Average Annual Cost Research Articles

Tax Compliance Costs for SMEs: A Survey of Tax Professionals in Ghana on External Cost of Compliance

The study sought to ascertain the magnitude of the external tax compliance costs incurred by SMEs in Ghana from the perspective of the tax professionals who provide the service. Tax professional firms were selected from the Institute of Chartered Accountants and the Chartered Institute of Taxation for the study. The study distinguished between the average annual costs for small, medium and larger firms to compute and file returns, deal with tax authorities, implement changes in tax laws, and maintain records for tax purposes on behalf of their clients. The cost was found to be regressive in nature, indicating that the burden was relatively higher for small businesses.

Medical resource utilization and the associated costs of asthma in China: a 1-year retrospective study

BackgroundDespite evidence that severe and poorly controlled asthma are associated with more clinical unmet needs and intensive utilization of healthcare resources, limited data is available on severe asthma expenditure in China. The study aimed to assess Medical Resource Utilization (MRU) costs of asthma and explore the cost drivers in order to better understand the economic burden of the Chinese population suffered from asthma.MethodsA retrospective analysis was conducted using Chinese sampled national claim database. Patients aged 6 years and above with primary diagnosis of asthma and asthma-related medical visit/hospitalization during 2015 were included. Medication was used as a proxy per the GINA and China guideline to identify asthma severity (i.e. mild, moderate, and severe). multiple linear regression model was conducted to identify MRU costs drivers.Results7,254 patients diagnosed with asthma were included: 4,529 (62.4%), 2,200 (30.3%), and 525 (7.2%) had mild, moderate, and severe asthma, respectively. On average, each severe patient spent 6,782 Chinese Yuan (CNY) on asthma treatment and had 57.0% hospitalization rate during the year, 3.9- and 4.4-fold of the average of overall population (P < 0.001 for both). The proportion of patients experiencing exacerbation significantly higher in the severe asthma population (66.5%; P < 0.001) compared to mild (30.0%) and moderate (16.8%) groups. In subgroup with 1,660 samples had annual consecutive data, severe patients had annual cost of CNY 8,314 and 52.2% hospitalization rate. 13% of severe patients who had frequent severe exacerbation (≥ 2 events) experienced the highest annual average cost CNY 23,037, P < 0.001) whereas children aged from 6 to 14 with a lower annual cost of CNY 1,094.2, 1,660.2 and 3,020.2 for mild, moderate, and severe patients respectively. The multiple model identified degree of severity, control status, complications, age, and live region as independent drivers of MRU costs.ConclusionsChinese asthma patients bear heavy economic burden. Severe asthma associated with higher MRU (mainly from hospitalization) and costs compared with mild to moderate asthma in China. More efforts should be devoted to the control of the disease severity and complication as the main drivers of asthma cost.

Estimating the economic burden of influenza on the older population in Malaysia

Background Influenza is a contagious respiratory illness that can cause life-threatening complications among high-risk groups. Estimating the economic burden of influenza is essential to guide policy‐making on influenza vaccination programmes, especially in resource‐limited settings. This study aimed to estimate the economic burden of influenza on older adults (those aged ≥60 years) in Malaysia from the provider’s perspective. Methods The main data source in this study was the MY-DRG Casemix database of a teaching hospital in Malaysia. Cases with principal and secondary diagnoses coded in the International Classification of Diseases version 10 (ICD-10) as J09, J10.0, J10.1, J10.8, J11.0, J11.1, J11.8, J12.8, and J12.9, which represent influenza and its complications, were included in the study. The direct cost of influenza at all severity levels was calculated from the casemix data and guided by a clinical pathway developed by experts. The effect of the variations in costs and incidence rate of influenza for both the casemix and clinical pathway costing approaches was assessed with sensitivity analysis. Results A total of 1,599 inpatient and 407 outpatient influenza cases were identified from the MY-DRG Casemix database. Most hospitalised cases were aged &lt;18 years (90.6%), while 77 cases (4.8%) involved older people. Mild, moderate, and severe cases comprised 56.5%, 35.1%, and 8.4% of cases, respectively. The estimated average annual direct costs for managing mild, moderate, and severe influenza were RM2,435 (USD579), RM6,504 (USD1,549), and RM13,282 (USD3,163), respectively. The estimated total annual economic burden of influenza on older adults in Malaysia was RM3.28 billion (USD782 million), which was equivalent to 10.7% of the Ministry of Health Malaysia budget for 2020. The sensitivity analysis indicated that the influenza incidence rate and cost of managing severe influenza were the most important factors influencing the total economic burden. Conclusions Overall, our results demonstrated that influenza imposes a substantial economic burden on the older Malaysian population. The high cost of influenza suggested that further efforts are required to implement a preventive programme, such as immunisation for older people, to reduce the disease and economic burdens.

Cost of Patients with Alzheimer's Disease in Spain According to Disease Severity.

Alzheimer's disease (AD) has been associated with great healthcare and non-healthcare resource consumption. The aim of this study was to estimate the burden of AD in Spain according to disease severity from a societal perspective. A self-administered questionnaire was designed by the researchers and completed by the informal caregivers of patients with AD, reporting data on themselves as caregivers and on the AD patients for whom they care. The patients' sociodemographic and clinical data, their healthcare and non-healthcare resource consumption in the previous 12 months, and the impact of the disease on labor productivity were compiled. Data collected on informal caregivers included sociodemographic data and the impact of caring for a person with AD on their quality of life and labor productivity. Costs were estimated by multiplying the number of consumed resources by their unit prices. The cost of informal care was assessed using the proxy good method, and labor productivity losses were estimated using the human capital method. Costs were estimated by disease severity and are presented per patient per year in 2021 euros (€). The study sample comprised 171 patients with AD aged 79.1 ± 7.4 years; 68.8% were female, time from diagnosis was 5.8 ± 4.1 years, diagnosis delay was 1.8 ± 2.3 years, and the mean Cumulative Illness Rating Scale-Geriatric (CIRS-G) total was score 8.2 ± 6.0. According to disease severity, 14% had mild cognitive impairment or mild AD, 43.9% moderate AD, and 42.1% severe AD. The average annual cost per patient was €42,336.4 in the most conservative scenario. The greatest proportion of this cost was attributed to direct non-healthcare costs (86%, €36,364.8), followed by direct healthcare costs (8.6%, €3647.1), social care costs (4.6%, €1957.1), and labor productivity losses (less than 1%, €367.4). Informal care was the highest cost item, representing 80% of direct non-healthcare costs and 69% of the total cost. The total direct non-healthcare cost and total cost were significantly higher in moderate to severe disease severities, compared to milder disease severity. AD poses a substantial burden on informal caregivers, the national healthcare system, and society at large. Early diagnosis and treatment to prevent disease progression could reduce this economic impact.

Estimating Transfusion-Related Medical Costs and Associated Time Burden in Patients with Myelofibrosis: A Comparison of Momelotinib Vs Ruxolitinib Based on Simplify-1

Introduction: Myelofibrosis (MF) is a myeloproliferative neoplasm characterized by splenomegaly, debilitating symptoms, and bone marrow fibrosis. Transfusion-dependent (TD) anemia is present in one-quarter of patients (pts) with MF at diagnosis and becomes more common over time. Transfusion dependence imposes a high cost burden on healthcare systems, with annual total medical costs up to 9 times higher for TD pts than for non-TD pts (Gerds A, et al. ASH 2022. Abstract 1729). Momelotinib (MMB) is a Janus kinase (JAK) 1/JAK2/activin A receptor type 1 inhibitor that has demonstrated symptom, spleen, and anemia benefits in pts with MF across 3 phase 3 trials. Evidence in JAK inhibitor-naive pts comes from SIMPLIFY-1 (NCT01969838), a randomized, double-blind, phase 3 trial of MMB vs ruxolitinib (RUX). Eligible pts had International Prognostic Scoring System high-risk or intermediate-2-risk MF, or intermediate-1-risk MF associated with symptomatic splenomegaly, hepatomegaly, or anemia (hemoglobin &amp;lt;10 g/dL) and/or unresponsiveness to available non-JAK inhibitor therapy. MMB was associated with higher red blood cell (RBC) transfusion independence rates (66.5% vs 49.3%), lower transfusion dependence rates (30.2% vs 40.1%), and fewer RBC units transfused (median of zero units/month vs 0.4 units/month) compared with RUX by week 24. This study estimated the projected differences between MMB and RUX in total medical costs as well as cost and time burden associated with outpatient transfusion visits, based on results from SIMPLIFY-1, in all pts with MF and separately in those aged ≥65 years. Methods: Analyses were based on transfusion status (TD, transfusion independent [TI], or transfusion requiring [TR]) and mean rates of outpatient transfusion visits over 24 weeks in SIMPLIFY-1. TD was defined as ≥4 RBC units transfused or hemoglobin &amp;lt;8 g/dL in the prior 8 weeks, TI was defined as no RBC transfusions and all hemoglobin ≥8 g/dL in the prior 12 weeks, and TR was defined as being neither TD nor TI. Projected cost offsets for MMB relative to RUX were calculated based on observed transfusion status and rates over 24 weeks from SIMPLIFY-1 combined with cost estimates for TD vs TI/TR from the IBM MarketScan Database used to inform commercial health plans. Projected time savings were calculated similarly using transfusion rates from SIMPLIFY-1 and previously reported time burden estimates for transfusion visits in pts with TD β-thalassemia (Knoth RL, et al. EHA2022. Poster P1741). For pts aged ≥65 years, individual pt data from SIMPLIFY-1 and cost estimates from the Medicare fee-for-service database were used instead. Results: Based on the IBM MarketScan Commercial Database, projected average annual total medical cost savings based on week 24 transfusion status with MMB vs RUX were $20,215 per pt with baseline TD status and $23,991 per pt with baseline TI/TR status. Fewer outpatient transfusion visits with MMB vs RUX resulted in projected annual savings of $25,704 per pt with baseline TD status and $12,083 per pt with baseline TI/TR status. Among pts with baseline TD status, projected annual time savings in transfusion visits for MMB vs RUX (147 vs 253 hours) totaled 106 hours per pt (42 hours, preparation and waiting; 50 hours, transfusion and recovery; 15 hours, travel), a 42% reduction for MMB vs RUX. In the subgroup analysis that focused on pts aged ≥65 years, based on the Medicare fee-for-service database, projected average annual total medical cost savings with MMB vs RUX were $11,102 per pt with baseline TD status and $17,373 per pt with baseline TI/TR status. Fewer outpatient transfusion visits with MMB vs RUX resulted in projected annual savings of $28,826 per pt with baseline TD status and $18,255 per pt with baseline TI/TR status. Among pts aged ≥65 years with baseline TD status, projected annual time savings in transfusion visits accounted for MMB vs RUX (160 vs 279 hours) totaled 119 hours per pt (47 hours, preparation and waiting; 56 hours, transfusion and recovery; 16 hours, travel), a 43% reduction for MMB vs RUX. Conclusions: Reductions in transfusion dependence and transfusion visits for MMB vs RUX were associated with projected healthcare system savings in transfusion costs and transfusion-related time burden in JAK inhibitor-naive pts with MF, including in subgroup analyses of pts aged ≥65 years.

Social/ economic burden and health-related quality of life in patients with Spinal Muscular Atrophy (SMA) in Greece

Objective: The objective of this study was to determine the economic burden and health-related quality of life (HRQoL) of patients with SMA and their caregivers in Greece, which is still unknown, and explore the economic impact of the implementation of a reproductive carrier screening (RCS) program. Methods: A cross-sectional study was conducted in which an online questionnaire was completed by caregivers of SMA patients. A cost of illness (COI) model was developed in which costs per patient were calculated from a societal perspective and extrapolated to the Greek SMA population. Parents’/caregivers’ HRQoL was measured using the 36-item PedsQL™ Family Impact Module. Resources for the implementation of RCS program were estimated and its short-term impact was assessed. Results: The COI was estimated at €261,785 per patient in 2022. When extrapolating this across all affected persons, the average annual cost ranged from €49,739,395 to €91,036,017 depending on the prevalence considered. Out-of-pocket expenses accounted for 8% of the total. Results of the analysis on HRQoL indicated a high burden on parents/ caregivers with the majority of scores falling below 50 and a mean total score of 45. Depending on the scenario used, an RCS program could save the Greek healthcare system at least €167,181 or increase its costs by €564,804. Conclusions: SMA imposes a significant economic burden in affected patients, caregivers, and health care system. The cost-saving magnitude of a potential implementation of a CRS program is dependent on the parents' reproductive choices following a positive screening result.

Natural History of Pediatric Patients With Crohn's Disease Treated With Mesalamine Therapy.

5-aminosalicylates (5-ASA) are used to treat mild to moderate ulcerative colitis. Despite their lack of efficacy in Crohn disease (CD), they are still used in real-world practice. Additionally, when patients have progressive disease, they may escalate to biologic therapy, at which time 5-ASA may or may not be discontinued. The aim of this study is to assess the clinical outcomes of patients started on 5-ASA for the treatment of pediatric CD. The secondary aims were to evaluate the outcomes of those who continue 5-ASA to those who discontinue 5-ASA upon biologic escalation. We performed a single-center retrospective chart review of pediatric CD patients from 2010 to 2019 who were initially treated with 5-ASA. Demographics, medication and laboratory data, and clinical disease activity were collected. Sixty-one patients were included in the study; the majority had inflammatory CD with ileocolonic involvement. Twenty-four patients were on a concomitant immunomodulator. The majority of patients (85.2%) required escalation to biologics. Thirty-two patients (61.5%) who escalated to biologic therapy continued on 5-ASA. Eighty percent of patients achieved clinical remission at 1 year, and there was no difference between those who continued 5-ASA at time of biologic initiation compared to those who did not continue the medication. Patients who discontinued 5-ASA had an average annual cost savings of $6741. 5-ASA is not a durable monotherapy for the treatment of pediatric CD. Patients who require escalation from 5-ASA to biologic therapy do not benefit from concomitant 5-ASA therapy. Further prospective studies are needed to confirm these findings.

Integrating 100% renewable energy into electricity systems: A net-zero analysis for Cambodia, Laos, and Myanmar

This article assesses developing-countries’ power sector pathways toward net zero. The Low Emissions Analysis Platform (LEAP) combined with the Next Energy Modeling system for Optimization (NEMO) is used to simulate 100% renewable energy integration into power systems. While many studies have been carried out using LEAP, few have utilized NEMO (the latest optimization add-on for LEAP) for analyzing net-zero pathways of the power sector in developing countries. NEMO enables the inclusion of energy storage capacity in the long-term simulation of power system capacity expansion. Storage is crucial for balancing intermittent renewable energy especially when high penetration of renewable energy is considered. The analysis is applied to three countries in the Global South: Cambodia, Laos, and Myanmar. These three cases are selected because they share important similarities (e.g., all three are below the energy poverty line and vulnerable to climate change impacts) but also have differences (notably, electrification rates), making them suitable for comparison. The LEAP-NEMO results indicate that the average electricity consumption per capita of Laos, Cambodia, and Myanmar will pass the energy poverty line by 2030, 2035, and 2045, respectively. On the supply side, the results show that the three countries can integrate 100% renewable energy into their power systems by realizing their hydropower potential and deploying non-hydro renewables. As expected, energy storage systems will have to play a critical role in balancing variable renewable energy with a total storage capacity of 16.1 GW by 2050. The annual average costs for the sustainable path range from 1.1% to 1.8% of GDP in 2020. While the approach presented in this article is applied to three specific developing countries, it can be replicated in other developing countries to analyze the integration of 100% renewable energy into the power system to achieve net zero emissions.

Budget impact analysis of dexamethasone intravitreal implant for the treatment of diabetic macular oedema

ObjectiveTo assess the economic impact following the inclusion of an intravitreal implant of dexamethasone for the treatment of diabetic macular oedema in a healthcare area in Spain. MethodA 3-year budget impact model was designed to estimate healthcare direct costs for adult patients with diabetic macular oedema from the National Health System perspective. The approved therapies in use (aflibercept/ranibizumab/dexamethasone) were considered. The target population was estimated from published diabetic macular oedema prevalence (6.41%) and incidence (0.82%) for a population of 25,000 adults. Dexamethasone was assumed to be used annually in 20%, 30% and 40% of patients, respectively. Annual total costs included: drug acquisition (based on frequency of injections per every year, considering ex-factory prices with mandatory deduction and split of vials), intravitreal administration, patient monitoring, management of cardiovascular and ocular adverse events (cataracts, increased intraocular pressure, endophthalmitis, vitreous haemorrhage and retinal detachment). Detailed resource consumption reflecting clinical practice was provided from local experts in retina and vitreous. Unitary costs (€, 2016) were obtained from national databases and literature. Sensitivity analyses were performed to assess model robustness. ResultsThe inclusion of intravitreal dexamethasone implant would lead to annual cost savings of €35,030 (–4.2%), €10,743 (–1.8%) and €5,051 (–0.9%), years 1-3 respectively. Total costs were reduced mainly by the fewer annual injections required by dexamethasone. The average annual incremental costs were –€350, –€96 and –€41 per patient. ConclusionsThe inclusion of an intravitreal dexamethasone implant for the treatment of diabetic macular oedema would lead to cost-savings for the considered health area, mainly by reducing the administration costs.

Techno-economic feasibility of using solar energy in small-scale broiler production

Poultry farming is an energy intensive industry necessitating a substantial amount of fossil fuel consumption and leading to elevated operational expenses. This study investigated the economic feasibility of implementing renewable energy in small-scale broiler farms to decrease their dependency on fossil fuels and increase their profit. Assessment was based on experimental data collected from broiler production operations carried out in a green poultry house equipped with solar renewable energy systems and a conventional poultry house operated on conventional energy source. The experiments were conducted during both the warm and cold seasons in a semi-arid rural area in Lebanon. Average annual costs and benefits from broiler operations were calculated based on a total of 8 production cycles/year. Cost-benefit analysis was conducted to assess the viability of introducing renewable energy in broiler production. In addition, a twenty-year financial feasibility analysis was performed for both green and conventional systems using two different time value of money parameters; the Net Present Value (NPV) and the Benefit Cost Ratio (BCR). The results showed that broiler production using conventional energy achieved a total cost of 2.25 % lower than the cost incurred using green energy and higher total revenues of 5.55 %. Negative NPV and less than 1 BCR values were computed for both green and conventional systems demonstrating that broiler production in the study area is non-profitable in small-scale broiler farms, independently of the source of energy. Accordingly, it is recommended to adopt renewable energy cooperatives based on partnership between small-scale farms. This cooperative-based partnership model has proven to allow the adoption of renewable energy sources as sustainable and economically viable approach, contributing to increased farmers' revenues. Government subsidies and financial incentives are also essential to ensure the success and sustainability of the renewable energy cooperatives.

Cost of Implementing mHealth in Community Mental Health Settings: External Versus Internal Facilitation.

This study aimed to compare the costs of two implementation models for the mobile health (mHealth) intervention FOCUS in community mental health settings. The external facilitation (EF) approach uses a hub-and-spoke model, in which a central specialist provides support to clinicians and clients at multiple agencies. With the internal facilitation (IF) approach, frontline clinical staff at each center are trained to serve as their organization's local specialists. Financial and economic cost data were collected in the context of a hybrid type 3 effectiveness-implementation trial by using a mixed-methods, top-down expenditure analysis with microcosting approaches. The analysis compared the incremental costs of both models and the costs of successfully engaging clients (N=210) at 20 centers. Costs were characterized as start-up or recurrent (personnel, supplies, contracted services, and indirect costs). The average annual financial cost per site was $23,517 for EF and $19,118 for IF. EF yielded more FOCUS users at each center, such that the average monthly financial costs were lower for EF ($167 per client [N=129]) than for IF ($177 per client [N=81]). When using a real-world scenario based on economic costs and a lower organizational indirect rate, the average monthly cost per client was $73 for EF and $59 for IF. Both models reflected substantial cost reductions (about 50%) relative to a previous deployment of FOCUS in a clinical trial. Compared with IF, EF yielded more clients who received mHealth at community mental health centers and had comparable or lower costs.

PACTA-Ped: Antimicrobial stewardship programme in a tertiary care hospital in Spain

IntroductionFighting against antimicrobial resistance is a current priority, and further efforts need to be made to improve antimicrobial prescribing and reduce the spread of infections in paediatric care settings. MethodsWe conducted a prospective longitudinal study on the use of antimicrobials from the time the antimicrobial stewardship programme (ASP) was introduced in January 2016 to December 2017 (period 2 [P2]) in our children’s hospital. We compared the obtained results on antimicrobial prescribing with retrospective data from the period preceding the introduction of the ASP (2014–2015, period 1 [P1]). The sample consisted of paediatric inpatients who received broad-spectrum antimicrobials, antifungals or intravenous antibiotherapy lasting more than 5 days. We compared the use of antimicrobials in P1 versus P2. ResultsA total of 160 patients were included during P2. The antibiotics for which a recommendation was made most frequently were meropenem (41.6%) and cefotaxime (23.4%). In 45% of care episodes, the consultant recommended “no change” to the prescribed antimicrobial. The final rate of acceptance of received recommendations by the prescribing physicians was 89%. We found average decreases of 27.8% in the days of treatment per 1000 inpatient days and 22.9% in the number of antimicrobial starts per 1000 admissions in P2. The use of carbapenems, cephalosporins and glycopeptides decreased in P2 compared to P1. The average annual cost of antimicrobial treatment decreased from є150 356/year during P1 to є98 478/year in P2. ConclusionOur ASP achieved a significant decrease in the use of broad-spectrum antibiotics and antifungals. The costs associated with antimicrobial prescribing decreased following the introduction of the ASP, which was a cost-effective action in this study period.

Socio-economic burden of cystic fibrosis in Europe: a systematic review of cost of illness evidence

Abstract Background Cystic Fibrosis (CF) is one of the most prevalent severe genetic diseases, with a high economic impact on healthcare systems due to its complexity. The life expectancy of CF patients has substantially lengthened due to early diagnosis and improvements in therapeutic regimens with Cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Therefore, strategies to ensure equitable access to these treatments should be optimized. Our study aimed to summarize existing literature regarding the costs of CF in Europe. Methods A systematic literature review was performed querying three online database (PubMed, Scopus, Web of Science) from January 2013 to March 2023. Studies carried out in European countries, written in English language, and focused on the socio-economic burden of CF were selected. Results Overall, 11 studies were considered. Across countries, the average total annual cost for a CF patient amounted to €14.174,00-53.256,00, higher for children (€15.771-60.412,00) compared to adults (€15.714-€47.217,00). The largest expenditures were recorded for annual direct healthcare costs, which amounted, per patient, to €9861,00-28.827,00, followed by direct non-healthcare costs (€4512,00-18.329,00). For adults, drugs, tests, and hospitalizations represented the primary cost drivers of direct healthcare costs, while for children, direct non-healthcare costs, especially for caregivers, were predominant. Moreover, indirect costs, whose main expenses were related to productivity loss and early retirement, ranged between €1,094-12,443 per patient per year. Conclusions The CF management is associated with relevant costs. CFTR modulators represent an important therapeutic opportunity of reducing the clinical and economic burden of CF. Therefore, new evidence and value-based economic evaluations, that also take into account a social perspective, are needed to support the decision-making process. Key messages • The use of new health economic models is needed to guide the policy-makers in a value-based evaluation of Cystic Fibrosis treatments that take into account their whole value. • The assessment of the socio-economic burden of Cystic Fibrosis could guide the identification of the main actions to be implemented to respond adequately to the real health needs of patients.

Average annual cost of Parkinson's disease in a Brazilian multiethnic population

IntroductionWith the current demographic transition, it is estimated that by 2050 Brazil will have a population of 90 million people aged 60 years or more, and in parallel Parkinson's disease (PD) will bring a considerable economic burden to our society. Brazil is considered multiracial due to its colonization, generating important social and regional inequalities. Knowing the costs of the PD may aid to improve local public policies. However, in Brazil, no estimates of these values have been made so far. ObjectivesTo evaluate direct, indirect, and out-of-pocket costs in Brazilian people with PD (PwP). MethodsCategorical and numerical data were collected through a customized and standardized cost-related-questionnaire from 1055 PwP nationwide, from 10 tertiary movement disorders centers across all Brazilian regions. ResultsThe estimated average annual cost of PwP was US$ 4020.48. Direct and indirect costs accounted for 63% and 36% of the total, respectively, and out-of-pocket costs were 49%. There were no evidence of differences in the total cost of PD across the regions of the country; however, differences were reported between the stages of the Hoehn and Yahr scale (H&Y). ConclusionThis data suggests a considerable burden of PD for Brazilian society in general, not only for the public health system, but mainly for those with PD.

PACTA-Ped: programa de optimización de antimicrobianos en un hospital de tercer nivel en España

IntroductionFighting against antimicrobial resistance is a current priority, and further efforts need to be made to improve antimicrobial prescribing and reduce the spread of infections in paediatric care settings. MethodsWe conducted a prospective longitudinal study on the use of antimicrobials from the time the antimicrobial stewardship programme (ASP) was introduced in January 2016 to December 2017 (period 2 [P2]) in our children's hospital. We compared the obtained results on antimicrobial prescribing with retrospective data from the period preceding the introduction of the ASP (2014–2015, period 1 [P1]). The sample consisted of paediatric in patients who received broad-spectrum antimicrobials, antifungals or intravenous antibiotherapy lasting more than 5 days. We compared the use of antimicrobials in P1 versus P2. ResultsA total of 160 patients were included during P2. The antibiotics for which a recommendation was made most frequently were meropenem (41.6%) and cefotaxime (23.4%). In 45% of care episodes, the consultant recommended “no change” to the prescribed antimicrobial. The final rate of acceptance of received recommendations by the prescribing physicians was 89%. We found average decreases of 27.8% in the days of treatment per 1000 inpatient days and 22.9% in the number of antimicrobial starts per 1000 admissions in P2. The use of carbapenems, cephalosporins and glycopeptides decreased in P2 compared to P1. The average annual cost of antimicrobial treatment decreased from €150 356/year during P1 to €98 478/year in P2. ConclusionOur ASP achieved a significant decrease in the use of broad-spectrum antibiotics and antifungals. The costs associated with antimicrobial prescribing decreased following the introduction of the ASP, which was a cost-effective action in this study period.

The burden of disease and quality of life in patients with acute hepatic porphyria: COPHASE study

BackgroundAcute hepatic porphyria (AHP) comprises a group of rare genetic diseases characterized by neurovisceral crises that are manifested by abdominal pain and neurological and/or psychological symptoms that interfere with the ability to lead a normal life. Our objective was to determine the burden of the disease in one year and the health-related quality of life (HRQoL) in patients with AHP. Results28 patients were analyzed. The mean age was 36.6±10.2 years, 89.3% were women, and the average number of crises was 1.9±1.5. The average annual cost per patient was €38,255.40. 80.2% of the costs was direct medical costs, 17.5% was associated with loss of productivity and 2.3% was direct non-medical costs. 85.9% of the total cost corresponded to the crises. The intercrisis period accounted for the remaining 14.1%. The global index of the EQ-5D-5L (HRQoL) was 0.75±0.24. The dimensions of pain/discomfort, anxiety/depression and daily activities were the most affected. Leisure, travel/vacations and household activities were the most affected daily activities. 53.6% of patients required a caregiver due to AHP. 92.9% did not present overload and 7.1% presented extreme overload. ConclusionsPatients with AHP are associated with a high economic impact and an affected HRQoL in the pain/discomfort dimension, with a negative impact on the performance of daily activities and a risk of psychiatric diseases.

Energy storage system based on hybrid wind and photovoltaic technologies

Clean energy sources like wind and solar have a huge potential to lessen reliance on fossil fuels. Due to the stochastic nature of various energy sources, dependable hybrid systems have recently been developed. This paper's major goal is to use the existing wind and solar resources to provide electricity. A 6 kWp solar-wind hybrid system installed on the roof of an educational building is studied and optimized using HOMER (Hybrid Optimization of Multiple Energy Resources) software at different levels of reliability. At an average annual Cost of Energy (COE) of $1.156 per kWh, the system generates 1996 kWh of power overall. Investigations are made on the techno-economic characteristics of real and ideal hybrid system topologies with maximum capacity shortfalls of 0 %, 5 %, 10 %, and 20 %. The hybrid system's sensitivity analysis looks at how a capacity gap affects overall net present costs and excess power generation. A 2 kWp PV system with one string of ten 12V batteries is shown to be more cost-effective than the existing system with a COE of $0.575/kWh. The most effective configuration for utilizing the site's solar and wind resources is demonstrated to be a 5 kWp wind turbine, a 2 kWp PV system, and battery storage. A wind-solar hybrid system is more expensive than the current system. Despite this, an additional 1 kWp solar PV system may be added to the current system due to the reduction in the limit deficit from 22.3 % to 3.1 %. The findings show that solar-wind hybrid energy systems may efficiently use renewable energy sources for dispersed applications. Additionally, new research directions are noted.

Analysis of the activities of cord blood banks in the Russian Federation

This review aimed to analyze the activities of all state and commercial cord blood banks in the Russian Federation, to estimate the total number of cord blood samples in storage at the beginning of 2023, and to determine the practical use of the biomaterial for treatment allogeneic and autologous transplants for oncohematological diseases, as well as for scientific research in the field of regenerative medicine for the entire period of the banks' operation, which is twenty years.&#x0D; To date, there are 12 cord blood banks providing personal, public or mixed storage of samples. At the moment, up to 26,000 cord blood samples are in public storage, and about 75,000 samples are in personal storage.&#x0D; As part of the review, the main and additional services provided by banks, as well as their current cost, were studied. The average cost of cord blood sample collection in the Russian Federation is 62,500 rubles, and the average annual cost of storage is 6,000 rubles. The main market indicators, trends, key problems of biobanking and prospects for the use of cord blood cells in the Russian Federation in the coming years are considered in detail.&#x0D; Separately, data on the prospects for the use of umbilical cord mesenchymal stem cells, a widely studied biomaterial, which, like cord blood, can be collected after childbirth and cryopreserved for long-term storage, are briefly presented. Stem cells of the umbilical cord are being actively studied in the field of regenerative medicine due to their properties to restore cartilaginous muscle and bone tissue, stimulate the growth of new blood vessels, and block autoimmune reactions.&#x0D; In addition, the current tasks and results of the activities of Ruscord, an association of specialists and organizations in the field of procurement, storage, use of cord blood cells and cell technologies, which over several years of its activity has already made a significant contribution to the development of the biobanking market, were analyzed. In September 2020, a unified standard for the collection, processing, storage and issuance of cord blood for use was approved the Russian standard RUSCORD.

Analysis of energy storage capacity optimization of distribution network based on quadratic planning algorithm under large scale DG access

Abstract The intermittent, random and uncontrollable characteristics of renewable energy generation bring many challenges to the actual operation of distribution grid (DG) energy storage. This paper firstly establishes a whole life cycle model applicable to the distribution grid energy storage system, which fully considers the various types of costs of VSC converter stations. Secondly, for comprehensive reactive power optimization, a sequential quadratic programming algorithm is used, and inequality constraints are added to the objective function in the form of penalty functions to optimize the state of on-load transformers and capacitors. Finally, the effectiveness of its distribution grid energy storage configuration optimization is verified by applying the distribution grid energy storage optimization based on the quadratic programming algorithm to electric vehicle charging piles. The results show that after two stages of optimization, the configuration capacity of distribution grid energy storage is increased by 53.14Kw/h compared with that before optimization, which is a substantial increase. The average annual cost of battery 0’ access decreases by 0.275, and battery 2’ access decreases by 0.581. This shows that the energy storage capacity optimization strategy based on the sequential quadratic programming algorithm proposed in this paper can improve the efficiency of energy storage utilization. It provides the basis for the user to select the energy storage capacity.

The cost-of-illness and burden-of-disease of treatment-resistant depression in Austria

BackgroundTreatment-resistant depression (TRD) in major depressive disorder (MDD) is most commonly defined as the failure to respond to at least two antidepressant (AD) treatments of adequate duration and adherence. While the health care utilization (RU) and costs of patients with MDD are well documented, little is known about patients with TRD. Therefore, the aim of this study was to determine the direct medical RU of complex therapy pathways and to analyze the total cost-of-illness and the burden-of-disease in Austria.MethodsIn order to quantify the cost-of-illness and burden-of-disease of TRD, the analysis was designed with two steps. First, RU data were collected through an extensive survey of Austrian experts and a systematic literature review. Second, direct, indirect, and intangible costs were calculated using the micro-costing method. The results are presented per patient and based on a patient flow for the entire cohort of TRD patients.ResultsIn Austria, the derived prevalence of TRD is 43,732 patients or 583 per 100,000 population. For 2021, the annual direct costs of TRD were estimated at 345.0 million €. At 684.7 million €, the estimated indirect costs were higher than the direct costs, representing 66.5% of the total cost-of-illness. The average annual cost per TRD patient is 23,547 €, of which direct costs are 7,890 €. Adding the years lived with a disability to the years lost due to premature death attributed to TRD resulted in a total of 29,884 disability-adjusted life years (DALYs) for the Austrian society.ConclusionAlthough TRD accounts for only 0.7% (range: 0.6%–1%) of the total health care budget, it represents a significant burden-of-disease. In addition, TRD is associated with a high level of lost productivity in the Austrian economy. These findings support efforts to prioritize TRD as a focus area to achieve health-related goals.