012 QALY gain at five years, which was associated with an incremental cost per QALY of £13,078 for a unit undertaking 400 cases per year. A cost per QALY of less than £20,000 was achieved when ≥ 300 cases were performed per year. However, on removal of the cost for a revision for presumed infection (mUKA group, n = 1) the cost per QALY was greater than £38,000, which was in part due to the increased intraoperative consumable costs associated with rUKA (£626 per patient). When the absolute cost difference (operative and revision costs) was less than £240, a cost per QALY of less than £20,000 was achieved. On removing the cost of the revision for infection, rUKA was cost-neutral when more than 900 cases per year were undertaken and when the consumable costs were zero. rUKA was a cost-effective intervention with an incremental cost per QALY of £13,078 at five years, however when removing the revision for presumed infection, which was arguably a random event, this was no longer the case. The absolute cost difference had to be less than £240 to be cost-effective, which could be achieved by reducing the perioperative costs of rUKA or if there were increased revision costs associated with mUKA with longer follow-up.

Policy complementarity and the paradox of carbon pricing

AbstractWe present an economics framework appropriate to the exceptionally broad scope of the climate change problem. This considers that economic and social processes, particularly those involved in purposive transitions of energy technologies and systems, involve the interplay between three distinct domains of decision-making and associated actors. The first concerns small-scale and often short-term decision-making, much of which reflects extensive ‘satisficing’ and habituation as identified in behavioural economics. Calculated economic optimization decisions, especially of companies in the energy and energy-intensive industries, then best reflect the core assumptions of neoclassical and welfare economics, including discrete market failures. Third, at the largest scale are strategic judgements made by big actors (e.g. governments, large multinational companies) relevant to transformation of complex systems over long periods—particularly concerning innovation and structural changes, for which lessons from theories of evolutionary and institutional economics are most relevant.Economically, these can be logically mapped in relation to the technology (or more accurately, ‘best practice’) frontier. Each has corresponding policy implications: most directly, respectively in terms of (i) standards and engagement to establish norms; (ii) competitive markets with the critical role of prices; and (iii) strategic investment in innovation and infrastructure. Each faces challenges of implementation and government failure, as observed, for example, with wholly inadequate carbon pricing to date, naïve and ineffective approaches to enhancing energy efficiency, or misdirected support to R&amp;D. Based on the domain distinctions, we argue that the corresponding pillars of policy are naturally complementary, and can be mutually supportive: strong standards and norms on energy efficiency, for example, would enhance the political space for carbon pricing by reducing its direct consumer impacts, while carbon pricing has multiple positive two-way interactions with enhanced low-carbon innovation.From this we also posit a ‘carbon pricing paradox’: that adequate carbon prices, the central recommendation of most economists, are in most jurisdictions only feasible (or even optimal) if equal analytic and policy attention is devoted to the other pillars, and the wider context of macroeconomic and fiscal policies. Only these other aspects can reduce the absolute cost impact of carbon pricing (potentially turning into a gain) and offer consumers and businesses better lower-carbon alternatives, which are critical to establishing climate-compatible pricing structures across our economies.

Retrospective pharmacoeconomic study of antibiotic therapy in community-acquired pneumonia

Background. The global recommendations for the treatment strategy of community-acquired pneumonia (CAP) include the empirical prescription of antibiotic therapy (ABT) – beta-lactams, fluoroquinolones, macrolides until the results of laboratory tests are obtained to identify the etiological agent responsible for CAP to determine etiotropic therapy. According to the national Russian clinical guidelines, macrolides, fluoroquinolones, cephalosporins and aminopenicillins are recommended for empirical prescription. Meta-analyses found better outcomes in patients treated with a combination of macrolides with beta-lactam compared to beta-lactam alone. At the same time, the clinical benefit of adding macrolides to beta-lactams for the empirical treatment of moderate CAP remains controversial, since the difference in the results of therapy may depend on the age and comorbid conditions of patients.Objective: to analyze the costs of treating CAP with various ABT strategies in order to optimize the cost structure of a medical organization and plan the budget of local healthcare systems.Material and methods. A retrospective epidemiological analysis of extracts from 157 medical records of middle-aged patients in accordance with the World Health Organization classification treated in multidisciplinary medical organizations was carried out. The methods included frequency analysis, cost of illness analysis, cost minimization analysis, and cost-effectiveness analysis. Depth of research was 2 years.Results. Frequency analysis revealed that the initial strategy of ceftriaxone and azithromycin combination (n=74; 47%) prevailed in prescriptions. In terms of the rate of prescriptions, ceftriaxone monotherapy (n=37; 24%) was in the second place. The analysis of the effectiveness of the selected ABT strategies showed that, in general, 113 (72%) of prescriptions were effective. Standard therapy strategies were equivalent in absolute costs and had a similar cost structure.Conclusion. Doctors’ adherence to national clinical guidelines for CAP treatment was found when prescribing the initial empirical ABT, the dominant strategies were identified. Cost of illness analysis demonstrated that the applied strategies were optimal in terms of cost minimization, and cost-effectiveness ratio. The costs structure in therapy with various ABT strategies did not have significant differences. In medical organizations, they adhere to the most rational and cost-effective strategy for CAP treatment and prescribe ABT regimens in each individual case based on risk factors, as well as the results of studies of CAP pathogens sensitivity.