Cost Analysis Research Articles

Quantitative Analysis of Green H2 Production Costs: A Comparison between Domestic Developed and Imported Electrolyzers

This study aims to present a quantitative cost analysis of hydrogen utilizing a developed alkaline electrolyzer, a similar-capacity imported alkaline electrolyzer, and a similar-capacity PEM electrolyzer.The research also finds the key parameters that can reduce or increase the production cost. One of the subjected electrolyzers is a locally developed Alkaline Electrolyzer (AE); the other two are similar-capacity imported AE and Polymer Electrolytic Membrane (PEM) electrolyzers. The study uses the Hybrid Optimization of Multiple Energy Resources (HOMER) software for estimating the Levelized Cost of Electricity (LCOE) and the Life Cycle Cost (LCC) method for hydrogen production cost estimation. Results show that the imported electrolyzers have higher production costs due to import duty, fees, and taxes. The estimated cost is 88.4% (AE) and 110.3% (PEM), higher than the locally developed electrolyzer. The economic changes also significantly impact production costs. Government policies can reduce the cost by rescheduling the hydrogen components taxes.

Digital twins and dynamic NFTs for blockchain-based crowdsourced last-mile delivery

In this paper, we propose a blockchain-based crowdsourcing framework leveraging Digital Twins (DTs) and dynamic Non-Fungible Tokens (NFTs) for a transparent last-mile delivery. Existing works propose package delivery through crowdsourced workers managed by centralized or blockchain-based platforms. While the centralized platforms suffer from data security and reliability vulnerabilities, the blockchain-based platforms lack real-time and transparent package status monitoring. The availability of immediate access to status updates and early warnings regarding package storage conditions greatly contributes to ensuring the safe delivery of sensitive packages and preventing spoilage or further damage. As a solution, we propose a decentralized crowdsourcing platform for last-mile delivery utilizing Ethereum smart contracts and DTs for both the packages and the workers. The contracts are leveraged to facilitate interactions between the requesters and workers, and securely execute the task allocation mechanism, which relies on a computed Quality-of-Service (QoS) metric. The package DTs are proposed to oversee the package status and promptly alert workers’ DTs when delivery conditions are violated. To ensure data integrity and prevent malicious alterations, the DTs’ data is securely stored using NFTs. Upon task completion, a calculated Quality-of-Delivery (QoD) acts as a feedback loop in updating workers’ reputations. The proposed allocation mechanism is benchmarked against distance-based and preferences-based allocation mechanisms where our framework improves the average QoS by 76%, average QoD by 22%, and quality of selected workers by 11%. In addition, the DTs are implemented to verify alert generation through a use case. We provide a detailed cost analysis of deployed smart contracts, along with insights into current limitations and proposed mitigation strategies.

Abstract PO2-07-04: Applying the Alliance Trial Guidelines in Multi-focal Breast Disease Using an Artificial Intelligence Computational Platform: Economic Analysis and Cosmetic Sensitivity

Abstract Background: Traditionally, multi-focal breast cancer results in mastectomy. The Alliance Trial offers a paradigm shift in surgical options available for multi-focal breast cancer patients in the context of adjuvant chemotherapy. In the trial, patients with multi-focal disease (< 3 tumors) who underwent breast conservation surgery (BCS) were found to have similar outcomes to patients undergoing mastectomy. BCS for large volume tumors ( >30%) has been cited as having a high potential for cosmetic defect, and hence represents a typical upper limit for potential tissue removal in BCS. Here, we evaluated a patient cohort to better understand the economic impact of the Alliance trial and further categorize patients that would most benefit without suffering cosmetic impact. We employed a novel computational technology to quantify the ratio of tumor size to breast tissue volume. Methods: Using a publicly available, single site cohort (n=243, DUMC) of breast cancer patients that underwent mastectomy, we segmented the tumors using our TumorSight Viz software platform. This platform uses artificial intelligence to segment the tumor and surrounding tissues and allows for a volumetric and morphologic assessment in 3D space. We then applied relevant inclusion/exclusion criteria from the Alliance Trial to the cohort (Saha et al, 2018). In trial eligible patients, we used TumorSight Viz to create a convex hull (CH) around the multi-focal disease using dilations of 1 cm and 2 cm. The volume of the CH, corresponding to proposed surgical extirpation, and the overall breast volume (BV) were then computationally assessed in 3D. The ratio of CH to BV (CH:BV) was calculated and a cutoff of 30% (high potential for cosmetic deformity) was applied. A cost analysis was then carried out. We determined the aggregate per annum savings that could potentially be realized by transforming a subset of mastectomies to BCS by tabulating total costs of mastectomy+reconstruction vs. BCS+WBI (whole-breast irradiation), as well as adjusted for relative rates of adjuvant therapy (~80%) across the nationwide patient population. Results: We found that 19.3% of adjuvant mastectomy patients were eligible for BCS based on Alliance Trial criteria. Of those, 68% had tumor CH:BV < 30% when using a 1 cm dilation around the tumor. When using a 2 cm dilation, 56% had tumor CH:BV < 30%. Together, these results indicate that of all adjuvant mastectomy patients, an estimated 10.8-13.1% are eligible for BCS based on volumetric measures of cosmetically acceptable breast tissue removal. Our economic analysis of BCS vs. mastectomy revealed an estimated $28,500 cost savings for patients with private insurance, suggesting that both decreased costs and improved quality-of-life (QOL) can be mutually aligned. By assessing the nationwide number of patients receiving adjuvant therapy for breast cancer, alongside the percentage potentially eligible for BCS using the above cosmetic defect analysis, we estimate that BCS conversion from mastectomy offers to provide a net savings of $300-350 million annually. Conclusion: The Alliance Trial guidelines unveiled the potential option of BCS in ~20% of patients with multi-focal disease in our cohort, demonstrating considerable cost-savings. Computational tools can further differentiate individuals who may not be best candidates for BCS in this setting, ensuring high QOL and informed decision-making. Citation Format: John Pfeiffer, Matthew Biancalana, Dorys Lopez-Ramos, Bradley Feiger, Anuja Antony. Applying the Alliance Trial Guidelines in Multi-focal Breast Disease Using an Artificial Intelligence Computational Platform: Economic Analysis and Cosmetic Sensitivity [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-07-04.

Abstract PO3-01-02: Real world outcomes of neoadjuvant therapy with Trastuzumab and Pertuzumab associated with carboplatin and docetaxel (TCHP) in HER2+ early breast cancer patients unfit for anthracyclines: a retrospective cohort comparative study

Abstract Backgound Neoadjuvant chemotherapy (CT) with anti-HER2 blockade using trastuzumab (H) and pertuzumab (P) is a standard of care for patients (pts) with HER2-positive early-stage Breast Cancer (eBC). Historically, taxanes (T) and anthracyclines (A) have been the mainstays of (neo)adjuvant CT in this setting, but the added benefit of A in the era of anti-HER2 therapy has been questioned. This study aimed to assess the effectiveness, cardiac safety, and cost-effectiveness of an anthracycline-free regimen (TCHP) in a real-world population of pts deemed unfit for A, compared to pts treated with the standard regimen of doxorubicin and cyclophosphamide plus dual-blockade associated with docetaxel (AC-DHP) at a single Portuguese Comprehensive Cancer Center. Methods This retrospective cohort study included a consecutive series of female eBC HER2+ pts who initiated primary treatment with TCHP between July 2018 and August 2022. The primary endpoint was pathological complete response (pCR), and secondary endpoints were cardiac safety and disease-free survival (DFS). The outcomes were compared with a historical database of eBC HER2+ pts who started primary treatment with AC-DHP between August 2015 and May 2021. Clinical data was collected from medical and administrative records. Descriptive statistics were used to describe categorical and continuous variables, and the Kaplan-Meier method was used for DFS analysis. Costs analysis employed the micro-costing technique, considering individual medical direct costs from diagnosis until surgery. Multivariate logistic regression models were used for effectiveness analysis and the gamma general model for costs analysis. The incremental cost-effectiveness ratio (ICER) was calculated using the pCR rate as a measure of effectiveness. Results A total of 233 and 23 pts were included in the TCHP and AC-DHP groups respectively. Reasons for choosing the anthracycline-free regimen in the TCHP group were primarily age-related frailty (52%), medical comorbidities (26%), and previous exposure to anthracyclines (22%). The TCHP pts were older (median age 71 years, range [45-77] vs. 47 years [24-70]) and had lower baseline Left Ventricular Ejection Fractions (LVEF) (median 65% [51-80] vs. 60% [56-73]), with a higher proportion of hormone receptor (HR) negative pts (78.3% vs. 33.0%). Clinical stages were balanced between groups, but the TCHP group had a higher nodal involvement (N+) (73.9% vs. 61.8%). The pCR rates were higher in the TCHP group (65.2% vs. 46.1%, HR 0.98 [95% CI 0.36 - 2.70]). Subgroup analysis by HR status showed comparable pCR rates: 77.1% vs. 74.1% in HR- pts and 40% vs. 39.7% in HR+ pts. Cardiac safety analysis indicated a median decrease in LVEF of 9% in both the TCHP and AC-DHP groups, with 43.5% of TCHP pts experiencing a decline of 10% or more, and 13.0% dropping below 50%. In comparison, these figures were 44.2% and 3.9%, respectively, in the AC-DHP group. At the end of the follow-up, only one patient in the TCHP group with a LVEF < 50% persisted with mild symptoms of chronic heart failure. The median follow-up time for DFS events, starting from surgery, was 31.1 months in the TCHP group and 45.7 months in the AC-DHP group, with 1-year DFS rates of 91.3% and 100%, respectively. The ICER analysis indicated that TCHP was cost-effective, as the incremental cost for achieving an additional pCR in similar subgroups can be outweighed by later cost savings, mainly due to further adjuvant treatment with trastuzumab instead of TDM-1. Conclusions In a real-world population of HER2+ eBC patients unfit for anthracyclines, the TCHP regimen demonstrated a higher overall pCR rate compared to a historical control treated with the AC-DHP regimen, along with an acceptable cardiac safety profile. These results support the broader use of the TCHP regimen in HER2+ eBC pts, as recommended by current NCCN guidelines. However, larger studies involving similar populations are needed to provide higher levels of evidence. Citation Format: Ricardo Pinto, Rita Calisto, Patrícia Redondo, Ana Silva, Pedro Castro, Rute Fernandes, Raquel Teixeira, Diana Mata, Ana Ferreira, Maria Bento, Cláudia Vieira. Real world outcomes of neoadjuvant therapy with Trastuzumab and Pertuzumab associated with carboplatin and docetaxel (TCHP) in HER2+ early breast cancer patients unfit for anthracyclines: a retrospective cohort comparative study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-01-02.

Abstract PO2-03-09: Cost-effectiveness analysis of RAD51 functional biomarker for platinum sensitivity in the GeparSixto trial

Abstract Background: Homologous recombination repair deficiency (HRD) has long been recognized as a predictive biomarker for platinum sensitivity and is present in up to 60% of early triple negative breast cancers (TNBC). Different commercial and lab-developed assays to measure HRD are available, but they do not necessarily reflect homologous recombination functionality. Functional HRD, defined by a low score in RAD51 foci, is emerging as an accurate and dynamic biomarker to predict DNA damaging agents’ response. We performed a cost-effectiveness evaluation of the RAD51 test compared to tumor BRCA1/2 mutation (tBRCA1/2) or genomic HRD by Myriad Mychoice® to identify patients sensitive to platinum-based chemotherapy within the GeparSixto trial. Methods: The effectiveness measure was the primary outcome of the GeparSixto study: rate of pathological complete response (pCR), defined as ypT0 ypN0. The pharmacological costs were calculated following treatment protocol of GeparSixto where TNBC patients received neoadjuvant paclitaxel plus Myocet®-nonpegylated liposomal doxorubicin (PM) or PM plus carboplatin (PMCb), both arms including bevacizumab. Bevacizumab was excluded from the cost analysis as it is not administered by standard practice. The cost of a session/stay at the day hospital was added, as well as the cost of the test used, comparing 4 scenarios: All comers (assuming all patients receiving PMCb); RAD51 test (assuming RAD51 ≤10% received PMCb and RAD51 >10% received PM); tBRCA1/2 test (assuming tBRCA1/2 mutated received PMCb and tBRCA1/2 non-mutated received PM) and genomic HRD by Myriad Mychoice® (HRD score ≥42 received PMCb, and HRD score <42 received PM). The available commercial costs were considered for tBRCA1/2 and Myriad Mychoice®, and the VHIO performance cost was considered for the RAD51 test. Parameter uncertainties were assessed by means of one-way and probabilistic sensitivity analyses. Results: All comers total cost was 20,530€ per patient, with associated pCR rate of 54.5%. Functional RAD51 test was associated with a pCR probability of 55.1% with a Δ cost of 198€, as opposed to tBRCA1/2 which presented a pCR rate of 40.1% with a Δ cost of 814€, and genomic HRD with 47% pCR rate and the higher Δ cost of 1,023€ per patient, when compared to all comers. The incremental cost-effectiveness ratio (Δ cost/Δ pCR) was 33,000 for RAD51 test and dominated in both tBRCA1/2 and genomic HRD tests. These results were robust on one way and probabilistic sensitivity analyses. Conclusion: The most efficient scenarios are the functional RAD51 test and all comers. Both tBRCA1/2 and genomic HRD by Myriad Mychoice® scenarios provide worse health outcomes at a higher cost, based on the data of the GeparSixto trial. This study highlights the potential overall benefit of functional HRD biomarkers to predict PARPi sensitivity. Citation Format: Isabel Pimentel, Carles Forné, Alba Llop-Guevara, Misericòrdia Carles-Lavila, Violeta Serra, Montserrat Rué, Judith Balmaña. Cost-effectiveness analysis of RAD51 functional biomarker for platinum sensitivity in the GeparSixto trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-03-09.

Study on the Evaluation of the Profitability, Efficiency and Investment Trends of Different Poultry Farming Systems

Over the past 20 years, the Indian poultry sector has transformed into a dynamic entity with more structured operations. Following all these practices almost at every level, poultry industry is now achieving new heights day by day. The entire livestock sector's contribution to India's GDP is greatly aided by the poultry industry in the country. India's poultry sector ranks second and third in the world in terms of meat and egg output, respectively, with 3.4 million tonnes of meat and 65 million tons of eggs produced (FAO). Significant advancements in the industry have resulted from management initiatives. Most of India's organized structure has contributed to the effective use of resources and the right implementation of policies, which have improved firm financial positions and produced the intended results. The data was collected from stakeholders with the help of pretested interview schedule. Separate interview schedule was prepared for broiler farmers (100 samples), breeder farmers (10 samples) and processing cum distribution centers (20 samples). A combination of tools viz. average, percentage, cost and return analysis. To get better understanding of the study, the sample farmers were classified into different supply chains based on their mode of working and business stages performed. Feeding management practices were followed aptly by most of the farmers. Almost all farmers were following suitable health management practice by vaccinating their birds. Based on number of birds reared poultry farms were classified as small, medium and large poultry farms. Small farms were in only in Supply Chain II and III. Fixed investment they did was `583010 and `46733 out of which nearly 85 per cent building charge. In medium sized poultry farms category, poultry farms from Supply Chain II, III and IV were present. Fixed investment they made was `12,22,096, `15,94,147 and `13,27,778 respectively of which more than 90 per cent was spent on farm buildings construction purpose. In large poultry farms, Supply Chain IV farmers had made quite huge fixed investment. For all the farms, of the total investment, 90 per cent was in buildings and 10 per cent was in equipments.

Identification of Beach Erosion in Colombo- North Coast Line: Effectiveness of the Engineered Solutions

Coastal erosion is a silent disaster in Sri Lanka due to the loss of valuable land. Already, millions of rupees have been spent on coastal protection. This study assessed the long-term effectiveness of those engineered solutions, especially focusing on the Colombo- North coastline. The effectiveness was assessed by comparing erosion rates in the last 20 years with available historical data. Shorelines of the last 20 years were observed and digitized by Google Earth image analysis and erosion rates were calculated by GIS and Digital Shoreline Analysis (DSAS) tools. The evolution of the structures was observed and analysed by satellite image analysis and other available data from reliable sources such as reports produced by the Government. Cost estimation for the observed structures was carried out using BOQ analysis and discounted methods. Results showed that more than 60 numbers of structures have been constructed during the last 20-30 years along the study area. Uswetakeyyawa to Estuary of Kelani River stretch was identified as the region with the highest structure density. When analyzing the results, it was revealed that the structures built in that region have reduced the erosion rate (0.43 m/year) compared to the 1996 rates (2.5 m/year). Digital shoreline analysis further indicated effectiveness as most of the protected areas from Negombo to Maha Oya estuary have been accreted during the last 20 years while unprotected areas from Uswetakeyyawa to Negombo lagoon, have been subjected to erosion. According to cost estimations, approximately Rs 1.23 billion have been spent in the last 20-30 years on the entire study area. Further, the cost analysis of the Uswetakeyyawa to Kelaniya stretch revealed that the investment for 1m accretion was Rs 28.5 million. However, the cost-effectiveness of the structures should be further assessed against the land loss value with an integrated Coastal Vulnerability Index.

Economic evaluation of anti-CD19 CAR T-cell pathway for large B-cell lymphomas in the real-life setting: the experience of an Italian hub center in the first three years of activity

Poor literature report actual and detailed costs of chimeric antigen receptor (CAR) T-cell pathway in a real-life setting. We retrospectively collect data for all patients with relapsed/refractory aggressive large B-cell lymphoma who underwent leukapheresis between August 2019 and August 2022. All costs and medical resource consumption accountability were calculated on an intention-to-treat (ITT) basis, starting from leukapheresis to the time when the patient (infused or not) exited the CAR T-cell pathway for any reason. Eighty patients were addressed to leukapheresis and 59 were finally infused. After excluding CAR-T product cost, the main driver of higher costs were hospitalizations followed by the examinations/procedures and other drugs, respectively 43.9%, 26.3% and 25.4% of the total. Regarding costs of drugs and medications other than CAR T products, the most expensive items are those referred to AEs, both infective and extra-infective within 30 days from infusion, that account for 63% of the total. Density plot of cost analyses did not show any statistically significant difference with respect to the years of leukapheresis or infusion. To achieve finally 59/80 infused patients the per capita patients without CAR-T products results 74,000 euros. This analysis covers a growing concern on health systems, the burden of expenses related to CAR T-cell therapy, which appears to provide significant clinical benefit despite its high cost, thus making economic evaluations highly relevant. The relevance of this study should be also viewed in light of continuously evolving indications for this therapy.

EcoSonicML: Harnessing Machine Learning for Biodiversity Monitoring in South African Wetlands

Biodiversity monitoring, particularly in a country as diverse as South Africa with its extensive migratory bird population, presents significant challenges. This challenge becomes even more pronounced in environments with a multitude of coexisting bird species, notably wetlands, which serve as crucial breeding and feeding grounds for various avian species. This research will address this challenge by designing a cost-effective sound-based sensor system capable of deployment in diverse wetland ecosystems. The primary aim is to aid in the monitoring of bird species by detecting their presence and distribution and then transmitting this valuable data to a central base station. To assess the system’s feasibility and performance, a series of experiments were conducted at the Rondevlei Nature Reserve in Cape Town, South Africa. These experiments focused on the sensor’s capacity to accurately identify avian species while maintaining robustness in varying environmental conditions. The results yielded promising outcomes, demonstrating the successful identification of bird species. Furthermore, the system exhibited reliability across different weather conditions, positioning it as a viable choice for long-term deployment in wetland environments. Beyond species detection, this project also delved into practical aspects of data transfer and storage efficiency, ensuring the system’s suitability for real-world applications. Modularity was another crucial consideration, simplifying maintenance and upgrades. Moreover, a preliminary cost analysis indicated the cost-effectiveness of the system compared to commercial alternatives. The integration of climate sensors into the monitoring system was explored as a future direction. This addition holds the potential to provide a more comprehensive approach to environmental monitoring by incorporating climate data into the analysis. Such a holistic approach can further enrich our understanding of bird behaviour in relation to changing environmental conditions. The findings of this research have significant implications for avian conservation and ecological studies, particularly in the unique context of South Africa. This project introduces an affordable and practical tool for monitoring bird species in wetland habitats, offering valuable insights into the preservation and management of these critical ecosystems.

Improving Access to Care, Patient Costs, and Environmental Impact Through a Community Outreach Lung Cancer Rapid Assessment Clinic.

In Southeastern Ontario, increased patient distance from the regional lung cancer diagnostic assessment program (LDAP) is associated with a lower likelihood of patient care via LDAP while receiving care via LDAP is associated with improved survival. We implemented an LDAP outreach clinic to provide specialist assessment for patients with suspected lung cancer at a regional community hospital and assessed the impact on timeliness and accessibility of care. The Kingston Health Sciences Centre LDAP team engaged with community hospital partners to develop and launch the LDAP outreach clinic. We performed a retrospective chart review of LDAP patients (N = 1,070) before (August-November 2021; n = 234) and after implementation of the outreach clinic (November 2021-October 2022; n = 836). Descriptive data are reported as No. (%). Unpaired t tests and statistical process control charts assess for significance. A cost analysis of out-of-pocket patient costs related to travel and parking is presented in 2022 Canadian dollars (CAD). Compared with a 3-month matched time period before (August-October 2021) and after outreach clinic (August-October 2022), the mean time from referral to assessment and time from referral to diagnosis decreased from 20.3 to 14.4 days (P = .0019) and 40.0 to 28.9 days (P = .0007), respectively. Over 12 months, the total patient travel was reduced by 8,856 km, which combined with parking cost-savings, resulted in patient out-of-pocket savings of CAD $5,755.60 (CAD $47.60/patient). Accounting for physician travel, the total travel saved was 5,688 km, corresponding to reduced CO2 emissions by 1.9 tCO2. Implementation of a lung cancer outreach clinic led to improved timeliness of care, patient cost-savings, and reduced carbon footprint while serving patients in their community.

Interventions to Prevent Hospital Admissions in Long-Term Care Facilities: A Rapid Review of Economic Evidence

ObjectivesHospital admissions can be hazardous for older adults, particularly those living in long-term care facilities. Preventing nonessential admissions can be beneficial for this population, as well as reducing demand on health services. This review summarizes the economic evidence surrounding effective interventions to reduce hospital attendances and admissions for people living in long-term care facilities. DesignRapid review of economic evidence. Setting and ParticipantsPeople living in long-term facilities. MethodsWe searched MEDLINE, CINAHL, Cochrane CENTRAL, PubMed, and Web of Science on September 20, 2022, and again on January 10, 2023. Full economic evaluations and cost analyses reporting on advanced care planning, goals of care setting, nurse practitioner input, palliative care, influenza vaccinations, and enhancing access to intravenous therapies were eligible. Data were extracted using a prepiloted data extraction form and critically appraised using either the Drummond-Jefferson checklist or an amended NIH Critical Appraisal Tool appended with questions from a critical appraisal checklist for cost analyses. Data were synthesized narratively. ResultsWe included 7 studies: 3 full economic evaluations and 4 cost analyses. Because of lack of clarity on the underlying study design, we did not include one of the cost analyses in our synthesis. Advanced care planning, a palliative care program, and a high-dose influenza vaccination reported potential cost savings. Economic evidence for a multicomponent intervention and a nurse practitioner model was inconclusive. The overall quality of the evidence varied between studies. Conclusions and ImplicationsA number of potentially cost-effective approaches to reduce demand on hospital services from long-term care facilities were identified. However, further economic evaluations are needed to overcome limitations of the current evidence base and offer more confident conclusions.

Perovskite photovoltaics for aerospace applications − life cycle assessment and cost analysis

In the past few years, we have witnessed a rapid evolution of perovskite solar cells. In this study, we employ life cycle assessment (LCA) to identify the potential environmental impacts of perovskite solar cells (PSC) optimised for aerospace applications but could be used in conventional terrestrial applications too. One PSC module is manufactured by spin coating equipped with ITO glass and gold cathode. The other PSC module is manufactured by slot-die coating with a PET layer and carbon cathode and gold cathode respectively. Life cycle assessment is employed to compare potential environmental impact of two manufacture methods by impact method of Recipe(H), as well as the fabrication cost of PSC module. The primary data of material and energy used for fabricating PSCs are collected from spin coating with lab scale and slot-die coating with pilot scale. The life cycle impact assessment of the PSC module in the pilot scale shows much lower in all the assessed 18 impact categories than in the lab scale thanks to the material use efficiency and reducing energy consumption. Gold as a conduct electrode has the highest impacts in both spin coating and slot-die coating modules. Calculating with a two-year lifetime (typical of aerospace applications), the impact of global warming potential from the PSC module with carbon electrode with pilot scale used in a terrestrial application is calculated to be 12 g/kWh.

Constructing an elderly health monitoring system using fuzzy rules and Internet of Things

Monitoring the health of the elderly using wearable sensors and Internet of Things (IoT) devices necessitates the collection of data from various sources, thereby increasing the volume of data to be gathered at the monitoring center. As previously elucidated, the system exhibits high accuracy in measuring variables such as blood oxygen saturation (BOS) and heart rate (HR), as well as demonstrating proficient accuracy in implementing fuzzy rules to detect the “stable” or “unstable” condition of elderly patients. Therefore, by integrating wearable sensors and IoT devices into the elderly health monitoring system, we can enhance the quality of monitoring and provide more timely healthcare solutions tailored to the elderly population’s needs. The integration of fuzzy rules and IoT technology into the elderly health monitoring system offers an efficient and effective solution for continuous health surveillance. In this research, we integrated fuzzy rules and IoT technology into the elderly health monitoring system using parameters such as BOS and HR, through the integration of MAX30100 sensors and ESP32 microprocessors. The implementation of fuzzy rules resulted in nine rules indicating whether an elderly patient is in a “stable” or “unstable” condition. The methodology involved (1) component preparation, (2) device accuracy analysis, (3) fuzzy rule development, (4) Android-based mobile application development, (5) fuzzy rule accuracy analysis, and (6) cost analysis. Experimental results indicated a device accuracy of 98.89% in measuring BOS and HR variables compared to medical devices and a fuzzy rule accuracy of 96% in detecting whether the patient’s condition is “stable” or “unstable.” Based on the experimental findings, the elderly health monitoring system provides a user-friendly, precise, and cost-effective solution to enhance the quality of life for the elderly population.

Assessing the Economic Benefits of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Cervical Deformity Patients: Is the Initial Additive Cost of Protocols Offset by Clinical Gains?

To assess the financial impact of Enhanced Recovery After Surgery (ERAS) protocols and cost-effectiveness in cervical deformity corrective surgery. Retrospective review of prospective CD database. Enhanced Recovery After Surgery (ERAS) can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, the economic benefit of ERAS protocols, nor the heterogeneous components that make up such protocols, has not been established. Operative CD patients ≥18 y with complete pre-(BL) and up to 2-year(2Y) postop radiographic/HRQL data were stratified by enrollment in Standard-of-Care ERAS beginning in 2020. Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors, and complication rates were assessed through means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay scales. QALY was calculated using NDI mapped to SF6D using validated methodology with a 3% discount rate to account for a residual decline in life expectancy. In all, 127 patients were included (59.07±11.16y, 54% female, 29.08±6.43kg/m 2 ) in the analysis. Of these patients, 54 (20.0%) received the ERAS protocol. Per cost analysis, ERAS+ patients reported a lower mean total 2Y cost of 35049 USD compared with ERAS- patients at 37553 ( P <0.001). Furthermore, ERAS+ patients demonstrated lower cost of reoperation by 2Y ( P <0.001). Controlling for age, surgical invasiveness, and deformity per BL TS-CL, ERAS+ patients below 70 years old were significantly more likely to achieve a cost-effective outcome by 2Y compared with their ERAS- counterparts (OR: 1.011 [1.001-1.999, P =0.048]. Patients undergoing ERAS protocols experience improved cost-effectiveness and reduced total cost by 2Y post-operatively. Due to the potential economic benefit of ERAS for patients incorporation of ERAS into practice for eligible patients should be considered.

Academic versus Community Retinal Surgery for Primary Retinal Detachment: Characteristics, Duration, and Value Analysis of Teaching Modifier

To compare operative time and case characteristics of primary rhegmatogenous retinal detachment (RRD) repairs between academic and community vitreoretinal surgeons. A retrospective, observational clinical study. Patients who underwent primary RRD repair surgeries at Massachusetts Eye and Ear between 2019 and2021. A random sample of 20 vitreoretinal surgeons distributed evenly among the academic or community setting was selected. Fifteen consecutive cases of primary RRD repair surgeries were included from each surgeon. A cost analysis was performed for the teaching modifier for the physician fee and for hospital costs. Length of surgery. Of 300 primary RRD repairs, fellows were present in 75%, which comprised all academic surgeon cases and 50% of community surgeon cases, P < 0.001. Mean operation length was shorter for community surgeon cases without fellows (55.0 ± 24.1) than either academic (73.0 ± 30.8) or community surgeon cases with fellows (75.7 ± 32.5) (P < 0.001). There was a higher percentage of macula-off RRDs in academic versus community surgeon cases (52.7% vs. 38.0%, P= 0.002) and higher rates of combined scleral buckle (SB)/pars plana vitrectomy (PPV) repairs (14% vs. 3%, P < 0.001). When excluding combined SB/PPV cases, there was no difference in operative time between academic and community surgeon cases. Among RRDs repaired by PPV only, there was a 31.4% (16.6 minutes) greater procedure duration in cases with fellows compared with cases without fellows (P < 0.001). Covariates associated with greater surgery time: addition of an SB (β= 32.6), membrane peel (β= 18.5), presence of a fellow (β= 14.5), proliferative vitreoretinopathy (β= 12.8), and greater number of retinal breaks (β= 2.4). The teaching modifier adds 16% extra reimbursement ($184.16) to the physician fee, which is 50.9% of what is necessary to cover the percentage increase in surgeon time (31.4%). Using a time-driven activity-based costing for hospital costs, the extra 16.6 minutes leads to an additional $1038.00, which is 5.6 times more than the reimbursement for the modifier. Retinal detachment repair cases performed by academic surgeons are more likely to be macula-off and include the addition of an SB, which drive longer operative times. Medicare's reimbursement of the assistant modifier in a teaching facility significantly undercompensates the time-driven activity-based costing of trainee participation. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs

Background and purposeThe rise in hip and knee arthroplasty for osteoarthritis requires addressing healthcare system pollution to support Ireland's climate change goals. This research aimed to quantify waste generated and determine environmental and economic impacts to promote sustainable strategies in joint arthroplasty and shed light on the suboptimal waste management practices. MethodsThe study was conducted at National Orthopaedic Hospital Cappagh (NOHC), measuring waste generated during hip and knee arthroplasty. Clinical, domestic, and recycled waste weights were recorded, including the segregation of Central Sterile Supply Department (CSSD) Blue Wrap waste in ten operations. Kilograms of carbon dioxide emissions (kgCO2e) and disposal costs were calculated. ResultsIn a sample of 100 joint arthroplasty operations, the study found that revision knees produced 23.58 ​kgCO2e per case, revision hips 23.50 ​kgCO2e, primary knees 15.82 ​kgCO2e, and primary hips 14.64 ​kgCO2e. CSSD Blue Wrap contributed on average 13.5% of OT waste. Extrapolating these findings to the estimated number of joint arthroplasties performed in 2022 ​at NOHC (1556 hip and knee joint arthroplasties), the emissions were estimated to be 24,576 kgCO2e, with the cost of disposal up to €29,228. Strategies to mitigate this waste have been identified and proposed. ConclusionThe research aimed to address the environmental impact of orthopaedic joint arthroplasties, offering strategies to reduce waste generation, carbon emissions, and cost. Utilising our methodology to calculate greenhouse gas emissions will empower sustainability offices to conduct their own waste audits and implementing our strategies for waste management practices can help minimise environmental waste.

Boosting large‐scale construction project risk management: Application of the impact of building information modeling, knowledge management, and sustainable practices for optimal productivity

AbstractThis study investigates the relationship between Building Information Modeling (BIM) and knowledge management in large‐scale construction projects, emphasizing risk management, and increasing productivity. This study aims to identify the most important and impactful aspects of modern management techniques in the large‐scale construction sector to improve construction quality; focusing on cost reduction, energy conservation, and pollution reduction during construction. Employing a validated questionnaire from experts and the Analytical Hierarchy Process (AHP), the research prioritizes key factors, elucidating the pivotal role of BIM in understanding project geometry, efficient documentation, design flexibility, and reduced project delays. Ascertained through data analysis employing the pairwise comparisons method of the AHP analysis method, the compatibility of all comparisons and matrices arising from the decision‐making process of experts was below 0.1. The results establish BIM's technical capabilities, economic considerations, and pollution reduction as paramount, contributing significantly to improve large‐scale construction project risk management. The prioritization of the main criteria reveals their significance in the following order: BIM technical capabilities (0.281), BIM economic capabilities (0.231), pollution reduction (0.228), knowledge management capabilities (0.096), BIM time capabilities (0.090), and human resources management capabilities (0.074). BIM can improve risk management for large‐scale construction projects by: using the BIM model to understand the geometry and features of large‐scale construction projects; digitizing and organizing contract documents, project data, plans, work instructions, roles and responsibilities, cost, time, and energy analysis, and other project‐related documents for efficient project management; decreased duplication and project delays; reducing the need for on‐site personnel during implementation and CO2 emissions reduction. According to the results of the BIM model utilization to better understand the geometry and characteristics of large‐scale construction projects, the item was identified as the most significant and influential among the main components.

P22. Cost and Utilization Analysis of Operating Room Instruments in Plastic and Reconstructive Surgery

P22. Cost and Utilization Analysis of Operating Room Instruments in Plastic and Reconstructive Surgery

Analysis of cost of illness and diagnosis-related group payment system in breast cancer patients with chemotherapy in Indonesia

Background: Often, breast cancer patients undergoing chemotherapy sacrifice their finances, and the financial costs also affect the government. Objective: This study aims to analyse the cost of illness and the application of an insurance payment system among breast cancer patients receiving various chemotherapy regimens. Method: This study was retrospective and used a bottom-up prevalence approach. Data were collected from a secondary hospital between 2020 and 2021. The inclusion criteria were breast cancer patients undergoing chemotherapy. Patients with incomplete detailed cost data were excluded. The cost of illness was calculated from direct medical costs and the estimated non-medical and indirect costs. Results: The cost of illness for a chemotherapy visit for a breast cancer patient spanned from USD 130.37 to USD 932.05. However, these values did not include healthcare service costs and laboratory tests. The highest regimentation chemotherapy cost is for the combination of docetaxel–cyclophosphamide–trastuzumab. There was a significant margin between insurance claims and variable medical costs (p &lt; 0,05), ranging between USD 24.21 and 104.83. Conclusion: The cost of illness for chemotherapy for breast cancer patients is high, and the coverage of the diagnosis-related payment system is limited. Therefore, the government should accelerate prevention programmes to reduce the incidence of cancer.

Advancing thermochemical storage: synthesis and characterization of cement-based composite materials

Thermal Energy Storage (TES) is crucial for sustainability of the energy sector, yet the development of cost-effective, robust materials remains a significant challenge. This study aims at exploring the synthesis and thermal characterization of cement-based composites for seasonal thermochemical energy storage, with the goal to harness the high energy density of hygroscopic salts while mitigating their limitations. We investigate composites with several cement matrices to improve salt-cement compatibility. Furthermore, we investigate the possible incorporation of porous low-cost compounds to enhance porosity and improve economic aspects. As far as the characterization aspects are concerned, we show experimental adsorption isotherms at different temperatures to estimate key material properties like isosteric heat and water uptake, along with the relevant figures of merit such as energy density. Our research leverages on adjustable porosity and affordability of cement as a host matrix for the ‘active phase’. We studied two synthesis approaches: traditional dry impregnation and an in-situ technique suitable for cements. The in-situ method, being straightforward and reproducible, permits greater control over salt content. Preliminary cost analysis positions these composites competitively in the market. Although we are still at sub-optimal stage, potential cost reduction of some less popular cement matrices suggests an opportunity for improvement.