Average Cost Research Articles

The contronymity of project accounting for performing the relevance of project outcomes

PurposeThis paper aims to advance recent literature on the performativity of accounting by examining how project accounting affects a project organization’s ability to deliver a relevant project outcome, such as a product or a building, for a receiving client organization.Design/methodology/approachThe paper draws on a longitudinal case study of a 41.4-billion-kroner (5.5-billion-euro) Danish project of constructing 16 new public hospitals. Its objective was to reduce the average unit costs and improve the quality of patient care. Each hospital construction was managed by a separate project organization and handed over to a separate receiving hospital organization. The project organizations applied a common approach to project accounting. The paper relies on Michel Callon’s concepts of performativity and sociotechnical agencement – approaching project accounting as an arrangement of devices.FindingsThe paper shows that the project-accounting agencement simultaneously supported and undermined the project organizations’ ability to deliver hospitals relevant to the receiving hospital organizations. The agencement performed hospital designs, disciplined project actors and guided decision-making, thus supporting the overall work of the project organizations. It also, however, compelled the project organizations to compromise on hospital designs when unexpected events occurred. These compromises led to the delivery of hospitals, which largely prevented the receiving hospital organizations from achieving the project’s objective.Originality/valueThis paper advances our limited understanding of the dynamic and complex relationship between project accounting and the relevance of project outcomes. It introduces the concept of a “contronymity device” to capture the way project accounting simultaneously produces two opposing consequences, both supporting and undermining the enactment of a particular reality. The paper lastly enriches our understanding of how project-accounting devices impact hospital organizations’ operating cost structures and challenge patient care capabilities.

Hardware information flow tracking based on lightweight path awareness

Vulnerabilities and Trojans in hardware design may cause sensitive data to be leaked and tampered. Information flow tracking technology can effectively verify the confidentiality and integrity of hardware design. Currently, this technology mainly analyzes the reachability of information flow and lacks fine-grained analysis of information flow paths. It is difficult to find structural defects in information flow paths and malicious sensitive information processes in hardware design. To solve above problem, we propose Path-aware Dynamic Information Flow Tracking (PDIFT) technology, which performs taint tracking and path tracking while sensitive information is propagated. It analyzes the propagation of sensitive information in hardware design with fine-grained taint label propagation logic and inserts path label propagation logic only on basic blocks divided by branch nodes, which greatly simplifies the path tracing overhead compared to the full node sequence tracing on the path. Experiments have shown that compared to CellIFT, PDIFT has a 12.1% increase in static analysis time and a 0.1% increase in dynamic validation time. The average instrumentation area cost of each basic block has increased by 16.4 um2. In terms of detection capability, PDIFT makes up for the limitation of false negatives in traditional taint tracking technology through joint analysis of path labels and taint labels, then detect problems such as insufficient iterations of encryption components and malicious processing of important assets, thereby improving the accuracy of hardware security verification.

The influence of cost of debt, cost of equity and weighted average cost of capital on dividend policy decision: evidence from non-financial companies listed on the Frankfurt Stock Exchange

Non-financial companies listed on the Frankfurt Stock Exchange face considerable difficulties due to expensive funding and the need to make complex decisions about their capital structure. These problems impact their judgments about dividend policy, resulting in ambiguity and possible inefficiency. This study draws on the bird-in-hand theory to investigate the influence of the cost of capital on dividend policy decisions among non-financial firms listed on the Frankfurt Stock Exchange, focusing on 227 companies from 2005 to 2022. The data for this study were sourced from Thomson Reuters Datastream. Employing the common shock autoregressive distributed lag (CS-ARDL) and two-step generalized method of moments (GMM) estimations, findings reveal that the cost of debt consistently negatively impacts dividend payouts and coverage ratios. In contrast, the cost of equity has an insignificant effect. Conversely, the weighted average cost of capital positively influences dividend payouts and coverage ratios but negatively influences dividend yield. All the findings supported the bird-in-hand theory except for the negative impact of WACC on dividend yield. These insights highlight the importance of considering the cost of capital and market share dynamics in dividend policy formulation. Firms should prioritize efficient debt management to sustain dividend distributions, and aligning dividend policies with overall capital structure management is crucial in this regard, providing a sense of reassurance and confidence to the firms and their stakeholders. This study provides valuable guidance for financial decision-makers navigating dividend-related strategies within corporate environments.

Service-Based Periodic Payment Provided/PBBL by the Government of Indonesia to Bayung Lencir – Tempino – Simpang Ness Toll Road

In 2020, PT Hutama Karya (Persero), a state-owned enterprise mandated by the government to build the Trans Sumatra Toll Road, appointed a private consultant to conduct a feasibility study and for the proposed construction of the Betung – Tempino – Jambi Toll Road. However, due to the low traffic volume in the Jambi Province, the toll road was deemed financially not feasible to be developed. Given the substantial costs required for the development of the Betung – Tempino – Jambi Toll Road, this toll road segment was divided into several sections. Betung – Tempino – Jambi Toll Road is a segment of the primary route of the Trans Sumatra Toll Road, Phase 2, which spans 171 kilometers across the provinces of South Sumatra and Jambi. Bayung Lencir – Tempino – Simpang Ness Toll Road, which stretches 52 kilometers, is a part of the Betung – Tempino – Jambi Toll Road prioritized for construction and operation. According to Presidential Regulation of the Republic of Indonesia Number 131 of 2022, a funding scheme known as Service-Based Periodic Payments/Pembayaran Berkala Berbasis Layanan (PBBL) shall be provided to PT Hutama Karya (Persero) to enhance the financial feasibility and to ensure the funding, technical planning, construction execution, operation, and maintenance of the toll road. This study will analyze and evaluate the financial feasibility of the Bayung Lencir – Tempino – Simpang Ness Toll Road before and after the implementation of PBBL provided to PT Hutama Karya (Persero) during the estimated duration of toll road concession for 50 years. The duration of the PBBL granted by the Government of Indonesia to PT Hutama Karya (Persero) is 15 years, with an annual payment of 880 billion Rupiah. Based on the financial feasibility analysis without PBBL, the results indicate a negative NPV, an IRR lower than the Weighted Average Cost of Capital (WACC), a Discounted Payback Period exceeding the toll road concession period, and a Profitability Index below 1, indicating that the project is not yet financially viable. On the other hand, the financial feasibility analysis after PBBL implementation shows a positive NPV, an IRR greater than WACC, a Discounted Payback Period within the toll road concession period, and a Profitability Index above 1, indicating that the project is financially feasible. Therefore, PT Hutama Karya (Persero) shall develop the Bayung Lencir – Tempino – Simpang Ness Toll Road with PBBL scheme that contributed by the Government.

Correlated Equilibria in Large Anonymous Bayesian Games

We consider multipopulation Bayesian games with a large number of players. Each player aims at minimizing a cost function that depends on this player’s own action, the distribution of players’ actions in all populations, and an unknown state parameter. We study the nonatomic limit versions of these games and introduce the concept of Bayes correlated Wardrop equilibrium, which extends the concept of Bayes correlated equilibrium to nonatomic games. We prove that Bayes correlated Wardrop equilibria are limits of action flows induced by Bayes correlated equilibria of the game with a large finite set of small players. For nonatomic games with complete information admitting a convex potential, we prove that the set of correlated and of coarse correlated Wardrop equilibria coincide with the set of probability distributions over Wardrop equilibria and that all equilibrium outcomes have the same costs. We get the following consequences. First, all flow distributions of (coarse) correlated equilibria in convex potential games with finitely many players converge to mixtures of Wardrop equilibria when the weight of each player tends to zero. Second, for any sequence of flows satisfying a no-regret property, its empirical distribution converges to the set of distributions over Wardrop equilibria, and the average cost converges to the unique Wardrop cost. Funding: This work was partially supported by European Cooperation in Science and Technology Action 16228 GAMENET. F. Koessler acknowledges the support of the Agence Nationale de la Recherche [Grant StratCom ANR-19-CE26-0010-01]. M. Scarsini acknowledges the support of the Gruppo Nazionale per l’Analisi Matematica, la Probabilità e le loro Applicazioni project [Grant CUP_E53C22001930001], the Ministero dell’Università e della Ricerca Progetti di Rilevante Interesse Nazionale [Grant 2022EKNE5K], and the European Union-Next Generation EU, component M4C2, investment 1.1 (Ministero dell’Università e della Ricerca Progetti di Rilevante Interesse Nazionale Piano Nazionale di Ripresa e Resilienza) [Grant P2022XT8C8]. T. Tomala gratefully acknowledges the support of the HEC foundation and Agence Nationale de la Recherche/Investissements d’Avenir [Grant ANR-11-IDEX-0003/Labex Ecodec/ANR-11-LABX-0047].

A Comprehensive Economic Analysis of Production and Maintenance Cost of Per Milch Animal Buffaloes of Ghazipur District of Uttar Pradesh, India

This study analyzes milk marketing in the Bhanwarkola and Ghazipur Sadar Blocks of Ghazipur District, Uttar Pradesh, focusing on the various channels for selling milk. It categorizes cattle owners, studies demographic patterns, and links these variables to milk marketing methods and efficiency. Using a descriptive and analytical design, the study divides cattle owners into small, medium, and large-scale enterprises. It evaluates demographic data such as age, gender, education, and social categories, as well as a thorough review of milk marketing methods and associated expenses. Data were gathered through biennial personal interviews done on a predetermined timetable, with an emphasis on production costs such as feed, fodder, labor, and animal care. The statistics suggest that the overall average production cost for desi buffaloes is Rs. 50,519.65 and Rs. 56,857.32 for murrah buffaloes, giving policymakers and dairy farmers vital insights into increasing profitability and sustainability.

Cost of Providing Advanced HIV Disease Treatment Services through Malawi's Hub-and-Spoke Model.

Antimicrobial prophylaxis and treatment of opportunistic infections immediately before or at the start of antiretroviral therapy (ART) improves prognosis and decreases death rates among patients with advanced HIV disease (AHD). In this study, we estimated the average cost per patient receiving AHD services (PP) and per client retained (PR) at 12 months. The study population included children, adolescents, and adults enrolled in the AHD program at 13 hub and 19 spoke sites in Malawi. To evaluate the cost PP and PR, we divided the cost of providing AHD services at 12 months by the total number of patients who received these services and who were retained in AHD services care at 12 months, respectively. We enrolled 246 AHD patients, with 137 retained at 12 months. The cost of providing AHD services to 246 patients at 12 months was $59,063; cost PP was $240, and cost PR was $431. Drugs were the largest expenditure (30%), followed by travel for supportive supervision (24%), clinic visit costs (19%), site support personnel (8%), laboratory tests (7%), annualized training costs (6%), consumables (3%), and meetings (3%). The cost of ART was $11,754; however, ART would be provided regardless of whether the AHD package was in place. Any reduction in overall costs of AHD care will require coordination among procurement partners and negotiations with manufacturers to help reduce the prices of drugs and laboratory consumables. This calls for further improvement of efficiency and capacity of site-level staff to reduce costs related to supportive supervision.

Budget impact of resmetirom for the treatment of adults with non-cirrhotic non-alcoholic steatohepatitis (NASH) with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis)

Aims This study assessed the budget impact of resmetirom as a treatment for adults with non-cirrhotic non-alcoholic steatohepatitis (NASH) with moderate-to-advanced liver fibrosis and estimated total costs for a hypothetical private payer in the United States. Materials and methods A three-year budget impact analysis based on an open cohort state transition model was developed for a hypothetical one-million-member private health plan. The comparator was Standard of Care (SOC), defined as routine care for non-cirrhotic NASH patients with moderate-to-advanced liver fibrosis. Each year, the number of resmetirom treatment-eligible patients was estimated through prevalent, incident, and diagnostic rate estimates. Costs included resources incurred by the medical and pharmacy benefits of private payers, including resmetirom drug acquisition costs, diagnosis and monitoring, other medical and other prescription costs stratified by disease progression status (i.e. non-cirrhotic vs. cirrhotic/advanced liver diseases). Resmetirom adverse event management costs were included in sensitivity analysis. Drug costs were estimated based on the average wholesale acquisition cost as of March 2024. Other costs were based on published sources and inflated to 2023 US dollars. Budget impact outcomes were presented in aggregate, net, and on a per-member per-month (PMPM) basis. Results Compared with a scenario without resmetirom, the introduction of resmetirom yielded results ranging from 50 to 238 treated patients, net budget impact of $2.2 to $9.5 million, and PMPM from $0.19 to $0.80 over years one and three. Net costs excluding resmetirom declined over time. In sensitivity analyses, results were most sensitive to diagnostic and epidemiologic inputs. Limitations Market shares are based on internal forecasts, a short time horizon, average treatment effects, and other limitations common to BIMs. Conclusion The adoption of resmetirom on the formulary for the treatment of non-cirrhotic NASH with moderate-to-advanced liver fibrosis resulted in a moderate increase in budget impact with declining costs related to NASH progression.

Economic Impact of Bladder Cancer in the USA.

Incidence and mortality for bladder cancer has changed very little over the past 20 years. Approximately 40% of patients with high-risk nonmuscle invasive bladder cancer eventually recur/progress. It is important to understand the economic impact of disease recurrence/progression in bladder cancer. Our aim was to estimate and understand the direct costs associated with the treatment of bladder cancer from the payer's perspective in the USA, in the year of 2021, including costs for both newly diagnosed bladder cancer (stages 0a-IV) and recurrent patients. An economic model was constructed to calculate the number of patients receiving each treatment modality at every stage of disease and their respective costs. Epidemiological data were based on the CancerMPact Patient Metrics (PM) database and treatment modality data retrieved from CMP Treatment Architecture (TA), 2021 version. Resource utilization and costs were obtained from medical literature and public data sources. Only direct costs were considered. There were an estimated 83,532 newly diagnosed patients with bladder cancer of all stages in 2021 with a projected total cost of treatment of ~$2.6 billion. Average cost per newly diagnosed patient varied from $19,521 (stage 0a) to $169,533 (metastatic disease). Cost profile differed substantially among the stages of disease. For the 75,760 patients that were expected to have a recurrence in 2021, an additional cost of ~$3.9 billion was estimated at an average cost per patient of $52,179. The expected total cost to treat newly diagnosed and newly recurrent patients is reported in this model, with the total cost in 2021 estimated to exceed $6.5 billion. Treatment and resource costs increase for bladder cancer as the disease recurs/progresses. More effective treatments that can delay recurrence/progression may reduce the economic burden associated with bladder cancer.

Residential demand response online optimization based on multi-agent deep reinforcement learning

Demand side management in the context of smart grids exploits the value stream of load flexibility, promoting stable and economic operation of the power grid. To address multi-uncertainties such as device characteristics, distributed renewable generation, and residential electricity demand, this paper proposes a model-free framework based on multi-agent deep reinforcement learning to achieve efficient online optimization of demand response strategies. Firstly, the demand side management is formulated as a partially observable Markov game. Then, a multi-agent soft actor-critic algorithm is proposed, combining a temporal electricity price feature extraction technology to improve learning efficiency. Reward correction mechanism is designed to avoid new charging and discharging peaks in the demand response. Finally, case studies demonstrate the effectiveness of the proposed method in reducing the electricity cost and aggregate peak demand of residents. The proposed method reduces the daily average cost by 21.40%, 8.09%, and 5.88% compared to MAPPO, MADDPG, and SUMADRL, and exhibits the highest training efficiency and scalability against the benchmarks.

Reprocessing capabilities of newly approved devices for use in surgery

IntroductionSingle-use medical devices used in surgery can create environmental waste and increased costs. Reprocessed medical devices may reduce cost and environmental impact. This study investigated the reprocessing capabilities of newly FDA-approved devices in surgery. MethodsDevices were identified using the publicly-available FDA Releasable 510(k) Database from 2018 to 2023 using the instrument product codes for laparoscope, general, and plastic surgery (GCJ); and electrosurgical (GEI) devices. GCJ and GEI devices were categorized based on usage, and the number of devices (total, single, and reprocessed) were extracted. Costs were obtained from public websites. ResultsThere were 658,510(k) applications for surgical devices, representing 3.8 % (658/16723) of total applications. Reprocessing capabilities existed for 29 % of GCJ devices and 14 % of GEI devices. Among GCJ devices, 5 (56 %) laparoscopy and 16 (38 %) camera devices had reprocessing capabilities. For GEI devices, 7 (50 %) laparoscopic and 5 (50 %) cable devices had reprocessing capabilities. Only one (6 %) tissue ablation device had reprocessing capabilities. The average cost of GCJ and GEI single-use devices ($11314; $8554, respectively) was less than reprocessed counterparts ($17206; $16134, respectively). ConclusionReprocessing capabilities for newly approved surgical devices are variable and overall limited. To enhance adoption of reprocessing in surgical practice, future efforts will likely be needed to expand the reprocessing potential of new surgical devices.

An Empirical Study of Financial Efficiency and Stability of Crab–Shrimp Farming Model In Mekong Delta, Vietnam

The study is conducted with the goal of analyzing the financial efficiency of 308 crab - shrimp farming households in the Mekong Delta, finding factors that affect financial efficiency and the extent of their influence on farm household income. Research results show that extensive crab-shrimp farming households are highly effective. With the average cost of investment in production during the crab farming process of 2,051 thousand VND/1,000m2, the average revenue brought from farming Crab farming of 5,099 thousand VND/1,000m2, farmers have an average profit of about 3,020 thousand VND/1,000m2. The average value of the financial ratios shows that the production model in the Mekong Delta is financially effective, the average value of the revenue/cash cost is 8.08, profit/total costs is 2.31, net income/cash costs is 7.08, and profit /revenue is 0.37. Factors affecting the profits of extensive mud crab farmers consist of three influencing factors: Area, crab/total crab ratio, and farmers in Kien Giang Province. Additionally, the number of years of farming experience has an influence, but its impact is not statistically significant

Alternative service network design for bus systems responding to time-varying road disruptions

In practice, road disruptions occur frequently, interrupting multiple bus routes at the same time and causing widespread passenger delays. Typically, these disrupted roads are repaired sequentially and then gradually put into service. In response to such time-varying road disruptions, this paper aims to assist bus operators in developing effective alternative service networks for passengers. The proposed approach involves the joint optimization of service-based route adjustments, bus timetables, and passenger assignment to minimize the total passenger cost and weighted bus operation time. Specifically, a novel service-based adjustment strategy is introduced to flexibly adapt each bus service to time-varying road disruptions. An integer programming model is built for the studied problem based on the set of passengers’ time-space itineraries. To efficiently generate these time-space itineraries and solve models for large-scale problems, this paper develops a hierarchical solution framework. The framework consists of three key parts: (1) a column generation procedure to iteratively explore passengers’ spatial paths; (2) a customized extension algorithm to extend these spatial paths to time-space itineraries; and (3) a tailored adaptive large neighbourhood search heuristic to solve the final itinerary-based model. After that, the overall methodology is tested with both an illustrative example and a real-world example in Beijing. Experimental results show that our methodology produces a high-performance solution with only 7.3% of unserved passengers. Besides, compared to the two benchmark adjustment strategies, our service-based adjustment strategy reduces the average itinerary cost for all passengers by 27.0% and 43.3%, respectively.

Start-Up and Implementation Costs for the Trust Based Relational Intervention.

Capturing costs associated with prevention activities related to substance use disorders (SUD) and mental health (MH) is critical. In this study, Trust Based Relational Intervention (TBRI®), an attachment-based, trauma-informed intervention, is conceptualized as a preventive intervention to reduce substance and opioid use among youth involved with the legal system. When implemented alongside community reentry, TBRI leverages family systems as youth transition from secure residential care into communities through emotional guidance and role modeling. Activity-based cost (ABC) analysis was used to guide cost data collection and analysis for both start-up and implementation of the TBRI intervention. Start-up costs were estimated using data across eight sites during their start-up phase. All components, activities, personnel involved, and time associated with implementation of TBRI sessions according to protocol were defined. National wages were extracted from O*NET and utilized to calculate total costs for each TBRI component. Total and average TBRI intervention costs were calculated with a breakdown by TBRI sessions and number of staff and participants. A sensitivity analysis was conducted to estimate TBRI implementation costs with travel. The total cost for the TBRI intervention, representing 42 sessions, ranges from $6,927, without travel expenses or $12,298, with travel expenses. The average per family cost ranges from $1,385 (without travel) to $2,460 (with travel). Costs are primarily generated by time investments from primary interventionists. The sensitivity analysis shows costs for responsive coaching would double with travel costs included. Results aim to show that using ABC for prevention activities, like TBRI, to understand cost drivers can facilitate future intervention sustainability.Clinical Trail.gov ID: NCT04678960.

Budget impact analysis of implementing trauma registries in Argentina

IntroductionIn high-income countries, quality improvement interventions and research are usually guided by trauma registries. In low- and middle-income countries, the implementation of trauma registries has been limited mainly for cost reasons. ObjectiveTo analyze the budgetary impact of the implementation of trauma registries in Argentina. MethodsWe estimated direct costs of implementing trauma registries in public hospitals located in cities with a population over 50,000 inhabitants. In large urban areas, we selected hospitals by estimating a minimum volume of 240 severe trauma admissions/year and using the NBATS-2 instrument with geolocation techniques. We estimated costs based on a micro-costing approach of a trauma registry developed by Fundación Trauma. Scenario analysis was carried out restricting the population to hospitals from bigger cities and/or with higher concentration of trauma patients’ care. For the high budget impact threshold, we used the total health spending estimation, and alternatively the health spending of the public sector. ResultsFor the base case, 139 hospitals from 104 cities were included, comprising 175,605 injury-related discharges and 13,707 severely injured patients/year. The average cost for the initial three years was USD 3,753,085 (21.4 USD/per patient), falling below the high budget impact thresholds. The scenarios analysis showed a significantly costs reduction. ConclusionsThe implementation of trauma registries in Argentina would be affordable, and in consequence, it would improve the coordination, management and quality of care for this great public health issue.

Economic Evaluation of the Direct Use of Sago Palm in Nakhon Si Thammarat Province

This research aimed to study the utilization and economic evaluation of Sago Palm in Nakhon Si Thammarat Province. The research study covered a total area of ​​9,942.502 square kilometers of wetlands. Data were collected by interviewing 272 families that utilized sago. First, the data were gathered from the utilization of sago palm by the villagers for consuming and selling. Second, the quantity of sago palm collected was evaluated for economical values. From the study, it was found that villagers can use most parts of sago palm. For example, the use of leaves, petioles, and barks for the processing of tools whereas leaves, petioles, barks and stems are utilized for foods and animal feeds. Sago leaf is found to be the most utilization part. For economic evaluation, the turnover rate in the area was 24,201,272 baht per year, the total cost was 2,968,647 baht per year, and the net value was 21,232,625 baht per year. The average cost was 78,061.15 baht per person per year. Therefore, this research study can reflect the value of the sago palm, and the villagers should be aware of this value in order to promote the sustainable utilization of sago palm.

Geospatial assessment of the cost and energy demand of feedstock grinding for enhanced rock weathering in the coterminous United States

In an effort to mitigate anthropogenic climate impacts the U.S. has established ambitious Nationally Determined Contribution (NDC) targets, aiming to reduce greenhouse gas emissions by 50% before 2030 and achieving net-zero emissions by 2050. Enhanced rock weathering (ERW)—the artificial enhancement of chemical weathering of rocks to accelerate atmospheric CO2 capture—is now widely seen as a potentially promising carbon dioxide removal (CDR) strategy that could help to achieve U.S. climate goals. Grinding rocks to smaller particle size, which can help to facilitate more rapid and efficient CO2 removal, is the most energy-demanding and cost-intensive step in the ERW life cycle. As a result, accurate life cycle analysis of ERW requires regional constraints on the factors influencing the energetic and economic demands of feedstock grinding for ERW. Here, we perform a state-level geospatial analysis to quantify how carbon footprints, costs, and energy demands vary among regions of the coterminous U.S. in relation to particle size and regional electricity mix. We find that CO2 emissions from the grinding process are regionally variable but relatively small compared to the CDR potential of ERW, with national averages ranging between ~5–35 kgCO2 trock−1 for modal particle sizes between ~10–100 μm. The energy cost for feedstock grinding also varies regionally but is relatively small, with national average costs for grinding of roughly 0.95–5.81 $ trock−1 using grid mix power and 1.35–8.26 $ trock−1 (levelized) for solar PV for the same particle size range. Overall energy requirements for grinding are also modest, with the demand for grinding 1 Gt of feedstock representing less than 2% of annual national electricity supply. In addition, both cost and overall energy demand are projected to decline over time. These results suggest that incorporating feedstock grinding into ERW deployment at scale in the coterminous U.S. should generally have only modest impacts on lifecycle emissions, cost-effectiveness, and energy efficiency.

Housing and supportive services for young mothers experiencing substance use disorder and homelessness: Cost-effectiveness analysis of a randomized trial

BackgroundMothers experiencing homelessness and caring for young children struggle with high rates of substance use and mental health problems. A comprehensive supportive housing intervention was implemented to assist young mothers experiencing substance use disorder (SUD) and homelessness. The cost-effectiveness of this intensive intervention could inform future dissemination. MethodsA cost-effectiveness analysis was conducted alongside a randomized controlled trial that lasted from May 2015 to October 2018. Mothers experiencing homelessness between the ages of 18–24 years with a SUD were randomly assigned to housing+support services (HOU + SS) (n = 80), housing-only (HOU) (n = 80), or services as usual SAU (n = 80). Using incremental cost-effectiveness ratios (ICERs), the study compared the costs of HOU + SS and HOU to SAU for three outcomes: housing stability (percent days of stable housing), substance use (percent days of substance use), and depressive symptoms (Beck Depression Inventory score). Direct intervention costs of HOU + SS and HOU from both payor and societal perspectives were estimated. Cost data were collected from detailed study financial records. Outcomes were taken from 6-month assessments. ResultsThe average societal cost of HOU + SS per participant was $5114 [CI 95 %, $4949-5278], while the average societal cost of HOU was $3248 [CI 95 %, $ 3,140–$3341] (2019 U.S. dollars). The calculated ICERs show that HOU was more cost-effective than HOU + SS and SAU for housing outcome. For illicit drug use, HOU + SS was more cost-effective than HOU. Finally, for depressive symptoms, neither HOU + SS or HOU were more cost effective than SAU. ConclusionWhile HOU is more cost-effective for increasing housing, HOU + SS is more cost-effective for reducing illicit drug use. However, housing without improvements in substance use may not be sustainable, and supportive services are likely essential for improved well-being overall beyond the housing outcome alone.

Efficiency Level of Health Spending Governments: Evidence from North Maluku Indonesia

This study aims to determine and analyze the level of technical efficiency, cost, technical systems and corrective steps that need to be taken by inefficient regions in 10 regencies/cities in North Maluku Province in 2016-2020. This research uses secondary data from 10 districts/cities in North Maluku Province. The variables used include the APBD expenditure variable according to the health function as input, the variable number of puskesmas, posyandu, medical personnel and midwives at puskesmas and government hospitals as intermediate output variables and the variable Infant Mortality Rate (IMR), Maternal Mortality Rate (AKI), Number Life Expectancy (AHH) and Human Development Index (IPM) as outcome output variables. This research method uses Data Envelopment Analysis (DEA) with the assumption of Variable Return to Scale (VRS) and is input oriented. The results obtained are an average cost technical efficiency of 0%, while the technical efficiency of the system reaches 70%, so that there are indications of inefficiency in the allocation of health sector spending and corrective measures are needed based on the potential for regional improvement which are still not efficient so that the proportion of input and output can be efficient according to the needs of each region.

Lipid Control and Medical Costs Among Patients With and Without Established Atherosclerotic Cardiovascular Disease Followed in a Brazilian Private Healthcare System.

There is limited real-world data of lipid control and healthcare costs among patients with and without Atherosclerotic Cardiovascular Disease (ASCVD) in Latin America. A retrospective cohort study including patients with LDL-cholesterol (LDL-C) assessment from 2015 to 2017 was performed in a health insurance database. Patient characteristics, comorbidities and laboratory data were collected, and International Classification of Diseases (ICD) codes were used to identify a subcohort of patients with ASCVD (secondary prevention) and assess the proportion of these patients with LDL-C controlled. Lipid control among patients without ASCVD (primary prevention) and healthcare costs in one year in the overall population were also assessed. From the 17,434 patients selected, 5,208 (29.8%) had ASCVD. The mean age of these patients in secondary prevention was 68.9 (±12.3) years and 47.8% were male patients. LDL-C < 70 mg/dL was identified in 19.1% of the ASCVD population and only 4.1% had an LDL-C < 50 mg/dL. LDL control was worse in women compared to men (13.1% vs. 25.7%; P < 0.01). The average cost in one year was 3,591 American dollars (USD) per patient in primary prevention compared to 8,210 dollars per year for patients in secondary prevention (P < 0.01). While outpatient costs accounted for 59.8% of the total cost in the primary prevention group, the main cost of the secondary prevention population was related to hospital costs (54.1%). Despite the favorable evidence for intensive cholesterol reduction, the evaluation of large real-world database with more than 17,000 individuals showed that the targets of guideline recommendations have not yet been adequately incorporated into clinical practice. Average annual cost per patient in secondary prevention is more than twice compared to primary prevention. Hospital expenses account for most of the cost in the secondary prevention group, while outpatient costs predominate in primary prevention.