Absolute Savings Research Articles

Drug Pricing Stewardship from Mark Cuban's Cost Plus Generic Drug Program.

The exceedingly high US spending per capita on prescription medications is mediated, at least in part, by the inefficiencies of existing generic pharmaceutical distribution and reimbursement systems; yet, the extent of potential savings and areas for targeted interventions for generic drug prescribers remains underexplored. We aimed to analyze 2021 Medicare Part D spending on generic drugs in comparison with pricing of a low-cost generic drug program, the Mark Cuban Cost Plus Drug Company (MCCPDC), to gauge the extent of achievable potential savings. In this retrospective, observational study, we performed a systematic analysis of potential Medicare Part D savings when using MCCPDC generic pricing. The 2023 MCCPDC data, as of August 2023, were obtained from the provider's publicly available database. The 2021 Medicare Part D data and prescriber datasets were obtained from the US Centers for Medicare and Medicaid Services. Outcomes included total prescription volume, proportion of drugs with savings, total US dollar Medicare savings, and average weighted price reduction per unit drug. Results were stratified by medical and surgical subspecialties to identify areas for targeted interventions. Subspecialty-wise contribution to total savings versus contribution to total prescription volume was characterized. Total estimated Medicare Part D savings were $8.6 billion using 90-day MCCPDC pricing, with surgical drugs accounting for over $900 million. Nearly 80% of the examined drugs were more price effective through MCCPDC using 90-day supply. Commonly prescribed drugs in cardiology, psychiatry, neurology, transplant surgery, and urology demonstrated the highest estimated absolute savings. The most disproportionate savings relative to prescription volume were observed for drugs in oncology, gynecology, infectious disease, transplant surgery, and colorectal surgery. This study underscores the significant potential for Medicare Part D savings through strategies that address the systemic overpayment for generic medications. We identified key areas for reform as well as specific medical and surgical subspecialties where targeted interventions could yield substantial savings.

The characteristics of heat exchanger for local utilization of wastewater heat under different operating conditions

RELEVANCE. The authors research the local utilization of wastewater heat (in close proximity to the place of their formation) based on a heat exchanger. To select rational characteristics of the heat exchanger and correctly assess the potential energy effect, it is necessary to take into account the influence of the operating conditions of the device (duration of individual use of the shower, mass flow of heated and heating water, temperature of heated water at the inlet to the heat exchanger, temperature of the flow at the moment the device is turned on).THE PURPOSE. The purpose of the work is to research the dependence of the efficiency of wastewater heat utilization on the operating conditions of the heat exchanger and to identify the parameters that have the greatest impact on the effect of energy-saving measures.METHODS. Based on a verified mathematical model of the thermal operation of a recovery heat exchanger, the temperature distribution inside the flows of the heated and heating water in time is calculated (from the moment of switching on until reaching a stationary operating mode). Based on the data obtained (the temperature of the heated water at the outlet of the heat exchanger at each point in time), the absolute and relative heat savings are determined under various operating conditions.RESULTS. The influence of the non-stationary phase of the heat exchanger operation on its energy efficiency is considered. For a specific heat exchanger configuration, the time required for the device to reach a steady state of thermal operation is determined. It was revealed that the greatest influence on the relative and absolute savings of thermal energy is exerted by such operating conditions as mass flow and temperature of heated water at the entrance to the heat exchanger. The temperature of the flow at the initial moment of time has the least influence on the energy effect.CONCLUSION. The operating conditions that have the greatest impact on the effect of local wastewater heat recovery are determined. The need to take these conditions into account when designing a heat exchanger and choosing its optimal parameters has been confirmed.

Turn down your thermostats – A contribution to overcoming the European gas crisis? The example of Germany

Europe's current gas crisis requires rapid government intervention to curtail natural gas consumption and mitigate expenses for consumers. This study aims to comprehensively assess the impact of adjusting thermostats, with single-family houses in Germany serving as a case study. A unique bottom-up approach for approximating gas consumption at the level of building archetypes reveals that decreasing temperature setpoints from 21 °C to 19 °C and 17 °C can save about 14 and 30 TWh/a of gas, respectively. This corresponds to 3–6 % of gas imports from Russia to Germany in 2020. The largest absolute savings can be realized in older and larger buildings. Additionally, our findings suggest that the adjustment of thermostats may decrease residential CO2 emissions by 3–6 Mt/a, achieved through a reduction of 2–4 °C in the setpoint. Therefore, the measure shows great promise regardless of the present crisis. From the consumer's perspective, a 1 °C temperature reduction can lead to a gas bill reduction of 4–9 %, contingent upon building type. Nevertheless, the cost burden associated with rising gas prices surpasses these savings. Residents of older buildings suffer more severe financial impacts than those in newer ones. Our research suggests that policymakers should consider implementing adjustments to residential thermostats. Furthermore, consumer financial assistance programs should factor in building type when designing relief mechanisms.

Does recalling energy efficiency measures reduce subsequent climate-friendly behavior? An experimental study of moral licensing rebound effects

Energy efficiency measures are a key element in the fight against climate change. However, their effectiveness is threatened by so-called rebound effects—behavioral changes that lead to increased use and thus to lower-than-expected absolute savings. The moral licensing bias might cause rebound effects on the individual level: When people implement energy efficiency measures, they may feel that they have done something good for the climate and thus license themselves to less climate-friendly behavior later on. We test this prediction with three pre-registered experiments (total n = 2315). While our manipulated efficiency does increase the feeling of having done something good for the climate, no negative effects emerge on subsequent climate-friendly behavior—contrary to the predictions derived from the moral licensing literature. Climate-friendly behavior is thus not hampered by prior energy efficiency behavior; rather, demographics (women and older people act in a more climate-friendly manner) and environmental attitude determine it. Our results imply that the literature suggesting moral licensing is probably not transferable to the field of energy efficiency, and thus moral licensing may not lead to rebound effects in this context. We discuss possible explanations, implications for climate policy making, and needs for future research.

Extending the Thermal Comfort Band in Residential Buildings: A Strategy towards a Less Energy-Intensive Society

Extending set-point temperatures in residential buildings has a significant impact on energy demand and thermal comfort. European governments have adopted this strategy to mitigate the energy crisis. Previous studies attempting to quantify energy savings by extending set-point temperatures were limited due to a lack of building stock characterisation, poor climate representation, and the absence of uniformity in the reference set-point temperature. In this study, a large-scale simulation was conducted, which included six building models covering 90% of southern Europe Köppen–Geiger climates, where 20 °C and 25 °C were the reference heating and cooling set-point temperatures, respectively. This also accounted for the thermal characteristics of the older building stock, built more than 15 years ago, and the new buildings built under the latest version of Directive 2010/31/EU. The results show that reducing the heating set-point temperature by 1 °C can lead to an average demand reduction of 20%, while raising the cooling set-point temperature by 1 °C can lead to a 25% cooling demand reduction. The oldest building stock shows a higher absolute savings potential. Adjusting thermostats by 1 °C in Spanish homes during the winter season could represent a saved natural gas volume of 1.8 million normal cubic meters, nearly 40% of the gas demand of households in 2022. These findings suggest that extending the set-point temperatures in residential buildings can be a promising strategy towards a more energy-efficient society without compromising the occupant’s thermal comfort.

Quantity bias in comparison-shopping of multi-item baskets.

Comparison-shopping applications are widespread and have been the subject of considerable research and development. There has also been widespread recognition that people are predictably irrational when making shopping decisions. In this work, we combine these two facts to propose a new type of predicable irrational behavior that has important implications for comparison-shopping applications that now utilize crowdsourcing to increase the information provided about sellers in these electronic marketplaces. In a series of three studies we demonstrate that, even after controlling for relative and absolute savings, the number of items in a shopping trip is an important consideration in the decision to make a trip to more than one store. This is true of both actual trips in physical shopping in the real world, and virtual trips to other vendors in online shopping. We term this effect quantity bias.

Clinic time required to manage remote monitoring of cardiac implantable electronic devices: impact of outsourcing initial data review and triage

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Remote monitoring is guideline-recommended to manage cardiac implantable electronic device (CIED) patients. With the continuous growth of implanted patients, clinic workload to review transmissions is increasing. Outsourcing initial data review and triage to an external monitoring center could be a valuable option for more efficient allocation of staff time, as high-skilled healthcare professionals can focus on patients in need rather than non-actionable data. Purpose The objective was to estimate the potential clinic staff time saved when outsourcing part of remote transmission review. Methods A previous time and motion evaluation described workflow tasks and time required for remote transmission review (4 EU sites, 674 observations). From real-world experience with a third-party monitoring service, the steps that can be outsourced were determined considering existing clinic-driven protocols for triage and transmission escalation. Staff time required with and without the monitoring service was thus modeled and compared. Results Outsourcing to an external monitoring center can reduce clinic staff time between 77.4% and 84.7% depending on device type. Absolute time savings range from 32.7 to 82.6 hours per year per 100 patients for therapeutic devices, and 301.3 hours for insertable cardiac monitor (ICM) patients, due to the higher frequency of transmissions in diagnostic devices. Conclusion Time to review remote transmissions can become overwhelming for clinics as growing CIED population often outpaces available staffing resources. Outsourcing initial review and triage to an external monitoring center (ensuring quality and regulatory compliance) can be an efficient option to save dedicated staff and facility time for other crucial healthcare activities. Clinic Staff Time Savings Per YearPacemakerICDCRTICMTRANSMISSIONS PER PATIENT PER YEARGreen (no further review required when outsourcing)3.04.35.020.8Yellow/Red (medical action/decision required)0.60.80.93.8ANNUAL STAFF TIME PER PATIENT, minutesNo outsourcing25.346.658.5219.7Outsourcing to monitoring center5.77.78.938.9ANNUAL STAFF TIME PER 100 PATIENTS, hoursNo outsourcing42.277.697.4366.2Outsourcing to monitoring center9.612.914.964.8TIME SAVED PER 100 PATIENTS, hours (%)32.7 (77.4%)64.7 (83.4%)82.6 (84.7%)301.3 (82.3%)Abstract Figure. Outsourcing Remote Transmission Review

Price Discount Framing: How it Can Increase the Purchase Intention?

The high level of competition makes companies compete to retain and win the market competition, one of the strategies are granting price discounts. This was an experimental study that aims to analyze the differences between males and females' intention for online purchase by given the price discount framing conditions, namely percentage saving and absolute saving. The participants in this study were 80 participants. This study was an experimental study since it involved the symptoms had to be investigated. The design of the study was a 2X2 factorial design. A case questionnaire was used for the data collection. The data were analyzed by using 2-ways ANOVA statistical analysis. The study reveals that (1) there is a difference in online purchase intention between those given the percentage saving condition and those given the absolute saving condition, (2) there is a difference in purchase intention between males and females. The consumers have different assumptions about the two types of discount framing even though they both have the same meaning. This should be a concern for retailers in providing sales promotions, especially for discounts because based on the results of this study it is found that discount framing with absolute savings had a slightly stronger effect on purchase intention than percentage saving.

The potential for energy savings in U.S. houses by using isothermal dehumidification

Potential energy savings achievable by using isothermal dehumidification instead of conventional air conditioning systems are modeled on a technology-agnostic basis. First, we use simple thermodynamics to model potential device-level energy savings by dehumidifying isothermally instead of by sub-dew-point cooling. A model for dehumidification demand in a prototypical house is then developed, and the device-level model is applied to the house under relevant climactic norms and weather extremes. Finally, we model all U.S. houses by coupling the household model with a statistical model for air infiltration representing all single-family, detached homes in the United States. The results show potential nationwide electricity savings of 8–25 or 5–14% of electricity usage for space cooling in U.S. single-family homes, depending on weather. The results also display large regional differences, with moist hot climates having the greatest potential absolute energy savings, but moist temperate climates having the greatest potential relative energy savings. Individual houses with high balance-point temperatures in moist climate zones are likely to derive the greatest benefit by using isothermal dehumidification over conventional systems. Ultimately, this technology-agnostic analysis provides fundamental, thermodynamics-based insight into where, when, and how isothermal dehumidification devices can reduce the energy and greenhouse gas footprints of space cooling.

De-risking Renewable Energy Investments in Developing Countries: A Multilateral Guarantee Mechanism

Summary Mitigation of global warming requires substantial investment in electricity generation from renewable sources. A large share of new generation capacity is required in regions with adverse financing conditions. We propose a global guarantee mechanism to reduce risk premia of renewable energy investments by means of risk pooling and increased market efficiency. Policymakers could establish this mechanism by scaling up existing international risk guarantee initiatives. We estimate the net present value of overall savings at US$2018 1.5 trillion globally for investments by 2030, with the largest relative savings (between 20.5% and 22%) in Sub-Saharan Africa and the Maghreb. The savings from such a mechanism outweigh its estimated average yearly operating cost. By lowering the cost of decarbonization in high-risk countries, the proposed mechanism offers policymakers a tool to make current global mitigation pledges more achievable and enables the global community to pursue more ambitious climate action.

Stock-flow relations in the socio-economic metabolism of the United Kingdom 1800–2017

Material stocks are the physical basis of production and consumption and shape the dynamics of resource use and socio-economic outcomes. We present an inflow-driven, long-term estimation of material stocks for the United Kingdom, covering 12 major materials from 1800 to 2017. We find the trajectory of the UK's stocks characterized by slow increases during the 19th century, followed by rapid growth and a slowdown in recent years. After a slump following the 2007/8 financial crisis, stock growth again accelerated to currently ∼1% per year. Per capita stocks barely increased during the 19th century. Proliferation far beyond population growth only started after WWI and pushed stocks to currently ∼272 tons/capita. Since WWI, material requirements for stock growth constituted a large share of domestic material consumption, indicating the importance of stock stabilization for reducing the size of societies’ metabolism. We find that materials required for stock buildup were increasingly imported, while more and more end-of-life metals and paper were exported. Over the past 60 years, energy and CO2 efficiency of stock operation and production improved, but absolute savings were curtailed by ongoing stock expansion. Material stocks grew tightly coupled to GDP, since ∼1995 showing first signs of relative decoupling. Alongside more than a doubling of per capita stocks from 1961 to 2005, life expectancy increased constantly but slowly. Interestingly, the indicator ‘life satisfaction’ remained fairly constant over that period. Directly targeting material stocks, for efficiency improvements but also limiting their ongoing expansion, is a crucial lever towards more sustainable resource use in the UK.

Control of Heat Pumps with CO2 Emission Intensity Forecasts

An optimized heat pump control for building heating was developed for minimizing CO 2 emissions from related electrical power generation. The control is using weather and CO 2 emission forecasts as inputs to a Model Predictive Control (MPC)—a multivariate control algorithm using a dynamic process model, constraints and a cost function to be minimized. In a simulation study, the control was applied using weather and power grid conditions during a full-year period in 2017–2018 for the power bidding zone DK2 (East, Denmark). Two scenarios were studied; one with a family house and one with an office building. The buildings were dimensioned based on standards and building codes/regulations. The main results are measured as the CO 2 emission savings relative to a classical thermostatic control. Note that this only measures the gain achieved using the MPC control, that is, the energy flexibility, not the absolute savings. The results show that around 16% of savings could have been achieved during the period in well-insulated new buildings with floor heating. Further, a sensitivity analysis was carried out to evaluate the effect of various building properties, for example, level of insulation and thermal capacity. Danish building codes from 1977 and forward were used as benchmarks for insulation levels. It was shown that both insulation and thermal mass influence the achievable flexibility savings, especially for floor heating. Buildings that comply with building codes later than 1979 could provide flexibility emission savings of around 10%, while buildings that comply with earlier codes provided savings in the range of 0–5% depending on the heating system and thermal mass.

Performance Analysis of a Solar DHW System with Adsorption Module Operating in Different World Locations

A numerical study was conducted on the performance of a solar domestic hot water storage system with an adsorption module operating in seven different world locations. The base system was optimized for Portuguese conditions and, without changing the system itself and the water consumption profile, its performance was investigated by altering local installation and operating conditions and solar collector inclination angles. The overall dynamical model of the system was used for numerical simulations. The improved performance of the system was assessed by the reduction achieved on the annual energy consumption of a backup water heater when compared with a similar conventional energy storage system (without an adsorption module). The results showed that the best performances were obtained in locations where winter and summer are clearly defined, especially locations where winters are colder, and with solar collectors’ inclination angles larger than the local latitude, except for locations with low latitudes, where solar collectors’ inclination angles are not so relevant to the system performance. It was also discussed how the performance results must be carefully analyzed, as for low-latitude locations the absolute savings are in fact smaller even if their relative values are of the same order or even higher than for higher-latitude locations.

Internet and prevalence of relative thinking

PurposeResearch demonstrates that individuals display relative thinking – the tendency to consider relative savings rather than just absolute savings in their decisions to search for a deal or purchase an item. This paper aims to review empirical and analytical literature on relative thinking, perceived search costs and price savings to propose and test a conceptual model of relative thinking.Design/methodology/approachThrough two studies, the paper tests whether individuals display relative thinking when shopping across stores vs online and how they perceive search and time spent in pursuing savings. Both studies are adaptations of the classic jacket-and-calculator scenario study (Tversky and Kahneman, 1981).FindingsResults show attenuation of the robust relative thinking phenomenon over the internet compared to shopping across stores. Individuals exhibit increased price sensitivity for both low and high relative savings conditions on the internet but demonstrate price sensitivity only in the high relative savings condition in the store shopping contexts. Diagnostic measures pertaining to the attractiveness of savings and the perceptions of search costs corroborate the support for relative thinking across stores but not over the internet.Originality/valueThese results lend weight to the central claim in this paper that the internet marks a new boundary condition for the relative thinking phenomenon in marketing literature. Theoretical and managerial implications of the findings, the limitations of the studies and future research opportunities are discussed.

Quantity Bias in Comparison-Shopping of Multi-Item Baskets

Comparison-shopping applications are widespread and have been the subject of considerable research and development. There has been widespread recognition that people are predictably irrational when making shopping decisions. In this work, we combine these two facts to propose a new type of predicable irrational behavior that has important implications for comparison- shopping applications. In a series of three studies we demonstrate that even after controlling for relative and absolute savings, the number of items in a shopping trip is still an important consideration in the decision to make the trip. This is true of both actual trips in physical shopping in the real world, and virtual trips to other vendors in online shopping. We term this effect quantity bias.

Measuring and modelling retrofit fabric performance in solid wall conjoined dwellings

There remains a significant number of occupied and uninsulated solid wall dwellings in the UK. Deep retrofit is often required for these buildings to become energy efficient but it is difficult to determine how these buildings will respond to retrofit without a detailed understanding of their fabric thermal performance Greater certainty can however be achieved by combining theoretical models and practical field tests, prior to the design of retrofit programmes. This type of approach can then be used to inform and optimize the design of retrofit interventions. This paper presents results from a series of in situ fabric performance tests undertaken on two no-fines concrete, conjoined dwellings pre- and post-retrofit and demonstrates how empirical data can be used to inform and calibrate the thermal performance of dynamic simulation models (DSMs). This is a particularly pragmatic calibration method as it eliminates the need for actual weather data, which is expensive and prohibitive to collect and collate. The DSM inputs and outputs were compared with those obtained from Standard Assessment Procedure (SAP) calculations. The results illustrate how the fabric performance of no-fines concrete can vary between similar house types within the same development. This research also validates the effectiveness of the calibration methodology that uses the whole house Heat Transfer Coefficient (HTC) as the qualifying metric. Furthermore, results also emphasize the importance of appropriately characterizing the physical properties of existing buildings before designing retrofit strategies. This paper contributes to the growing knowledge base concerned with the energy performance gap. In this instance, SAP predicts higher absolute savings then measured in situ which is problematic when assessing the financial viability of retrofits.

Gigawatt-hour scale savings on a budget of zero: Deep reinforcement learning based optimal control of hot water systems

Energy consumption for hot water production is a major draw in high efficiency buildings. Optimizing this has typically been approached from a thermodynamics perspective, decoupled from occupant influence. Furthermore, optimization usually presupposes existence of a detailed dynamics model for the hot water system. These assumptions lead to suboptimal energy efficiency in the real world. In this paper, we present a novel reinforcement learning based methodology which optimizes hot water production. The proposed methodology is completely generalizable, and does not require an offline step or human domain knowledge to build a model for the hot water vessel or the heating element. Occupant preferences too are learnt on the fly. The proposed system is applied to a set of 32 houses in the Netherlands where it reduces energy consumption for hot water production by roughly 20% with no loss of occupant comfort. Extrapolating, this translates to absolute savings of roughly 200 kWh for a single household on an annual basis. This performance can be replicated to any domestic hot water system and optimization objective, given that the fairly minimal requirements on sensor data are met. With millions of hot water systems operational worldwide, the proposed framework has the potential to reduce energy consumption in existing and new systems on a multi Gigawatt-hour scale in the years to come.

An automated residential demand response pilot experiment, based on day-ahead dynamic pricing

Abstract Dynamic pricing is a popular method to realize demand response. Automated response from smart appliances reduces the comfort impact for the users and hence reduces response fatigue concerns, while improving the price response. However, real-life experience with smart appliances is typically limited to heating and cooling appliances. The Linear pilot was a residential demand response pilot with 240 Belgian families using smart dishwashers, washing machines, tumble dryers and domestic hot water buffers in various experiments. Goal was to evaluate the performance of those smart appliances in real life circumstances for various applications of demand response. The results for the day-ahead dynamic pricing experiments, conducted from September 2013 till July 2014 at 58 families, are presented. These demonstrate a significant shift of the flexible share of the electricity consumption to the lower price periods. The dishwashers outperform the other appliances. The domestic hot water buffer shows the lowest performance in terms of relative cost savings, but its much larger energy consumption translates to larger absolute savings. As the flexible share of the total consumption remains small, the non-smart share represents a financial risk for the consumer. The smart appliances were well received by the users and no response fatigue was observed. However, there was a high variation in the group of pilot participants, both in terms of energy consumption as in terms of flexibility offered.

Benefits of glass fibers in solar fiber optic lighting systems

The transmission properties and coupling of solar light have been studied for glass core multimode fibers in order to verify their benefits for a solar fiber optic lighting system. The light transportation distance can be extended from 20 m with plastic fibers to over 100 m with the kind of glass fibers studied here. A high luminous flux, full visible spectrum, as well as an outstanding color rendering index (98) and correlated color temperature similar to the direct sun light outside have been obtained. Thus the outstanding quality of solar light transmitted through these fibers would improve the visibility of all kinds of objects compared to fluorescent and other artificial lighting. Annual relative lighting energy savings of 36% in Uppsala, Sweden, and 76% in Dubai were estimated in an office environment. The absolute savings can be doubled by using glass optical fibers, and are estimated to be in the order of 550 kWh/year in Sweden and 1160 kWh/year in Dubai for one system of only 0.159 m(2) total light collecting area. The savings are dependent on the fiber length, the daily usage time of the interior, the type of artificial lighting substituted, the system light output flux, and the available time of sunny weather at the geographic location.

Energy refurbishment of existing buildings through the use of phase change materials: Energy savings and indoor comfort in the cooling season

With reference to building applications, recent scientific literature shows good potential in reducing cooling loads by means of phase change materials (PCMs), integrated in the building exterior envelope.This paper proposes a deepening, by investigating if these dynamic components could contribute in reducing building cooling demand in Mediterranean climates. An office building is analyzed, with reference to the entire cooling season (from May 1st to September 30th), in reliable conditions as regards building use, and thus internal gains, occupancy, activation of cooling systems.More in detail, through hourly energy simulation, the achievable cooling energy savings have been calculated, with reference to a well-insulated massive building, refurbished by means of addition of PCM plaster on the inner side of the exterior envelope. Five Mediterranean climates have been taken into account: Ankara (Turkey), Athens (Greece), Naples (Italy), Marseille (France), Seville (Spain). The studies regarded the influences of the phase change temperature, thickness of the PCM wallboard and location of the PCM layer.Beyond the evaluation of the absolute savings of primary energy requests for cooling, the energy saving rate and the not-overheating time have been calculated, respectively by considering an air conditioned building and a naturally ventilated building with free-running indoor temperatures.Starting from the achieved results, through the values of the proposed indicators, this paper would suggest information useful for proper design and selection of phase change materials for building applications.