Analysis Of Cost Drivers Research Articles

Time is money: An analysis of cost drivers in ambulatory sinus surgery.

Functional endoscopic sinus surgery (FESS) is one of the most commonly performed otolaryngologic procedures and is associated with significant cost variability. We performed a retrospective analysis of all inflammatory sinus surgeries at a single tertiary care medical center from July 2021 to July 2023. The electronic medical record was reviewed for patient factors and cost variables for each procedure, and multivariable analysis was performed. A total of 221 patients were included in analysis with a mean age of 48.2 years. There was a 44.8% incidence (n=99) of nasal polyps and 31.2% (n=69) of cases were revision surgeries. The average total cost for the surgical encounter was $8960.31 (standard deviation $1967.97). Operating room time represented $4912.46 (54.8% of all costs), while average operating room supply costs were $1296.06 (14.5%) and recovery room costs were $919.48 (10.3%). Total costs were significantly associated with length of surgery ($7.83/min, p=0.04), in addition to presence of nasal polyps ($531.96, p=0.04). There was no significant association between total costs and the remaining clinical and demographic factors. Costs associated with ambulatory FESS for inflammatory sinus disease vary across patients and this cost variability is predominantly driven by time efficiency within the operating room, as well as supply utilization and nasal polyposis to a lesser degree. As a result, operating room efficiency represents a primary target for cost-related interventions. Additionally, our data provide a framework for surgeons and hospitals to make evidence-based decisions on intraoperative equipment in a tradeoff between efficiency and supply costs. Our findings indicate that an approach focused on streamlining efficiency across the entire ambulatory surgery encounter will have the greatest impact on reducing healthcare expenses for both the patient and the health system.

ІНСТРУМЕНТИ ПРИЙНЯТТЯ СТРАТЕГІЧНИХ РІШЕНЬ В УПРАВЛІННІ ВИТРАТАМИ ПІДПРИЄМСТВА

Traditional cost accounting is aimed at identifying costs that are incurred on an ongoing basis in connection with operating activities. The concept that supports the decision-making process in the long term is strategic cost management. The purpose of the article is to identify the tools for strategic decision-making in cost management focused on the corporate strategy of an enterprise.
 It is determined that strategic cost management is a process of making decisions on specific cost drivers in the context of the company's development strategy and value chain. An enterprise should evaluate its value chain in comparison with similar chains of competitors. The article presents a methodology for such an assessment.
 It is proved that strategic management is based on the following assumptions: connection with the value chain, strategic positioning of the enterprise, analysis of cost drivers, the client is the starting point for decision-making and activities, which results in the adoption of the market price as the basis for cost planning and product development, implementation of cost management in the early stages of the product life cycle, since the cost is largely determined by the product features determined at the stage of its design and development. A key element of targeted analysis is cost estimation in terms of the impact of specific factors (drivers). Strategic cost drivers are determined based on the implementation of the development strategy and its connection with the value chain. There are two main types of them: structural cost drivers and implementation cost drivers.
 It is substantiated that strategic cost management involves the use of product life cycle costing. Depending on the phases of the product life cycle, various management methods based on basic models are used: "ABC-Costing, Target-Costing. Strategic positioning of the company in terms of costs incurred should be carried out by means of cost benchmarking, which is aimed at comparing the costs incurred by the company and its competitors. The subject of comparisons is the cost of processes that allow achieving a competitive advantage.

Economic analysis of hydrogen production and refueling station via molten-medium-catalyzed pyrolysis of natural gas process

The urgent need for sustainable energy solutions has been underscored by escalating greenhouse gas emissions and the global commitment to net-zero emissions. Clean hydrogen energy, despite its potential for the global low-carbon transition, faces challenges such as high production and transport costs and significant carbon emissions. Herein, we investigate the molten-medium-catalyzed pyrolysis of natural gas (MPN) for hydrogen production and refueling. We highlight the urgent environmental and economic motivations for cleaner energy, specifically addressing the existing challenges faced by traditional hydrogen production methods. Our research introduces an innovative integrated system for onsite hydrogen production, showcasing its economic advantages, carbon emission reduction potential, and compatibility with current infrastructures. The study meticulously evaluates the MPN technology's economic feasibility, including a detailed analysis of cost drivers and the market value of by-product carbon materials. Furthermore, we stress the importance of further research to optimize the technology and promote its adoption for a low-carbon future. This investigation presents MPN as a promising alternative, potentially revolutionizing the hydrogen supply chain and contributing significantly to global decarbonization efforts.

Healthcare consumption among subjects with otitis media undergoing middle ear surgery—analysis of cost drivers

PurposeTo map healthcare utilized by subjects with chronic otitis media, with or without cholesteatoma and perform a cost analysis to determine key drivers of healthcare expenditure.MethodsA registry study of 656 adult subjects with chronic otitis media that underwent a middle ear surgery between 2014 and 2018. Healthcare contacts related to all publicly funded specialist ENT care, audiological care and primary care for a disease of the ear and mastoid process were extracted. The data are extracted from the Swedish National Patient Registry on subjects that reside in western Sweden.ResultsSubjects made 13,782 healthcare contacts at a total cost 61.1 million SEK (6.0 million EUR) between 2014 and 2018. The mean cost per subject was 93,075 SEK (9071 EUR) and ranged between 3971 SEK (387 EUR) and 468,711 SEK (45,683 EUR) per individual. In the most expensive quartile of subjects, mean cost was 192,353 SEK (18,747 EUR) over the 5-year period. These subjects made 3227 ENT contacts (roughly four each year) and 60% of total costs were associated with in-patient ENT care.ConclusionPatients with chronic otitis media are associated with high ENT resource utilization that does not diminish after surgical intervention and the disease places a long-term burden on healthcare systems. Significant costs are attributed to revision surgeries, indicating that these patients could be managed more effectively. In many such cases, reoperation cannot be avoided, especially due to recurrence of cholesteatoma. However, in some patients, when the indication for subsequent surgery is only hearing improvement, alternative options, such as hearing aids or implants, should also be considered. This is especially true in difficult cases, where revision ossiculoplasty is likely.

The Thermo‐Economic Potential of ORC‐Based Pumped‐Thermal Electricity Storage: Insights from the Integrated Design of Processes and Working Fluids

Higher shares of renewable energy increase the need for electricity storage. A promising storage technology is Pumped‐Thermal Electricity Storage (PTES): PTES systems transform electricity into heat using a heat pump (HP) and reconvert the heat into electricity using a heat engine. Since both HPs and heat engines require working fluids, maximum performance requires the optimal combination of PTES process and working fluids. Herein this work, the thermo‐economic potential of an Organic Rankine Cycle (ORC)‐based PTES system is analyzed by simultaneously designing both the PTES process and the working fluids used in the HP and the ORC. To rigorously explore the molecular design space, the 1‐stage Continuous‐Molecular Targeting ‐ Computer‐Aided Molecular Design method is employed. Detailed models for costing and sizing of the equipment allow for a thermo‐economic design of the PTES. The computer‐aided molecular design formulation integrates the working fluids as degrees of freedom into the process optimization. For the investigated ORC‐based PTES system with an input power of 60 MW, the optimal process and working fluids minimize the specific investment cost to . The analysis of cost drivers shows that with decreasing compressor cost, the investigated ORC‐based PTES system can become a competitive storage technology.

Cost and Cost Driver Analysis of Anterior Cruciate Ligament Reconstruction Using Time-Driven Activity-Based Costing: Bone-Tendon-Bone Autograft Versus Hamstring Autograft.

Background:As health care transitions toward value-based care, orthopaedics has started to implement time-driven activity-based costing (TDABC) to understand costs and cost drivers. TDABC has not previously been used to study cost drivers in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to use TDABC to (1) calculate bone-tendon-bone (BTB) and hamstring ACLR total costs of care and (2) evaluate the impact of graft choice and other factors on ACLR costs.Methods:Data were collected from electronic medical records for primary ACLR from the institutional patient-reported outcome registry between 2009 and 2016 in 1 ambulatory surgery center. Patients receiving allograft, revision ACLR, or concomitant meniscal repair or ligament reconstruction were excluded. The total cost of care was determined using TDABC. Multivariate regression analysis was conducted between ACLR cost and group characteristics.Results:A total of 328 patients were included; 211 (64.3%) received BTB autograft and 117 (35.7%) received hamstring autograft. The mean cost was $2,865.01 ± $263.45 (95% confidence interval: $2,829.26, $2,900.77) for BTB ACLR versus $3,377.44 ± $320.12 ($3,318.82, $3,436.05) for hamstring ACLR (p < 0.001). Operative time was 103.1 ± 25.1 (99.7, 106.5) minutes for BTB ACLR versus 113.1 ± 27.9 (108.0, 118.2) minutes for hamstring ACLR (p = 0.001). The total implant cost was $270.32 ± $97.08 ($257.15, $283.50) for BTB ACLR versus $587.36 ± $108.78 ($567.44, $607.28) for hamstring ACLR (p < 0.001). Hamstring graft (p = 0.006) and suspensory fixation on the femoral side (p = 0.011) were associated with increased costs.Conclusions:The mean cost of care and operative time for BTB autograft ACLR are less than those for hamstring autograft ACLR. Operative time, implant choice, and graft choice were identified as modifiable cost drivers that can empower surgeons to manage primary ACLR costs while maximizing the value of the procedure.Level of Evidence:Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.

Analysis of mass and cost drivers of unstiffened isotropic shell structures considering their imperfection sensitivity

The load carrying capacity of unstiffened thin-walled shell structures is highly sensitive to geometric imperfections. These imperfections are usually unknown during the preliminary design phase. The manufacturing process of these structures has a major influence on the geometric imperfections as well as on the manufacturing costs. The goal of this paper is to show the potential of a previously developed structural and economical design procedure and to analyse the cost and mass drivers of isotropic shell structures, considering their imperfection sensitivity. In order to do so, the available cost model is extended by a precise approach for calculating the material and scrap costs as well as by the assembly method TIG welding. Using an example structure, it is shown in detail how the used panel combination and the chosen assembly method have a significant impact on the structural mass and on the manufacturing costs. Additionally, it is shown that for a high manufacturing accuracy a high amount of panels is beneficial and vice versa. Furthermore, it is pointed out that it is possible to predict the buckling pattern based on the chosen panel combination.

Economic burden of cancers in Taiwan: a direct and indirect cost estimate for 2007–2017

ObjectiveCancers result in significant economic burdens on patients, health sectors and society. Reliable burden estimates will help guide resource allocation. This study aimed to perform a nationwide cost analysis of...

Supervised mixture of experts models for population health.

We propose a machine learning driven approach to derive insights from observational healthcare data to improve public health outcomes. Our goal is to simultaneously identify patient subpopulations with differing health risks and to find those risk factors within each subpopulation. We develop two supervised mixture of experts models: a Supervised Gaussian Mixture model (SGMM) for general features and a Supervised Bernoulli Mixture model (SBMM) tailored to binary features. We demonstrate the two approaches on an analysis of high cost drivers of Medicaid expenditures for inpatient stays. We focus on the three diagnostic categories that accounted for the highest percentage of inpatient expenditures in New York State (NYS) in 2016. When compared with state-of-the-art learning methods (random forests, boosting, neural networks), our approaches provide comparable prediction performance while also extracting insightful subpopulation structure and risk factors. For problems with binary features the proposed SBMM provides as good or better performance than alternative methods while offering insightful explanations. Our results indicate the promise of such approaches for extracting population health insights from electronic health care records.

Light water reactor nuclear power plant commodity cost driver analysis

Light water reactor nuclear power plant commodity cost driver analysis

Light water reactor nuclear power plant commodity cost driver analysis

Construction costs constitute the largest outlay of a nuclear power plant. Direct costs, such as the cost of materials and installation of materials and equipment, make up the majority of construction expenditures. The purpose of this study is to quantify the cost of the two most abundant materials: concrete and steel. This study shows that a 1% reduction in concrete installation rate results in a 0.6% reduction in concrete costs, and a 1% reduction in the steel installation rate creates a 0.3% reduction in steel costs. The additional cost paid for nuclear-quality concrete is shown to be 23% of total concrete budget. The additional cost paid for nuclear-quality steel is shown to be 41% of the total steel expenditures. These results show that focus on decreasing commodity expenditures (through increasing installation rate) can improve the cost of constructing nuclear power plants.

Economics of Nuclear Power Plant Investment: Monte Carlo Simulations of Generation III/III+ Investment Projects

This paper analyzes nuclear power plant investments using Monte Carlo simulations of economic indicators such as net present value (NPV) and levelized cost of electricity (LCOE). In times of liberalized electricity markets, largescale decarbonization and climate change considerations, this topic is gaining momentum and requires fundamental analysis of cost drivers. We adopt the private investors’ perspective and ask: What are the investors’ economics of nuclear power, or - stated differently - would a private investor consider nuclear power as an investment option in the context of a competitive power market? By focusing on the perspective of an investor, we leave aside the public policy perspective, such as externalities, cost-benefit analysis, proliferation issues, etc. Instead, we apply a conventional economic perspective, such as proposed by Rothwell (2016) to calculate NPV and LCOE. We base our analysis on a stochastic Monte Carlo simulation to nuclear power plant investments of generation III/III+, i.e. available technologies with some experience and an extensive scrutiny of cost data. We define and estimate the main drivers of our model, i.e. overnight construction costs, wholesale electricity prices, and weighted average cost of capital, and discuss reasonable ranges and distributions of those parameters. We apply the model to recent and ongoing investment projects in the Western world, i.e. Europe and the United States; cases in non-market economies such as China and Russia, and other non-established technologies (Generation IV reactors and small modular reactors) are excluded from the analysis due to data issues. Model runs suggest that investing in nuclear power plants is not profitable, i.e. expected net present values are highly negative, mainly driven by high construction costs, including capital costs, and uncertain and low revenues. Even extending reactor lifetimes from currently 40 years to 60 years does not improve the results significantly. We conclude that the economics of nuclear power plants are not favorable to future investments, even though additional costs (decommissioning, long-term storage) and the social costs of accidents are not even considered.

The Analysis of Cost Drivers to Successful Implementation of Reverse Logistics System

This research project is officially started from research conducted by Pulansari et al., [1] on the Maturity Level of Reverse Logistics (RL) implementation. This research discussed some company’s claims that RL successfully implements in their company. However, no clear key performance indicators, parameters, or assessment method is provided to measure it. After the framework is arranged, we analyze the most cost drivers influencing the success of RL implementation. Finally, the research goal is how to minimize the Total Reverse Logistics Costs (TRLC) by considering the reverse cost drivers. The result shows TRLC is influenced by 52% from total transportation costs, 36% of total holding costs and 12% from others.

Illuminating an Invisible Epidemic: A Systemic Review of the Clinical and Economic Benefits of Early Diagnosis and Treatment in Inflammatory Disease and Related Syndromes.

Healthcare expenditures in the United States are growing at an alarming level with the Centers for Medicare and Medicaid Services (CMS) projecting that they will reach $5.7 trillion per year by 2026. Inflammatory diseases and related syndromes are growing in prevalence among Western societies. This growing population that affects close to 60 million people in the U.S. places a significant burden on the healthcare system. Characterized by relatively slow development, these diseases and syndromes prove challenging to diagnose, leading to delayed treatment against the backdrop of inevitable disability progression. Patients require healthcare attention but are initially hidden from clinician’s view by the seemingly generalized, non-specific symptoms. It is imperative to identify and manage these underlying conditions to slow disease progression and reduce the likelihood that costly comorbidities will develop. Enhanced diagnostic criteria coupled with additional technological innovation to identify inflammatory conditions earlier is necessary and in the best interest of all healthcare stakeholders. The current total cost to the U.S. healthcare system is at least $90B dollars annually. Through unique analysis of financial cost drivers, this review identifies opportunities to improve clinical outcomes and help control these disease-related costs by 20% or more.

The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records

Objectives: Hepatorenal Syndrome (HRS) is characterized by renal failure in patients with advanced chronic liver disease (CLD) and is the leading cause of hospitalizations in CLD. This study examines the clinical and economic burden, outcomes, and unmet need of HRS treatment in US hospitals.Method: A retrospective cohort study was conducted based on a large electronic health records database (Cerner HealthFacts) with records for hospitalized HRS patients from January 2009–June 2015. Demographics, clinical characteristics, treatment patterns, and economic outcomes were analyzed. Prognostic indicators of cirrhosis, kidney injury, end-stage liver disease, and acute-on-chronic liver failure were used to determine mortality risk.Results: A total of 2,542 patients hospitalized with HRS were identified (average age = 57.9 years, 61.8% males, 74.2% Caucasian), with an average total hospital charge of $91,504 per patient and a mean length of stay (LOS) of 30.5 days. The mortality rate was 36.9% with 8.9% of patients discharged to hospice. Of all patients, 1,660 patients had acute kidney injury, 859 with Stage 3 disease, and 26.7% had dialysis. The 30-day readmission rate was 33.1%, 41% of which were unplanned. Nearly one-third of study patients had commercial insurance (30.2%), followed by Medicare (29.9%); hospital charges varied by LOS, receipt of dialysis, and discharge status. Regression analysis demonstrated that HRS costs are associated with LOS, dialysis, and hospital mortality.Conclusion: HRS is associated with poor outcomes and high hospital costs. Analysis of HRS cost drivers demonstrated an unmet need for additional treatment options to improve outcomes in this patient population.

Supply chain process optimisation via the management of variance

This paper presents a new optimisation approach for variance within a supply chain management process. The approach is presented by the variance cube of purchasing (VCP) that involves a lean method for variance optimisation, namely the cost and variance driver analysis. The approach focuses on the optimisation and the control of existing process variance within the supply chain. The application of the cube is presented by a case study involving a globally acting Tier 1 supplier, who produces steering systems for passenger cars and commercial vehicles. In this case, the sourcing process of this Tier 1 supplier will be analysed, evaluated and optimised regarding variance. The variance is presented in the form of the number of suppliers who are involved in the sourcing process. Unnecessary existing process variance, like an unnecessary huge number of suppliers within the sourcing process, is a type of waste. Time, money, quality and technology can be saved through a greater understanding of the optimal number of suppliers within a sourcing process. The results of the case study led to a generalised method to optimise the existing process variance, present cost improvements as well as optimising the key performance indicator to manage the number of suppliers in the sourcing process. The general approach can be used for other company departments like logistics and for different industries other than automotive. The insights of this article support the operative user and the strategic company management in order to reduce and improve unnecessary variance in different sections. The structured analysis of supply chain process variance via the VCP and the key performance indicator “optimal supplier number per sourcing process” are new to company management.

Real-World Data Analysis of Cancer Treatment Cost Drivers By Type and Place of Service

As the US healthcare system transitions from one of volume based delivery to one focused on quality and value there is a continued focus on understanding the drivers of cost, especially in oncology. Cancer drug costs have been a focus of much debate and this study analyzes real world data from two large volume cancer centers in the US to quantify drivers of cancer treatment costs. Integra Connect utilized Medicare claims data from two large cancer treatment centers in the US with over 60,000 cancer patients treated in the last 12 months. Overall treatment costs were categorized into 9 cost buckets (including Part B drug costs, Part D drug costs, Inpatient, E&M, Lab testing, Imaging, Emergency visits, etc.). Treatment costs were based on amounts paid by CMS from July 2016 through August 2016. Secondary research included a review of previously published studies on cost drivers of cancer care for comparison to current results. Our research found that prescription drug costs from both Part B and Part D paid Medicare claims accounted for 47% (site 1) and 51% (site 2) of total cancer treatment costs. Second to cancer treatment costs, inpatient hospitalization related costs accounted for 20% (site 1) and 17% (site 2) of overall costs. These results contrast previously published research that found cancer drug costs to be a smaller proportion of overall treatment costs (18% of overall costs attributed to chemotherapy and other cancer drugs)1. This real-world data analysis highlights the variability in cancer treatment costs and the continued need for cancer treatments to demonstrate value and savings among other areas that drive overall cost. 1“Cost Drivers of Cancer Care: A Retrospective Analysis of Medicare and Commercially Insured Population Claim Data 2004-2014”, Milliman

原価企画へのコスト・ドライバー分析の活用 : Shank & Govindarajanの見解を中心として

原価企画へのコスト・ドライバー分析の活用 : Shank & Govindarajanの見解を中心として

Managing costs by business model: issues emerging from the case of E-Car

Purpose The aim of this paper is to explore the managing of cost drivers using a business model (BM) design. Particularly, the paper explores the link between a BM and cost driver analysis adopting a service-dominant logic (SDL) perspective. The empirical domain addresses the dynamic and complex scenarios of electric cars, where many actors are involved, several marketing and technological aspects are still unclear and where the high cost of batteries delays the wide diffusion of electric vehicles. The paper explores how SDL could support the BM design and how the cost driver analysis and BM design are linked when the SDL perspective is adopted. Design/methodology/approach This paper analyses secondary data and findings collected by interviews performed with managers belonging to the automotive sector. Findings The results show that the BM design could be a solution to address cost problems and the cost driver analysis may play a role in formulating an economically sustainable BM. Splitting a product into a “package of services” can provide direction for research of an alternative BM design in an attempt to manage the impact of cost drivers and pursue economic sustainability. Originality/value This paper explores a topic that has not yet focused on cost management research, i.e. the link between BM and cost driver analysis adopting an SDL perspective.

Patient-level information and costing systems (PLICSs): a mixed-methods study of current practice and future potential for the NHS health economy

BackgroundTraditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in patient-level information and costing systems (PLICSs). Monitor (the economic regulator for health care) proposes that PLICS data will now form the basis for mandatory prices for health-care services across all care settings.ObjectiveOur main aim was to investigate the use of PLICSs.MethodsWe surveyed all English foundation trusts and NHS trusts, and undertook four case studies of foundation trusts. Three trusts were generalist and one was specialist. We also surveyed commissioning support units to explore the potential for PLICSs in commissioning.FindingsThe most significant use of PLICSs was cost improvement within the trusts. There was only modest utilisation of PLICSs to allocate resources across services and settings. We found that trusts had separate reporting systems for costs and clinical outcomes, engendering little use for PLICSs to link cost with quality. Although there was significant potential for PLICSs in commissioning, 74% of survey respondents at trusts considered their PLICS data to be commercially sensitive and only 5% shared the data with commissioners. The use of PLICSs in community services was, generally, embryonic because of the absence of units of health care for which payment can be made, service definitions and robust data collection systems. The lack of PLICS data for community services, allied with the commercial sensitivity issue, resulted in little PLICS presence in collaborative cross-organisational initiatives, whether between trusts or across acute and community services. PLICS data relate to activities along the patient pathway. Such costs make sense to clinicians. We found that PLICSs had created greater clinical engagement in resource management despite the fact that the trust finance function had actively communicated PLICSs as a new costing tool and often required its use in, for example, business cases for clinical investment. Operational financial management at the trusts was undertaken through service line reporting (SLR) and traditional directorate budgets. PLICSs were considered more of a strategic tool.ConclusionsBoth PLICSs and SLR identify and interrogate service line profitability. Although trusts currently cross-subsidise to support loss-making areas under the tariff, they are actively considering disinvesting in unprofitable service lines. Financial pressure within the NHS, along with its current competitive, business-oriented ethos, induces trusts to act in their own interests rather than those of the whole health economy. However, many policy commentators suggest that care integration is needed to improve patient care and reduce costs. Although the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. London: The Stationery Office; 2012) requires both competition and the collaboration needed to achieve care integration, the two are not always compatible. We conclude that competitive forces are dominant in driving the current uses of PLICSs. Future research should interrogate the use of PLICSs inNew Care Models – Vanguard Sites(NHS England.New Care Models – Vanguard Sites. NHS England; 2015) and initiatives to deliver the ‘Five Year Forward View’ (Monitor and NHS England.Reforming the Payment System for NHS Services: Supporting the Five Year Forward View. London: Monitor; 2015).FundingThe National Institute for Health Research Health Services and Delivery Research programme.