Annual Cost Research Articles

Estimating the minimal cost of delivering nutrition-specific and nutrition-sensitive interventions in Ethiopia.

The Ethiopia Food and Nutrition Strategy (FNS 2021-2030) aims to provide evidence-based, nutrition-specific, and sensitive interventions to address malnutrition. A costing exercise was done to estimate the minimum financing needed to implement nutrition interventions for the ten-year FNS, and further analysis was made to estimate the investment required to implement the prioritised recommended Lancet series interventions for 10 years. Activity-based costing methodology was used to carry out the FNS costing for nutrition interventions prioritised by the different line ministries, and then estimated costs to implement the 2021 recommended Lancets interventions were examined from the FNS. The minimum cost of implementing the National FNS was estimated to be US$ 2.55bn with an average annual cost of US$ 250 million over 10 years (2021-2030). The cost of nutrition-sensitive approaches represents US$ 1.8 billion (72%) and nutrition-specific US$ 704 million (28%) of the total cost of the FNS. The Lancet series intervention costs accounted for US$ 1.7 billion (66%) of the total cost of the strategy. In this costing, half of the strong/moderate evidence (7 out of 13) Lancet interventions are costed. Therefore, the strategy's costing should be revised every 3 years to integrate new evidence and consider lessons from real expenditure. Furthermore, the need to establish a nutrition expenditure tracking system is urgent.

National Trends in Healthcare Expenditures for the Management of Skin Cancer in the United States.

Malignant melanoma and keratinocyte carcinomas account for a substantial proportion of healthcare expenditures in the United States. To estimate trends in the economic burden of skin cancer in the United States between 1996 and 2016. The Disease Expenditure Project and Global Burden of Disease databases were used to estimate annual total costs and population-standardized rates of change for skin cancer-related healthcare spending. Skin cancer expenditures totaled $23.4 billion in 2016, of which $1.4 billion (95% CI: $1.3-$1.6 billion) was melanoma-related and $22 billion (95% CI: $18-$28 billion) was keratinocyte carcinoma-related. Most spending on skin cancer management occurred in ambulatory care settings [60.7% (95% CI: 57.7%-64.3%) for melanoma and 87.8% (95% CI: 87.2%-88.2%) for keratinocyte carcinoma]. Pharmaceutical costs for melanoma have increased since 2010 to $365 million (95% CI: $327-$416 million), which represents 26.1% (95% CI: 22.6%-29.3%) of total melanoma expenditure. Skin cancer management in the United States is costly. Expenditures have increased substantially since 1996 without signs of plateauing in recent years.

Stochastic economic sizing and placement of renewable integrated energy system with combined hydrogen and power technology in the active distribution network.

The current study concentrates on the planning (sitting and sizing) of a renewable integrated energy system that incorporates power-to-hydrogen (P2H) and hydrogen-to-power (H2P) technologies within an active distribution network. This is expressed in the form of an optimization model, in which the objective function is to reduce the annual costs of construction and maintenance of integrated energy systems. The model takes into account the planning and operation model of wind, solar, and bio-waste resources, as well as hydrogen storage (a combination of P2H, H2P, and hydrogen tank), and the optimal power flow constraints of the distribution network. Electrical and hydrogen energy are administered in an integrated energy system. The modeling of the uncertainties regarding the quantity of load and renewable resources is achieved through stochastic optimization using the Unscented Transformation method. The novelties of the scheme include the sizing and placement of a combined hydrogen and power-based renewable integrated energy system, the consideration of the impacts of bio-waste units, P2H, and H2P systems on the planning of the integrated energy system and the operation of the active distribution network, and the modeling of uncertainties using the Unscented Transformation method to reduce the calculation time. The study's results demonstrate the scheme's ability to improve the technical conditions of the distribution network by considering the optimal planning of integrated energy systems. In comparison to the network power flow, the operation status of the network has been improved by approximately 23-45% through the optimal siting, sizing, and energy management of hydrogen storage equipment, as well as renewable resources in the form of integrated energy systems. In other words, optimal energy management and planning of the integrated energy systems in the distribution network has been able to reduce energy losses and voltage drop by 44.5% and 42.4% compared to the load flow studies. In this situation, peak load carrying capability has increased by about 23.7%. In addition, compared to the case of the network with renewable resources, the overvoltage has decreased by about 43.5%. Also, Unscented Transformation method has a lower calculation time than scenario-based stochastic optimization.

Utilization Fraction of Ambulatory Hand Procedures: Cost-Reduction Through Surgical Instrument Tray Optimization.

Our objective is to evaluate the utilization fraction (UF) of surgical instruments during a commonly performed ambulatory hand surgery case as an avenue for cost reduction, increased operating room efficiency, and systems quality improvement. The total number of instruments opened at the start of the case was recorded followed by instruments being divided into those used and not used during the procedure. Total sterile processing costs were estimated at $1.56 per instrument according to data from our institution's central sterilization processing (CSP) department. Nineteen hand procedures performed by 2 surgeons were included in this study. An average of 120.1 ± 10.9 instruments were opened at the start of each case, while an average of 12.6 ± 5.4 instruments were used per case (Figure 1). This yielded an UF of 10.7% ± 4.8%. Using our internal CSP estimate, we calculated an annual cost of $16 863 to reprocess the current hand tray (Figure 2). Using literature data, this cost ranged from $5 513 to $34 484 annually. The same cost calculations were performed for the theoretical optimized tray (incorporating instruments used at least 20% of the time when opened) containing 23.2 instruments. The annual reprocessing cost of this new tray according to CSP data was $3 260, demonstrating a cost-reduction of $13 603 or 80.7% (Figure 2). Evaluation of pre- and peri-operative processes is a valuable technique to mitigate increasing healthcare costs and reduce unnecessary healthcare spending, with broad applicability to multiple surgical subspecialties and procedures.

Economic Burden of Haemophilia from a Societal Perspective: A Scoping Review.

Haemophilia is a rare genetic bleeding disorder that leads to musculoskeletal complications. The high cost of haemophilia treatment necessitates a thorough evaluation of its economic burden. However, due to the difficulty of estimating direct non-medical, indirect, and intangible costs, studies often underestimate the actual economic burden of haemophilia. This scoping review aims to summarise economic studies in haemophilia conducted from a societal perspective. A systematic search across eight scholarly databases, grey literature, and reference lists until the5th of July 2023 was conducted to identify relevant studies. The inclusion criteria encompassed full-text, English-language publications of economic analyses in congenital haemophilia from a societal perspective. Model-based studies and those adopting a payer perspective were excluded. Costs were adjusted to international dollars (I$) and US dollars (US$) in 2022 for comparability. Out of 2993 potential sources identified, 25 studies met the inclusion criteria, covering 7226 persons with haemophilia across 22 countries. All studies reported direct medical costs, with four excluding the cost of haemostatic therapy. Fifteen studies reported direct formal non-medical costs, while eight reported direct informal non-medical costs. All but one study reported the indirect costs. The average annual costs of haemophilia varied widely based on treatment modality, disease severity, geographical location, and included cost categories. When including the cost of clotting factor replacement therapy (CFRT), the total cost for severe haemophilia without inhibitors ranged from 1566 I$ to 700,070 I$ per person per year (lowest value reported in India and highest in the United States). CFRT represented up to 99.9% of the total cost for those receiving prophylaxis and up to 95.1% for episodic treatment. Haemostatic therapies accounted for 82% of the total cost in patients with inhibitors. There is a significant heterogeneity in defining cost categories required for a comprehensive economic analysis from a societal perspective. While haemostatic therapies constitute a substantial portion of the overall cost, direct non-medical and indirect costs are crucial as they are often paid out-of-pocket and may impede access to treatment. It is essential for haematologists and economists to establish a standardised costing framework for future studies, particularly in the era of novel therapies.

Annual Clinical and Economic Burden of Medically Attended Lower Respiratory Tract Illnesses Due to Respiratory Syncytial Virus among US Infants Aged

We developed a model to project the expected annual clinical and economic burden of medically attended lower respiratory tract illnesses due to respiratory syncytial virus (RSV-LRTI) among US infants aged <12 months by combining information on population size, disease rates, mortality rates, and unit costs. Among the 3.7 million US infants aged <12 months each year, a total of 592,700 cases of RSV-LRTI (hospitalizations: 48,499; emergency department visits: 144,599; outpatient clinic visits: 399,602) were projected to occur, yielding total annual costs of $1.6 billion. The annual burden of RSV-LRTI among US infants is considerable, especially among those aged <3 months, who account for 43% of total costs.

Global and Regional Economic Burden of Eating Disorders: A Systematic Review and Critique of Methods.

This systematic review aims to comprehensively examine up-to-date evidence on the economic burden of eating disorders (EDs), both globally and by region. A comprehensive search within five electronic databases, MEDLINE, Embase, CINAHL, PsycINFO, and EconLit, retrieved studies published from August 1, 2013, to June 30, 2024. Cost of illness (COI) studies, burden of disease, and other cost studies that reported costs in monetary values were included, and cost-effectiveness analysis studies were excluded. The quality of COI studies was assessed using Schnitzler's checklist. All cost estimates were converted into 2024 USD purchasing power parity (PPP). The PROSPERO registration number is CRD42022358136. Twenty-six studies were identified for inclusion in this review, with 11 COI studies. The nationwide annual financial cost of EDs is estimated at PPP-USD 70.5 billion. Indirect costs contributed 70%-93% of total financial costs in the reviewed studies. Intangible costs (burden of disease) were estimated to be PPP-USD 355.6 billion. About half of the COI studies met 60% of the elements of Schnitzler's checklist, either completely or partly. The number of COI studies has more than doubled in the last 10 years. Findings can inform healthcare administrators/policymakers to understand the magnitude of this burden when setting healthcare priorities and allocating resources to maximize social welfare. However, there are variations in the methods (thus quality) and perspectives used to assess this economic burden. Findings suggest that there is potential for enhancing the methodological rigor of future research.

Cost analysis of adding hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda.

In 2016, Uganda introduced services for hypertension and diabetes in selected HIV clinics. We evaluated the costs associated with scaling up these services in HIV clinics in Mbarara and Ibanda districts, Uganda. We estimated the annual costs of providing hypertension and diabetes services using an activity-based costing approach from the health system perspective in ten randomly selected HIV clinics in Mbarara and Ibanda districts. Cost inputs included 2023 data on costs of medications, health provider time, salaries, training costs, and monitoring costs. We determined the average annual cost and medication costs for hypertension and diabetes treatment per enrolled adult patient, stratified by type of health facility. The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 - 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 - 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13-58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10-75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 - 97) annually; $13 at public facilities and $50 at private not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 - 35); $11 at public facilities and $22 at private not-for-profit facilities. Adding hypertension and diabetes management to routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities. This variation was primarily driven by higher medication procurement prices at private facilities, revealing a potential area for optimizing costs through improved procurement practices.

Associations Between Hearing Loss and Health-Related Costs: A Retrospective Population-Based Cohort Study

Purpose: Hearing loss (HL) is a leading cause of disability worldwide, but its health-related costs have been incompletely studied. Our objective was to examine the association between HL and direct health care costs and identify subgroups in which costs associated with HL are especially high. Method: This was a retrospective population-based cohort study of adults treated in a universal health care system between April 2008 and March 2019. HL was identified using administrative health data. We estimate health care costs in 2023 Canadian dollars, including costs for hospitalization, provider claims, ambulatory care visits, prescription medications, and long-term care (LTC). Results: Of 4,424,632 participants, 146,644 (3.3%) had HL. Participants with HL were older ( Mdn = 55 years [interquartile range: 43–68] vs. 35 years [24–50]) and had more comorbidities (1 [0–2] vs. 0 [0–1]) at baseline than participants without, whereas the likelihood of female sex, rural residence, and material deprivation were similar between groups with and without HL. Over median follow-up of 11.0 years, total age–sex adjusted annual health costs and each of its component costs were significantly higher in participants with HL compared to those without (annual total costs: $6,871, 95% confidence interval [CI] [$6,778, $6,962] vs. $4,716, 95% CI [$4,729, $4,763]). After full adjustment (a maximum of 29 comorbidities), annual costs remained significantly higher in participants with HL overall and for certain subcomponents (provider claims, ambulatory visits, and medications), whereas adjusted costs of hospitalization and LTC were lower among people with HL. The magnitude of the incremental costs among participants with HL was most pronounced for younger participants, men, or those with less comorbidity. Total projected annual direct health costs for Alberta residents with HL were $1.01 billion in 2023, of which $125 million (95% CI [$116, $135 million]) was attributable to HL specifically. Conclusions: Compared to those without HL, health costs were markedly higher among participants with HL, partially due to a higher burden of comorbidity. The relatively high population attributable costs of HL suggest that better prevention, recognition, and management of this condition could yield substantial economic benefits. Supplemental Material: https://doi.org/10.23641/asha.27353439

Healthcare costs and resource utilization of patients with chronic post-traumatic stress disorder: a retrospective US claims analysis of commercially insured patients.

Aim: Exploring the healthcare costs and resource use among privately insured US patients with post-traumatic stress disorder (PTSD). Methods: This study used Merative MarketScan data. The index date was defined as the first PTSD claim. Study period included a 1-year pre-index and 2-year post-index follow-up. Cases with only acute PTSD, cancer, or insurance gap during the study period were excluded. The PTSD with (PwC) and PTSD without comorbidities (PwoC) cohorts were defined by the presence/absence of comorbid mental health conditions (schizophrenia, bipolar and major depressive disorder). Baseline PTSD (BP) cohort included PwoC cases with only index PTSD event and without FDA-approved PTSD medications or psychotherapy. Sub-analysis is conducted among patients with PTSD and substance/alcohol use disorder. Study cohorts were matched in a 1:1:1 ratio. Results: The matched sample included 5076 patients (1681 PwC, 1681 PwoC, 1714 BP). PwC patients had higher 2-year PTSD-related costs than PwoC and BP patients ($3762 vs $1750 and $841; all p<0.001). The same trend was noted among all-cause and anxiety-related costs. PwC patients had higher 2-year PTSD-related inpatient and emergency department (ED) rates than PwoC (10.2% vs 1.7% and 6.8% vs 2.6%, all p<0.001) and inpatient and outpatient rates than BP (10.2% vs 2.1% and 98.0% vs 93.1%; all p≤0.004). The sub-analysis had 3776 patients (3154 PwC, 537 PwoC, 85 BP). PwC had higher 2-year PTSD-related costs than PwoC and BP ($7668 vs $2919 and $1,483; all p<0.001). The same trend was noted in all-cause and anxiety-related costs. PwC also had higher 2-year PTSD-related inpatient and ED rates than PwoC (25.6% vs 10.4% and 12.7% vs 5.2%; all p<0.001) and inpatient and outpatient rates than BP (25.6% vs 8.2% and 95.5% vs 84.7%; all p<0.001). Conclusion: PTSD is associated with high healthcare costs and resource use. The highest economic burden was observed in patients with PTSD and mental health comorbidities.

Feasibility Assessment of Hybrid Renewable Energy Based EV Charging Station in Libya

This study presents an assessment of the feasibility of implementing a hybrid renewable energy-based electric vehicle (EV) charging station at a residential building in Tripoli, Libya. Utilizing the advanced capabilities of HOMER Grid software, the research evaluates multiple scenarios involving combinations of solar and wind energy sources integrated with energy storage and the utility grid. This analysis provides a novel approach to enhancing urban energy systems with renewable technologies in a region traditionally reliant on fossil fuels. Key contributions of this study include the demonstration of an innovative integration strategy that combines solar and wind power with battery storage to ensure a reliable and efficient energy supply for EV charging. Furthermore, the study addresses the practical implications for local energy policy, suggesting that such hybrid systems can significantly enhance energy security and support sustainable urban development. The authors studied five scenarios using HOMER. The results reveals that the annual total costs and payback periods are as follows: for Scenario 1 (wind/utility grid), the expenditure totals US$1,554,416 and payback period of 4.8/5.8 years; for Scenario 2 (solar/wind/Utility grid), the amount is US$1,554,506 and payback period of 4.8/5.8 years; and for Scenario 3(solar/wind/storage/utility grid), it escalates slightly to US$1,554,731, all predicated on the utility grid tariffs and payback period of 4.8/5.8 years. Furthermore, in Scenario 4 (solar/utility grid), the annual total cost is significantly reduced to US$30,589 and a payback period of 8.1/14.3 years, while Scenario 5 (solar/storage/utility grid) incurs an even lower expenditure of US$28,572, again based on the utility grid tariffs and a payback period of 14.0 years. The findings contribute valuable insights into the scalability and adaptability of renewable energy solutions, providing a robust framework for policymakers and planners considering similar implementations in other regions. Overall, the research underscores the potential of integrated renewable energy systems to transform urban energy infrastructures, promoting a sustainable and resilient energy future. The HOMER Grid analysis shows that configurations with energy storage are more cost-effective in the long run, even though they require higher initial costs. It also offers important insights into the economic viability and optimization of hybrid renewable energy systems for an EV charging station in Tripoli, Libya. These results highlight the significance of making calculated investments in renewable energy infrastructure and supporting policies for the development of sustainable energy.

Study of municipal solid waste treatment using plasma gasification by application of Aspen Plus

Abstract Plasma gasification is a viable and efficient technique for handling solid waste, including hazardous waste, while also holding the potential for energy recovery. The objective of this study is to analyze the treatment of municipal solid waste (MSW) using plasma gasification by application of Aspen Plus software. An earlier proposed model was used to analyze the effect of employing different types of gasifying agents as plasma gas, on the composition of syngas produced. The lower heating value, cold gasification efficiency and carbon conversion efficiency were calculated and compared in each case. A sensitivity analysis study was also carried out to observe the effect of variation in plasma gas flow rate and feed flow rate on the composition of syngas generated. The capital, operational and maintenance costs of the process were determined using existing correlations. For a feed rate of 20,000 kg per hour of MSW, the highest yield of syngas (CO (33.48 %), and H2 (34.30 %) with the highest LHV (7.9 MJ/N-m3)) were produced when air was employed as plasma gas. The cold gas efficiency and the carbon conversion efficiency were at their peak when air was used as the gasifying agent. The sensitivity analysis revealed that as the flow rate of plasma gas increases syngas production decreases while the increase in MSW flow rate results in an increase in syngas production. Additionally, the cost analysis revealed that for a plasma gasification plant that can handle 500 tons of MSW per day, the estimated capital and annual operational and maintenance costs are $125,496,721 and $9,833,892 respectively.

Supply Chain Design for Waste Valorization Through High-Energy-Density Pellet Production in Chile

This study presents the development and application of a mathematical optimization model to improve decision-making in the supply chain for high-energy-density pellet (HEDP) production and commercialization. Focused on the Metropolitan Region of Chile, the research involved a detailed analysis of key supply chain components, including identifying landfills and controlled dumps, waste volume assessments, plant location analysis, technology evaluation, and market potential exploration. The model revealed that the available raw material in the region was sufficient to meet 100% of HEDP demand, with a surplus of 2,161,952 tons remaining after satisfying maximum demand. An optimization analysis of potential plant locations identified Santa Marta as the optimal choice, resulting in annual cost savings of USD 100,000 compared to other sites. This work underscores the role of mathematical optimization in enhancing supply chain efficiency for biomass-based energy products, offering valuable insights for strategic decision-making in similar contexts.

BN SO44 - Is routine histological analysis of excised gallbladders necessary?

Abstract Background Gallbladder cancer is rare representing &amp;lt;1% of annual cancer diagnoses in the UK. It is more common in females (2.4/100,000 vs 1/100,000) with a peak age incidence of 85–89-years. Our trust routinely histologically analyses all resected gallbladders, over 1000 per year, regardless of indication. Our pathologists estimate that each specimen costs £75 to analyse, reflecting an annual cost of over £80,000. A 2021 systematic review suggested selective histological analysis is safe, reduces laboratory burden and costs. We aimed to assess our centre’s cholecystectomy specimens to ascertain the incidental gallbladder cancer diagnoses and explore the possibility of selective analysis. Method A retrospective search of our pathology database was carried out for the terms “cancer” and “gallbladder” from 2015 to 2018 inclusive. After exclusion of non-gallbladder primary cancers, all selected cases electronic notes were retrospectively reviewed. The primary outcome was the incidental findings of gallbladder cancer. Secondary outcomes were the indications for surgery, intraoperative findings, histological macroscopic description, final diagnosis and further management where applicable. Results We identified 4421 gallbladder specimens of which 12 (0.27%) identified cancer. The ratio of female to male diagnoses was 5:1 and the median age was 73.5 years. Of the 12 cancers, 7 (0.16%) of these were incidental findings, with 5 having surgery for symptomatic gallstones and 2 for gallbladder polyps. The 5 symptomatic gallstones patients all had grossly abnormal macroscopic appearances of the serosa, dense adhesions or exudate; all were confirmed as gallbladder adenocarcinoma. Three patients were fit enough for limited liver resection. Conclusion Our results demonstrate that across four years the rate of incidental gallbladder adenocarcinoma diagnosed by cholecystectomy was 0.16%. In all non-polypoidal cases (0.11%), the gallbladder was macroscopically abnormal. This suggests that with careful criteria, selective gallbladder histological analysis may reduce laboratory burden and therefore costs associated with elective gallbladder surgery. With increasing emphasis to improve efficiency and rationalise healthcare spending, our results suggest that selective histological analysis may be safe and effective. However, given the consequences of missing a cancer diagnosis it would require a larger scale multi centre study to support a move in this direction.

Cost-effectiveness of midomafetamine-assisted therapy (MDMA-AT) in chronic and treatment-resistant post-traumatic stress disorder of moderate or higher severity: A health-economic model.

To explore the cost-effectiveness of midomafetamine-assisted therapy (MDMA-AT) compared to placebo with therapy (PT) in US healthcare settings. A health state-transition model was used to analyze the cost-effectiveness of MDMA-AT for treating patients with chronic PTSD of moderate or higher severity. Both treatment arms consisted of 3 preparation (90-min), 3 interventional (8-h), and 9 integration (90-min) sessions, lasting ~4 months total. All sessions included psychotherapy, with interventional also including MDMA or placebo. After receiving treatment, patients were distributed across health states of No PTSD (not meeting PTSD diagnostic criteria), Non-Severe PTSD (treatment responders), Severe PTSD (treatment non-responders), and death. Each state had unique healthcare costs and utilities sourced from real-world data analysis and patient data from MDMA-AT clinical trials (including long-term follow-up). The base-case analysis considered the payer's perspective with a 5-year horizon, 3.5% annual cost and effect discounts, and an assumed MDMA medication price of $12,000 per session. Trial-derived utilities and US life tables mortality data were used to calculate quality-adjusted life years (QALY). The main outcome was an incremental cost-effectiveness ratio (ICER) with a $150,000 willingness-to-pay (WTP) threshold. The base-case ICER was $83,845 per QALY. Total direct costs were $64,745 in the MDMA-AT and $33,132 in the PT arms ($31,613 increment). The costs of intervention were $48,376 for MDMA-AT and $12,376 for PT. The highest MDMA medication cost to fit under the WTP threshold was $20,314 per session. Costs related to PTSD healthcare visits and other PTSD treatments were lower with MDMA-AT than PT (-$2,511 and -$1,877 increments, respectively). Utility benefits were higher in MDMA-AT than PT, with 3.691 and 3.314 QALYs generated over 5 years, respectively (0.377 QALY increment). These data suggest MDMA-AT may be a cost-effective treatment compared to PT for patients with chronic PTSD of moderate or higher severity.

Abstract 4137810: Association of Sociodemographic Characteristics on Costs of Care in Patients with Obstructive Hypertrophic Cardiomyopathy

Introduction: No evidence exists on the impact of sociodemographic characteristics on costs of care for obstructive hypertrophic cardiomyopathy (oHCM). Therefore, we evaluated 5-year cumulative costs by age, sex, and race/ethnicity. Methods: Retrospective cohort study of adults diagnosed with oHCM (January 2013 to December 2021) using Optum claims and electronic medical record data. Patients with ≥2 claims for HCM (ICD-9 and-10) at least 30 days apart (index date = earliest oHCM claim) with ≥1 additional oHCM claim or septal reduction therapy, 6-months pre-index and 5-year post-index continuous enrollment were included. HCM-related cumulative costs (2022 CPI adjusted) were reported for medical (ambulatory [AB]: office [OV] visits, outpatient [OP] visits); emergency room [ER] visits; inpatient admissions (IP); and pharmacy (Rx). Results: Among 5,129 patients with oHCM, 52% were female (mean age 63.9 ± 14.3 years; 77.6% non-Hispanic White; 40% Medicare). Compared to females (Table), male patients had greater costs including total ($71,581 vs $63,710, p= 0.014), medical ($70,395 vs $62,455, p= 0.013), ambulatory ($16,024 vs $10,776, p&lt;0.001), OV ($1,906 vs $1,573, p&lt;0.001), and OP ($14,118 vs $9,202, p&lt;0.001). Compared with White patients, Black patients had significantly greater IP costs ($54,572 vs $42,686, p= 0.01), Hispanic patients had greater ER costs ($1,724 vs $791, p&lt;0.001), and Asian patients had greater OV costs ($2,094 vs $1,800, p&lt;0.001). Patients aged 18-39 years had greater costs across all categories (p&lt;0.001; IP=NS), except Rx. Patients aged 40-54 years had the highest Rx costs ($1,557, p&lt;0.001), followed by 18-39, 55-64, 65-74, 75+ years ($1,528; $1,329; $1,197; $867), respectively. Conclusions: For oHCM patients , being male and age 18-39 years was associated with increased HCM-related healthcare costs. Differences in cost across race/ethnicity exist, including greater IP and ER costs for Black and Hispanic patients, respectively. Future research is required to understand the source of these differences among oHCM patients.

Reverse design of molecule‐process‐process networks: A case study from HEN‐ORC system

AbstractThe integrated design of the heat exchanger network (HEN) and organic Rankine cycle (ORC) system with new working fluids is a complex optimization problem. It involves navigating a vast design space across working fluid molecules, ORC processes, and networks. In this article, a new two‐stage reverse strategy is developed. The optimal HEN‐ORC configurations and operating conditions, and the thermodynamic properties of the hypothetical working fluid are identified by an equation of state (EOS) free HEN‐ORC model in the first stage. With two developed group contribution‐artificial neural network thermodynamic property prediction models, working fluid molecules are screened out in the second stage from a database containing more than 430,000 hydrofluoroolefins (HFOs). The presented method is employed in two cases, where new working fluids are found. The total annual cost of Case 1 is 12%–22% lower than the literature, and the power output of Case 2 is 5%–8% higher than the literature.

Survival, treatment duration and costs of patients with prostate cancer treated with triptorelin in Italy: a study of administrative databases.

Several data support the efficacy/effectiveness, safety and favorable impact on quality of life of triptorelin treatment in patients with prostate cancer. However, little evidence is available concerning triptorelin use in the long term. We analyzed data on triptorelin treatment in patients with prostate cancer in an integrated Italian administrative database, covering around 6 million health-assisted subjects throughout the country. Patients with at least one prescription for triptorelin in the period 2010-2020 and with no evidence of metastasis were included and followed up until 2021. Overall survival (OS) and duration of treatment were analyzed using Kaplan-Meier curves, starting from the date of first prescription. The cohort included a total of 3,411 patients (mean age: 76.8 ± 8.7 years), of whom 1,326 (38.9%) were treated with triptorelin only and 2,085 (61.1%) with triptorelin combined with an anti-androgen. Overall, 847 (24.8%) patients with prostate cancer died and 1,037 (30.4%) had a treatment switch during the follow-up period, and both the median OS and median duration of treatment were not reached in both groups. The mean annual total cost per patient was estimated as 5,574 €, with almost half of the costs related to medication expenses (2,737 €). We found a long survival and duration of triptorelin treatment in this population of Italian patients with prostate cancer. This study with a long follow-up period further highlights the usefulness of healthcare utilization databases to integrate results obtained from clinical studies with those from everyday clinical practice.

Water Resource Recovery Facilities Empower the Electrolytic Hydrogen Economy.

The global transition to net-zero emissions necessitates the integration of clean hydrogen as a key solution. To facilitate the required expansion of clean hydrogen production, sustainable water sources are required to support the electrolysis process. Utilizing nontraditional water sources such as water resource recovery facility (WRRF) effluents could potentially alleviate the water constraints and create cobenefits, but the real-world feasibility has not been explored in depth. Here, we investigated the geospatial interplay between WRRFs and H2 users in a clean hydrogen economy. We developed an optimization framework for contiguous U.S. that would identify H2 users-WRRF pairing through techno-economic constraint and multicriteria decision analysis, and we found that utilizing reclaimed water from WRRFs could save 66% (62-99%) of freshwater for clean hydrogen economy while accumulating $758 (275-1162) million annual national cost savings. The added benefits from H2 users to WRRFs such as pure oxygen aeration would provide a compelling new opportunity for infrastructural symbiosis but warrant a future investigation on its technical and economic feasibilities.

Excess costs of depression among a population-based older adults with chronic diseases in Singapore.

There is limited evidence on the economic burden of depression among the older population in Singapore. We aim to evaluate the impact of depression on healthcare expenditure and productivity loss among older adults with chronic diseases in Singapore. Using the data from the Well-being of the Singapore Elderly study (WiSE), a 2011 national representative survey of older adults aged 60 years and above, 2510 respondents were included in this study. The sample comprised 44% male and 56% female respondents with 75% respondents aged between 60 and 74 years old. Healthcare utilisation data was obtained from respondents and healthcare cost was tabulated by multiplying each service unit by the unit cost price. These services include care from polyclinic doctors, private general practitioners (GP), outpatient specialists and inpatient care. We modelled the relationship of healthcare cost and depression using two-part models (probit & generalised linear model - loglink and gamma distribution). For total healthcare expenditure, older adults with both depression and chronic diseases were associated with an average annual incremental cost of $7940 (95% CI 1490-14400; p = 0.016), compared to those without these conditions. They were also associated with an average incremental cost of $257 (95% CI 38.7-475; p = 0.021) for primary care. Likewise, in the case of specialist outpatient clinics, they had an average incremental cost of $970 (95% CI 163-1780; p = 0.018). However, for inpatient setting, the average incremental cost of $6180 (95% CI 418-12800; p = 0.066) was not significant. Additionally, older adults with depression and chronic diseases contribute to an annual productivity loss of $676 (95% CI 346-1010; p < 0.001). This study provides evidence that there are significant incremental costs associated with depression amongst the older adults with chronic diseases in Singapore's primary healthcare setting. The increased somatic presentations among the depressed older adults and the underdiagnosis of depression in primary care may contribute to higher utilisation of healthcare resources which entail higher expenditure. This is one of the first studies to look at the cost of depression using a representative sample of Singaporean older adults and taking into account the multi-ethnic nature of the population. Analyses were restricted to a cross-sectional design, and data relied heavily on the accuracy of self-report utilisation on health care services which was subjected to recall bias. Depression was found to inflate the total healthcare expenditure among older adults with chronic disease by two-fold. This study provides evidence that there are significant incremental costs associated with depression among the older adults with chronic diseases, demonstrating a need for more resources to improve systematic and clinical care for depressed older adults with chronic diseases.