Analysis Of Cost Savings Research Articles

Economic impact case study of a wearable medical device for the diagnosis of obstructive sleep apnoea

BackgroundAcuPebble SA100 (‘AcuPebble’) is a novel wearable medical device to diagnose obstructive sleep apnoea (OSA). This paper investigates the potential economic impact of the technology in the UK through cost savings analysis, and the redirection of savings into further diagnoses.MethodsA cost comparison study was conducted, comparing AcuPebble to the standard diagnostic approach of home respiratory polygraphy (HRP) and in-clinic polysomnography (PSG), estimating the net benefit value (NBV) and return on investment (ROI). Cohort size was varied to model the effects of volume discounted pricing and staff training costs. To demonstrate the potential for cost savings, data on the healthcare costs of undiagnosed OSA patients were used to quantify the benefit of increased OSA diagnosis rates, as facilitated by AcuPebble.ResultsFor 500 uses of AcuPebble, the NBV in the diagnostic pathway over one year would be in excess of £101,169, increasing to £341,665 for 1,500 uses, £1,263,993 for 5,000 uses, and to £2,628,198 for 10,000 uses, with ROIs of 2.02, 3.03, 5.05, and 6.56, respectively. Given an initial cohort of 1,500 patients, 4,555 extra AcuPebble studies could be completed by redirecting resources from HRP/PSG. Direct cost savings to the NHS from resultant lower undiagnosed rates could be between £24,147 and £4,707,810, based on the cost per use and the percentage of tests that result in a positive diagnosis (varied from 25 to 75% positives).ConclusionsAcuPebble presents an opportunity for substantial healthcare savings, enabling an increase in the number of people tested, diagnosed and treated for OSA.

Surgical Tray Optimization in the Setting of Cleft Lip and Palate Reconstruction: Implications for Operative Cost and Efficiency.

To assess surgical instrument usage in cleft lip (CL) and cleft palate (CP) surgery and create an optimized surgical tray with an associated cost-savings analysis. Prospective, observational study. Single institution, 6-month prospective review. A total of 10 primary CL surgeries and 10 primary CP surgeries were included in this study. Complete lists of surgical instruments utilized in CL and CP surgeries were collected. The average instrument UFs were 26.0% for CL and 22.6% for CP. The estimated costs were $33.15 to $290.29 for the original CL surgical tray and $10.20 to $63.80 for the optimized tray. For CP, the original tray's cost was estimated at $38.25 to $319.00, and the optimized tray at $9.18 to $57.42. This demonstrates a cost reduction of $22.95 to $226.49 for CL and $29.07 to 261.58 for CP. The idealized surgical instrument tray could contribute to reducing healthcare expenditures and promoting operating room efficiency, patient safety, and environmentally friendlier operating theaters.

Bleeding us dry: The financial impact of full blood examinations in the immediate postoperative period.

Full blood examinations, often referred to as FBE, are commonly ordered postoperatively, despite limited utility in many of its markers in the acute phase. It is estimated that in the 2022-2023 financial year, the Australian healthcare system billed over $13 million for full blood examinations (FBEs) to Medicare. This study aims to assess the cost of using FBE following surgery. We explore potential cost savings by using a haemoglobin examination (HE) in replace of FBE, with both tests run on identical machines, producing the same result, but at a fraction of the cost. A retrospective analysis was conducted at a single institution, including all patients who underwent minimally invasive laparoscopic pelvic surgeries between 1/7/2017 and 30/6/2019. Patient records were examined to identify patient demographics, postoperative pathology tests and interventions. Patients who received FBE in the first 24 h following surgery were identified and included in the study. Using national surgery and admission statistics, a potential cost-saving analysis will be performed. Among 519 men who underwent robotic-assisted pelvic surgery, 325 patients had routine postoperative investigations, with 323 receiving FBE and 2 receiving HE. Abnormal results were found in the majority of patients that underwent FBE. Eight patients received packed red blood cell transfusion, none of these meeting the hospital-specific criteria for transfusion protocol. Twelve patients received antibiotics, none were in response to abnormal FBE, with all patients experiencing a fever, given prophylactically or in the days following the surgery. FBE and HE are both listed on the Medicare Benefits Scheme at $16.95 and $7.85, respectively, the difference being $9.10. Extrapolating the existing data, within the first 24 h following surgery, the estimated savings were $8818, with savings increasing accumulatively with longer observation intervals following surgery. When similar savings are applied to national figures, the potential savings to the Australian Public Healthcare system likely exceeds millions. Our study revealed that over half of the patients who underwent a RARP received FBE within the first 24 h postoperatively, the vast majority of which exhibited abnormal results that were not acted upon. These findings substantiate the limited utility of FBE in the postoperative setting. Cell markers observed in FBE are predominantly subjective, but consensus exists regarding the importance of evaluating haemoglobin levels postoperatively. Considering that one in four hospital admissions involves surgical procedures, and a $9.10 price differential between FBE and HE, the potential annual economic impact of utilising routine FBEs for assessing haemoglobin levels immediately after surgery is likely to reach millions. Although having obvious flaws, these results underscore the potential accumulative cost arising from everyday clinical judgement and the importance of thoughtful consideration when ordering pathology. The routine ordering of FBE postoperatively, without properly considering its indication, incurs significant costs. This study highlights the potential cost savings by HE instead, emphasising the need for revaluation and appropriate utilisation of pathology tests in the immediate postoperative period given the physiological acute phase response expected postoperatively.

Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda

BackgroundEffective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda.MethodsWe installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device).ResultsChlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products.ConclusionThe STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.

Implementing an Oral Health Educator Contributes to Reduced MBI-CLABSI Rates for Pediatric Hematopoietic Stem Cell Transplant Patients

Mucosal barrier injury central line-associated bloodstream infections (MBI-CLABSIs) remain a challenge among the pediatric cancer population. These infections commonly occur by oral or gastrointestinal (GI) bacteria translocating through impaired gut or oral mucosa. Although strategies to prevent gut MBI-CLABSIs are well characterized, oral pathogen prevention strategies are lacking. The authors' oncodental collaboration quality improvement project, which included two Plan-Do-Study-Act (PDSA) cycles, aimed to improve MBI-CLABSI rates and oral care adherence on a pediatric hematopoietic stem cell transplant (HSCT) unit. PDSA cycle 1 integrated dental residents into existing rounds every third week to screen for dental, gum, and mucosal disease and provide targeted education to patients and families. PDSA cycle 2 implemented a novel oral health educator (OHE) role in which a trained dental hygienist rounded four days per week. Monthly MBI-CLABSI rates and oral care adherence were followed from December 2020 to May 2021 (baseline), June 2021 to March 2022 (PDSA cycle 1), and April 2022 to December 2022 (PDSA cycle 2). Qualitative surveys captured patient and family perception, and a cost savings analysis was completed. A 58.8% reduction in MBI-CLABSI rate (events per 1,000 central venous line days) was detected (baseline: 5.1; PDSA cycle 2: 2.1), oral care adherence improved 41.7% (baseline: 60.9%; PDSA cycle 2: 86.3%), 100% of patients found it beneficial to receive oral care demonstrations, and an annual cost savings of $541,000 was estimated. Direct patient outcomes have measurably improved. This project suggests the implementation of an OHE in pediatric HSCT inpatient units may be valuable to patients and families and may be a cost-effective way to reduce MBI-CLABSIs resulting from oral pathogens.

Vaginal Delivery Surgical Tray Utilization and Cost Savings Analysis

Introduction: The underutilization of surgical trays increases healthcare costs and strain on sterile processing operations. Other surgical specialties have reported instrument underutilization rates, including a reported rate in gynecology of 20.5% (26.3% in abdominal, 13.6% in vaginal, and 19.4% in laparoscopic surgeries), but data in obstetrics is lacking. The objective of this study is to characterize the instrument utilization rate in vaginal deliveries and to estimate potential cost savings with tray modification. Secondary objectives include determining if utilization correlates with the presence of an obstetric laceration and estimated blood loss (EBL). Methods: Instrument utilization data was prospectively collected through a data collection form which was completed immediately after vaginal deliveries. The form was completed by a resident physician or an assisting scrub technician immediately following the vaginal delivery at a tertiary care safety net hospital in 2022. The physician team classified perineal lacerations as first, second, third, or fourth-degree. Vaginal or vulvar lacerations without a perineal component were defined as “other.” The EBL from delivery was also determined by the physician team. Descriptive statistics were calculated as well as Mann Whitney U and Spearman’s rank order correlation analyses. The institutional review board deemed the project to be a quality improvement (#2073102-QI) and patient consent was waived. Results: The instrument utilization was collected for fifty vaginal deliveries. Each vaginal delivery tray contained 18 instruments. The median vaginal delivery tray instrument utilization rate was 27.7% (IQR 26.4-38.9). A median of only 5.0 instruments (IQR 4.7-7.0) were used per delivery. The most used instruments for all deliveries were Kochers (2), Lister bandage scissors (2), and ring forceps (1). In addition to those 5 instruments, deliveries requiring repair of an obstetric laceration also utilized a straight Mayo scissor and 6-inch Hegar needle holder. Twenty-one subjects (42.0%) experienced a delivery-related laceration including first-degree laceration (n=3), second-degree laceration (n=11), third-degree laceration (n=2), and other (n=5). There was a significantly higher median number of instruments required when a delivery-related laceration occurred (7.0 versus 5.0 instruments, p<0.001). There was no correlation between EBL and the number of instruments used in vaginal deliveries (p=0.96). Two deliveries required additional instruments from individually wrapped sterile packages, both of which were right-angle retractors. Conclusion: This is the first study to characterize instrument utilization rates in an obstetric setting. Only 5 of 18 instruments were used per delivery. This corresponds to an instrument utilization rate of 27.7%, which is higher than what other specialties have reported outside of obstetrics and gynecology (13-26%). Assuming the literature reported costs ranging from $ 0.51 to $3.19 per sterilized instrument, a 33% instrument reduction in the tray would save our institution of 1,700 deliveries between $5,196 - $32,538 per year. While the study is limited by a small sample size and a convenience sample type which may introduce bias against more complicated cases, lacerations requiring the repair of obstetric anal sphincter injuries (OASIS) were represented in the sample (4%), consistent with larger population studies. Regardless, this study provides baseline data that may motivate a broader assessment of current utilization rates among other institutions that can inform subsequent sterile tray design. This may not only help decrease costs but also address hospital labor shortages concerning sterile processing. Future studies may utilize larger, multi-institutional cohorts to confirm these preliminary findings of tray underutilization and introduce greater specificity regarding vaginal delivery sterile tray design and cost savings.

Benefits of Neurosurgical Teleconsults in the Management of Intracerebral Hemorrhage: Transfers and Transportation Cost Reduction

Our study explores the efficacy and economic benefits of neurosurgical teleconsultations in managing intracerebral hemorrhage (ICH), focusing on reducing unnecessary patient transfers and associated costs. We conducted a cost-savings analysis at our institution of a previously published pilot study involving a cohort of patients with ICH who were potential candidates for airlift to our tertiary care center but instead received neurosurgical consultation via teleconsultation to avoid the transfer. Data on patient demographics, distances, and costs were collected and analyzed to assess the economic impact of teleconsultations. The cohort comprised 14 patients; we noted significant cost savings from avoiding interhospital transfers, ranging from $84,346.52 to $120,495.03 per patient. Teleconsultations facilitated immediate, collaborative decision-making between healthcare providers at community hospitals and a tertiary care center, reducing the need for expensive air transportation and unnecessary hospital transfers. Neurosurgical teleconsultations offer a cost-effective alternative to traditional patient transfer methods for ICH management, providing substantial economic benefits while maintaining high physician and patient-family satisfaction levels. This study underscores the potential of our teleneurosurgery program to significantly reduce costs by reducing unnecessary financial burdens on patients' families and healthcare systems.

Cost Saving Analysis through Value Engineering Implementation in Hermina Aceh Hospital Building Project

Cost Saving Analysis through Value Engineering Implementation in Hermina Aceh Hospital Building Project

I-125 eye-plaque seed economics: To re-use or to not re-use? A single institutional cost savings analysis of re-using I-125 radioactive seeds for eye—Plaque brachytherapy

INTRODUCTIONIodine-125 (I-125) seeds, commonly used in low-dose rate brachytherapy for ocular malignancies, are often discarded after a single use. This study examines the potential cost savings at an institution with high ocular melanoma referrals, by re-using I-125 seeds for eye-plaque brachytherapy. METHODSIn this single-institutional retrospective analysis, data was collected from I-125 seed orders from 8/2019 through 10/2022. Information including number of seeds ordered per lot, number of plaques built per lot, and number of seeds used per lot were collected. Cost per lot of seed was assumed to be the current cost from the most recent lot of 35 seeds. RESULTSDuring the study, 72 I-125 seed lots were ordered bi-weekly, with a median of 35 seeds per lot (Range: 15–35). Each seed was used on average 2.26 times prior to being discarded. The average duration of each seed lot used was 62.2 days (Range: 21–126). Each seed lot contributed to the construction of an average of 8.4 eye plaques (Range: 2–20). With seed recycling, 2,475 seeds were used to construct 608 eye-plaques. Without re-using practice this would require 5,694 seeds. This resulted in a percentage cost savings of 56.5%, with a total seed cost reduction of $344,884, or $559 per eye-plaque on average. CONCLUSIONThis is the first study to evaluate cost savings relative to re-using I-125 seeds for eye plaques. The data demonstrates how an institution can decrease costs associated with I-125 radiation seeds used for eye-plaque brachytherapy by re-using them.

Feasibility assessment of behind-the-meter batteries under typical tariff structures for commercial and industrial customers

This paper presents a comprehensive analysis of cost savings and payback periods for the deployment of batteries by commercial and industrial customers, considering several typical tariff structures in the context of Australia. To achieve this, a battery energy management mechanism is proposed that enables battery charging, both from the solar photovoltaic system and the grid, and discharging precisely to maximize cost savings and minimize payback periods for commercial and industrial customers while minimizing battery degradation. The proposed mechanism directs the battery to charge from the grid during the most economical periods, and grid charging amounts are optimized based on the battery size and demand profiles, and to discharge during demand charge-, peak rate-, and shoulder rate-applicable periods in succession to reap maximum benefits. Furthermore, sensitivity analyses are conducted to showcase the economic viability of battery trial tariffs (tariffs introduced in Australia to expedite the uptake of batteries for commercial and industrial customers) compared to standard tariffs (usual tariffs imposed on commercial and industrial customers in Australia), considering various scenarios such as changes in battery sizes, customer profiles, and coulomb-ratings. The simulation results suggest that the battery trial tariff is more profitable for a sample commercial and industrial customer compared to the standard tariff, enabling the reduction of payback periods by between 1.53% and 38.05%, for example, under the Tariff 1 structure (one example of a tariff structure introduced by a typical service provider in Australia).

Understanding the financial aspects of digital pathology: A dynamic customizable return on investment calculator for informed decision-making

BackgroundThe adoption of digital pathology has transformed the field of pathology, however, the economic impact and cost analysis of implementing digital pathology solutions remain a critical consideration for institutions to justify. Digital pathology implementation requires a thorough evaluation of associated costs and should identify and optimize resource allocation to facilitate informed decision-making. A dynamic cost calculator to estimate the financial implications of deploying digital pathology systems was needed to estimate the financial effects on transitioning to a digital workflow. MethodsA systematic approach was used to comprehensively assess the various components involved in implementing and maintaining a digital pathology system. This consisted of: (1) identification of key cost categories associated with digital pathology implementation; (2) data collection and analysis of cost estimation; (3) cost categorization and quantification of direct and indirect costs associated with different use cases, allowing customization of each factor based on specific intended uses and market rates, industry standards, and regional variations; (4) opportunities for savings realized by digitization of glass slides and (5) integration of the cost calculator into a unified framework for a holistic view of the financial implications associated with digital pathology implementation. The online tool enables the user to test various scenarios specific to their institution and provides adjustable parameters to assure organization specific relatability. ResultsThe Digital Pathology Association has developed a web-based calculator as a companion tool to provide an exhaustive list of the necessary concepts needed when assessing the financial implications of transitioning to a digital pathology system. The dynamic return on investment (ROI) calculator successfully integrated relevant cost and cost-saving components associated with digital pathology implementation and maintenance. Considerations include factors such as digital pathology infrastructure, clinical operations, staffing, hardware and software, information technology, archive and retrieval, medical–legal, and potential reimbursements. The ROI calculator developed for digital pathology workflows offers a comprehensive, customizable tool for institutions to assess their anticipated upfront and ongoing annual costs as they start or expand their digital pathology journey. It also offers cost-savings analysis based on specific user case volume, institutional geographic considerations, and actual costs. In addition, the calculator also serves as a tool to estimate number of required whole slide scanners, scanner throughput, and data storage (TB). This tool is intended to estimate the potential costs and cost savings resulting from the transition to digital pathology for business plan justifications and return on investment calculations. ConclusionsThe digital pathology online cost calculator provides a comprehensive and reliable means of estimating the financial implications associated with implementing and maintaining a digital pathology system. By considering various cost factors and allowing customization based on institution-specific variables, the calculator empowers pathology laboratories, healthcare institutions, and administrators to make informed decisions and optimize resource allocation when adopting or expanding digital pathology technologies. The ROI calculator will enable healthcare institutions to assess the financial feasibility and potential return on investment on adopting digital pathology, facilitating informed decision-making and resource allocation.

AmBisome® Formulations for Pediatrics: Stability, Cytotoxicity, and Cost-Effectiveness Studies.

Liposomal amphotericin B (Ambisome®) is the gold standard for the treatment and prevention of fungal infections both in the adult and pediatric populations. The lyophilized dosage form has to be reconstituted and diluted by hospital staff, but its management can be challenging due to the spontaneous tendency of amphotericin B to form aggregates with different biological activity. In this study, the colloidal stability of the liposomes and the chemical stability of amphotericin B were investigated over time at storage conditions. Three liposomal formulations of amphotericin B at 4.0 mg/mL, 2.0 mg/mL, and 0.2 mg/mL were prepared and assayed for changes regarding the dimensional distribution, zeta potential, drug aggregation state, and onset of by-products. Our analyses highlighted that the most diluted formulation, kept at room temperature, showed the greatest changes in the aggregation state of the drug and accordingly the highest cytotoxicity. These findings are clinically relevant since the lower dosages are addressed to the more vulnerable patients. Therefore, the centralization of the dilution of AmBisome® at the pharmacy is of fundamental importance for assuring patient safety, and at the same time for reducing medication waste, as we demonstrated using the cost-saving analysis of drug expense per therapy carried out at the G. Gaslini children hospital.

Extended Sanitation Intervals for Cage Components and Automated Watering Valves: Validation and Cost Analysis.

Although the Guide suggests changing rodent cage components every 2 wk, it states that "decreased sanitation frequency may be justified if the microenvironment in the cages, under the condition of use ..., is not compromised." The purpose of this study was to evaluate extended sanitation intervals of cage components (automated watering valve, wire bar lid, and filter top) of mouse individually ventilated caging (IVCs) at our institution. We hypothesized that there would be no significant difference in relative light units measured by ATP luminometry of these cage components at the control time point of 14 d as compared with each extended time interval: 28, 56, and 84 d. In addition, for automated watering valves, the study was extended to 168 d. We also hypothesized that time-and-motion studies performed by moving to a sanitation interval of 84 d for all components would result in substantial time and cost savings. The components of a total of 24 cages containing 4 or 5 mice each were swabbed, and an ATP luminometer was used to detect organic matter. We found no significant differences in organic matter load between 14 d and all other time points for all cage components. Our time- and cost-savings analysis found that extending the sanitation interval of cage components from every 2 wk (14 d) to every 3 mo (84 d) for every 10,000 cages would save about 3,000 technician hours annually, for a total annual labor cost savings of about $100,000. This study is the first to validate the extended sanitation interval of automated watering valves and confirms the findings of previous studies that validated the extended sanitation frequency of wire bar lids and filter tops of rodent IVCs. Overall, extending the sanitation frequency of cage components reduces workload of animal care staff without compromising the cage microenvironment.

EE528 Analysis of Non-Pharmacological Cost Savings Derived from the Use of Fixed-Dose Combination of Pertuzumab and Trastuzumab for Subcutaneous Injection in Patients with HER2-Positive Breast Cancer in Spain

EE528 Analysis of Non-Pharmacological Cost Savings Derived from the Use of Fixed-Dose Combination of Pertuzumab and Trastuzumab for Subcutaneous Injection in Patients with HER2-Positive Breast Cancer in Spain

EE429 Current Parallel Trade Practice in the Pharmaceutical Industry Focusing on European Single Market, Utilizing a Cost-Saving Analysis in the Allergen Immunotherapy Market of Germany

EE429 Current Parallel Trade Practice in the Pharmaceutical Industry Focusing on European Single Market, Utilizing a Cost-Saving Analysis in the Allergen Immunotherapy Market of Germany

Anti-CGRP mAbs for the Preventive Treatment of Migraine: An Overview Review and a Cost Saving Analysis in the Global Scenario.

Objectives: Migraine is a neurological disease with a high frequency of incidence. The new monoclonal antibodies selective for the calcitonin gene-related peptide and its ligand (anti-CGRP mAbs) have been marketed both in the USA and EU based on the positive efficacy results in the prevention of migraine. This search has been carried out with the aim of collecting real-world evidence on the effectiveness of anti-CGRP mAbs, performing a cost-savings analysis, and comparing performances among anti-CGRP mAbs medicines marketed in the American and European market. Methods: The literature review has been performed in PubMed database on 31 December 2022; the cost of the unitary dose of anti-CGRP mAbs has been extracted consulting an American national database. Results: The results confirm efficacy and good tolerability of anti-CGRP mAbs, determining a difference in the purchase price. In fact, all extracted studies showed a protective risk factor exposure in monthly migraine days reduction for all the anti-CGRP mAbs, whereas the cost analysis showed that using eptinezumab, in a quarter there is a cost saving of at least $425 per patient, compared with the other anti-CGRP mAbs. Conclusions: With equal efficacy and equal safety, anti-CGRP mAbs should be prescribed also regard to the cost established at the negotiation, making sure to guarantee the best treatment to the patients, but at the same time impacting as little as possible to the healthcare services resources.

Energy-saving, economic and environmental benefits analysis of cool roofs and green roofs for retail buildings in America

Green roofs and cool roofs are considered to improve energy efficiency, and provide economic benefits, energy-saving benefits, environmental benefits for the traditional grey roofs. Some national and local standards have analysed and recommended these technologies in existing building renovations, but their research subjects were mostly office or residential buildings, which didnt include the evaluation and analysis of specific roof renovations in different thermal zones in the United States. This paper conducted a 40-year life cycle cost analysis of retail buildings roofs in 16 cities across 8 different thermal zones in the United States. LCCA found that cool roofs showed a positive life cycle NPV in all cities, while green roofs showed a negative NPV. This article also analysed and compared the environmental benefits of retail buildings roofs in 16 cities, and calculated the emission reductions that they can bring to power plants. This paper also selected retail buildings roofs from 8 representative cities in 8 different thermal zones for energy savings and cost savings analysis. The results show that decision-makers can transform ordinary roofs into green roofs or cool roofs according to the characteristics of each thermal zone, combined with energy-saving benefits, economic benefits, environmental benefits and other factors, which is conducive to the implementation of new specifications.

Clinical impact and cost-saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer.

Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.

Closing the Loop: Toward Sustainable 3D Print Recycling in the Clinic

THREE-DIMENSIONAL (: 3D) printing is becoming ubiquitous in Radiation Therapy resulting in large amounts of plastic waste generated. We report on the feasibility, workflows, material properties and cost effectiveness of 3D print recycling to increase sustainability of 3D printing in clinics. Polylactic acid (PLA) prints were recycled using a consumer-grade recycling system consisting of i) plastic shredder to granulate used prints ii) heated extruder to melt material into filament iii) fan-cooled path for rapid cooling iv) spooling rig and v) pelletizer to cut filament into more regularized pellets as input material for step ii). The recovery percentage of material was characterized after each step by weighing inputs/outputs; timing and workloads were also recorded. Resulting recycled filaments were characterized in diameter and tensile strength and were compared between two different extruder nozzle configurations and with vs without pelletization to find an optimal recycling process. Recycled filament was finally used to create clinical items and evaluated. Lastly, a cost analysis over the past 1 year of recycling use was performed to determine the cost effectiveness of the recycling system. PLA prints were recycled with an overall efficiency of 79.3 ± 12.2% (standard deviation) between color batch runs. The best recycled filament quality was produced using the pelletization process and wider 3.25mm extruder nozzle. Relative to new filament, tensile strength testing showed recycled filament strength was 79% vs 70% (pelletized vs unpelletized) and 86% vs 60% (3.25mm vs 2.85mm nozzle). Extrusion and spooling procedures proved difficult to optimize, requiring lots of operator supervision (∼45 minutes per spool, mean 475g) and achieved a best filament diameter of 2.85 ± 0.09mm. A cost analysis shows that without accounting for operator time, it would require over 25 years to recoup the cost of the recycling system. Over the past 1-year, clinical 3D printing at our site consisted of 40 patient boluses and 25 electron cutouts, consuming about 6.5kg of PLA. Due to infection control concerns only 35% of this material was eligible for recycling, however 3.5 times that amount was collected from other printing activities. Recycling reduced new filament use by 56% ($470). Recycling workflows proved difficult to streamline and resulted in filament diameter that was marginally outside common industry standards and about 20% less strong but deemed adequate for clinical printing. Although the cost savings analysis indicates a poor return on investment, increasing the scale of the operation would be beneficial. To achieve this, we plan to recycle PLA boluses after disinfection and solicit other clinics in our hospital network and local 3D printing hobbyist community to recycle their prints.

Cost minimization in breast conserving surgery: a comparative study of radiofrequency spectroscopy and full cavity shave margins

BackgroundIn an effort to minimize positive margins and subsequent re-excision after breast conserving surgery (BCS), many providers and facilities have implemented either a Full Cavity Shave (FCS) approach or adding the MarginProbe Radiofrequency Spectroscopy System.ObjectiveWe sought to create a functioning Pro-Forma for use by facilities and payers to evaluate and compare the cost savings of implementing FCS or MarginProbe based on personalized variable inputs.MethodsA decision tree demonstrating three possible surgical pathways, BCS, BCS + FCS, and BCS + MarginProbe was developed with clinical inputs for re-excision rate, mastectomy as 2nd surgery, rate of reconstruction, and rate of 3rd surgery derived by a literature review. A surgical pathway cost formula was created using the decision tree and financial inputs derived by utilizing the nation’s largest database of privately billed health insurance claims and Medicare claims data (fairhealth.org). Using the surgical pathway formula and financial inputs, a customizable Pro-Forma was created for immediate cost savings analysis of BCS + FCS and BCS + Marginprobe using variable inputs. Costs are from the perspective of third-party payers.ResultsUtilizing MarginProbe to reduce re-excisions for positive margins can be associated with better cost-savings than FCS due to the increased pathology processing costs by using an FCS approach. The reduction in re-excision provided by both FCS and MarginProbe offset their increased expense to various degrees with cost savings of each method improving as baseline re-excisions rates increase, until ultimately each may become cost-neutral or cost-prohibitive when compared to BCS alone. Our data suggest that in the privately insured population, MarginProbe provides a cost-savings over BCS alone when baseline re-excision rates are over 20% and that FCS becomes cost-saving when baseline re-excision rates are over 29%. For Medicare patients, MarginProbe provides a cost-savings when baseline re-excision rates exceed 34%, and FCS becomes cost-saving for re-excision rates over 52%. Our Pro-Forma allows an individual provider or institution to evaluate the cost savings of the FCS approach and/or utilization of the MarginProbe device such that the additional cost or cost-savings of utilizing one or both of these methods can be quickly calculated based on their facility’s volume and baseline re-excision rate.ConclusionsOur data suggest that utilizing either an FCS approach or the MarginProbe radiofrequency spectroscopy system may be a cost-saving solution to reducing the rate of re-excisions depending on a facility or practice’s surgical volume and baseline re-excision rate. The degree to which each of these interventions provides an added cost or cost-savings to healthcare payers can be evaluated by utilizing the Pro-Forma outlined herein with customizable variable inputs.