Average Cost Research Articles

The cost effectiveness of early assessment and intervention by a dedicated health and social care professional team for older adults in the emergency department compared to treatment-as-usual: Economic evaluation of the OPTI-MEND trial.

Over 65s are frequent attenders to the Emergency Department (ED) and more than half are admitted for overnight stays. Early assessment and intervention by a dedicated ED-based Health and Social Care Professionals (HSCP) team reduces ED length of stay and the risk of hospital admissions among older adults while improving patient health-related quality-of-life and satisfaction with care. This study aims to evaluate whether augmenting the treatment as usual for older adults admitted to ED is cost-effective. Cost-effectiveness analysis (CEA), conducted alongside the OPTI-MEND randomised controlled trial of 353 patients aged ≥65 with lower urgency complaints compared the effectiveness of early assessment and intervention by a dedicated HSCP team in the ED to treatment as usual (TAU). An economic analysis estimated the average cost per older adults randomised to the HSCP team, and compared to TAU, how contact with HSCP team changed health care use, and associated total costs, and estimated the effect of HSCP on Quality-Adjusted Life Years (QALYs). Within the OPTI-MEND trial, the average cost of a contact with the HSCP team during ED attendance is estimated to be €801 per patient. Compared to TAU, the incremental QALY of intervention is 0.053 (95% CI: 0.023 to 0.0826, p<0.0001). Accounting for cost savings because of contact with HSCP team, the average incremental saving in the total cost, compared to TAU, is -€6,128 (95% CI: -€9,217 to -€3,038, p<0.0001). Given the incremental health gains and significant cost savings, bootstrapped cost CEA suggests that dedicated HSCP care dominates over TAU for low urgency older adults attending the ED. A dedicated HSCP team in the ED significantly improves overall health for lower acuity older adults and, by reducing inpatient length of stay, results in staggering cost savings. This economic evaluation conducted on the OPTI-MEND trial provides convincing evidence that HSCP should be adopted as part of treatment as usual in Irish EDs. ClinicalTrials.gov, NCT03739515; registered on 12th November 2018. https://classic.clinicaltrials.gov/ct2/show/NCT03739515.

The Ordered Median Tree Location Problem

In this paper, we propose the Ordered Median Tree Location Problem (OMT). The OMT is a single-allocation facility location problem where p facilities must be placed on a network connected by a non-directed tree. The objective is to minimize the sum of the ordered weighted averaged allocation costs plus the sum of the costs of connecting the facilities in the tree. We present different MILP formulations for the OMT based on properties of the minimum spanning tree problem and the ordered median optimization. Given that ordered median location problems are rather difficult to solve we have improved the OMT solution performance by introducing covering variables in a valid reformulation plus developing two pre-processing phases to reduce the size of this formulations. In addition, we propose a Benders decomposition algorithm to approach the OMT. We establish an empirical comparison between these new formulations and we also provide enhancements that together with a proper formulation allow to solve medium size instances on general random graphs.

The value of waiting spaces: Tourists’ willingness to pay for high-quality bus terminals

Transport quality has long been recognized as an important factor in influencing travelers’ behavior, and transport terminal quality undoubtedly plays no small part. Indeed, transit promotion policies explicitly based on qualitative factors and high-standard architecture are increasingly being adopted in designing new bus terminals and stops. High architectural standards can be found in several bus terminals worldwide. Nevertheless, the literature in transport sector has yet to explore the impact of bus terminal “hedonic quality” on users’ behavior or use their willingness to pay (WTP) in cost–benefit analyses or other transport policy applications. Hedonic value is here intended as the aggregate of all elements related to travelers’ pleasure in spending time in a terminal where architectural beauty and the passenger services offered are arguably the most visible and representative attributes. Within this context, we propose a quantitative analysis of the perceived hedonic value of bus nodes in terms of users’ WTP (pure preference) for a high-quality bus terminal. To this end a discrete choice experiment based on a visual immersive experience was performed, and data were collected from 324 residents of Milan (Italy) traveling for tourism. Different binomial Mixed Logit models with panel data and random coefficients were estimated for the purpose. Monetary valuation of pure preference for using a high-quality bus terminal was estimated with a mean of about 25 % of the average trip cost observed for the case study considered. This pure preference means that the Italian tourist is willing to spend up to €4.35/trip more for a high-quality bus waiting space or travel up to 28.2 min/trip more, instead of using a traditional bus terminal for the same trip. Category-specific analyses show that females > 30 years old have a greater pure preference for a high-quality bus terminal (up to + 220 %) against males and young users. The employed also have a higher (+42 %) pure preference for the beauty of a bus terminal against others. The results of this paper should be compared with those from other case studies as they have a potential impact for transportation planning applications, underling the importance of also incorporating “hedonic quality” as explicit design variables for new/revamped transportation hub. At the same time, new challenges are posed for modeling user behavior and determining quality-related indicators and measures.

Cost Analysis of Prostate Cancer Care Using a Biomarker-enhanced Diagnostic Strategy with Stockholm3

Background and objectiveBuilding on previous research demonstrating better prostate cancer (PC) diagnostics via a biomarker-enhanced approach, this study focuses on cost analysis of PC care using the Stockholm3 test. We assessed the economic impact in European health care systems using real-world evidence for diagnostic outcomes and relevant costs. MethodsWe evaluated two PC diagnostic strategies: (1) the conventional prostate-specific antigen (PSA) strategy with magnetic resonance imaging (MRI) and (2) PSA testing with a reflex to biomarkers at PSA ≥1.5 ng/ml in guiding decisions to perform MRI. Data from the Swedish National Prostate Cancer Register and Capio St. Göran Hospital provided real-world evidence, supplemented by health economic modeling. A comprehensive cost analysis was conducted using a Markov model for treatment pathways for four PC disease states and overall spending, for which costs from various European health care systems were used. A deterministic sensitivity analysis was performed across different cost and diagnostic scenarios. Key finding and limitationsThe average cost for the four disease states was €2 182 for benign disease, €10 023 for low-grade disease, €13 073 for intermediate- to high-grade localized or locally advance disease, and €271 210 for metastatic disease. The overall spending was €358 239 (7.7%) lower per 1000 men tested in the biomarker-enhanced strategy in comparison to the PSA strategy. The primary cost saving was attributed to lower treatment expenses for metastatic disease. Sensitivity analysis affirmed the robustness of the findings across various diagnostic and treatment scenarios. Conclusions and clinical implicationsBiomarker-enhanced diagnostic strategies may reduce health care costs for PC management and are likely to improve quality-adjusted life years in a scenario in which metastatic disease is reduced. Patient summaryWe explored different ways to detect prostate cancer more cost-effectively. We found that using a specific blood test, called Stockholm3, after a PSA (prostate-specific antigen) test to decide if an MRI scan (magnetic resonance imaging) is necessary could save money, mainly by identifying localized cancer earlier and reducing the need for expensive treatments for advanced cancer.

ECONOMIC PERFORMANCE OF TURMERIC GROWERS

A study conducted in Belagavi district during 2018-19 examined the economic performance of turmeric growers using an ‘Ex-post facto’ research design. Two top turmeric-growing blocks were selected through multistage proportional sampling, with six villages chosen from each block based on irrigation sources. Data from 120 respondents across 12 villages was collected using pretested structured interviews. The cost of cultivation was estimated using the Commission for Agricultural Costs and Prices’ principles (A1, A2, B1, B2, C1, C2, C3). Labour was the most extensively used input, with an average of 134 man-days acre -1 . Canal/borewell farms (CBF) used more labour (137.5 man-days acre -1 ) compared to river basin farms (RBF - 130.50 man-days acre -1 ). The average cost of turmeric cultivation was Rs. 138010.78 per acre, with A1 cost at Rs. 91494.09 acre -1 and A2 cost at `95128.09 acre -1 . Mean gross returns were `194943.03 acre -1 . Net returns varied, with `100159.56 acre -1 at cost ‘A’, `82157.09 acre -1 at cost ‘B2’, and `56932.25 acre -1 at cost ‘C3’. CBF had higher net returns (`70099.83 acre -1 ) than RBF (`44390.73 acre -1 ). The benefit-cost ratio at cost ‘C3’ was 1:1.41 for the district, with CBF (1.49) outperforming RBF (1.33).

A Branch-and-Price algorithm for the electric autonomous Dial-A-Ride Problem

The Electric Autonomous Dial-A-Ride Problem (E-ADARP) consists in scheduling a fleet of electric autonomous vehicles to provide ride-sharing services for customers that specify their origins and destinations. The E-ADARP considers the following perspectives: (i) a weighted-sum objective that minimizes both total travel time and total excess user ride time; (ii) the employment of electric autonomous vehicles and a partial recharging policy. This paper presents the first labeling algorithm for a path-based formulation of the DARP/E-ADARP, where the main ingredient includes: (1) fragment-based representation of paths, (2) a novel approach that abstracts fragments to arcs while ensuring excess-user-ride-time optimality, (3) construction of a sparser new graph with the abstracted arcs, which is proven to preserve all feasible routes of the original graph, and (4) strong dominance rules and constant-time feasibility checks to compute the shortest paths efficiently. This labeling algorithm is then integrated into Branch-and-Price (B&P) algorithms to solve the E-ADARP. In the computational experiments, the B&P algorithm achieves optimality in 71 out of 84 instances. Remarkably, among these instances, 50 were solved optimally at the root node without branching. We identify 26 new best solutions, improve 30 previously reported lower bounds, and provide 17 new lower bounds for large-scale instances with up to 8 vehicles and 96 requests. In total 42 new best solutions are generated on previously solved and unsolved instances. In addition, we analyze the impact of incorporating the total excess user ride time within the objectives and allowing unlimited visits to recharging stations. The following managerial insights are provided: (1) solving a weighted-sum objective function can significantly enhance the service quality, while still maintaining operational costs at nearly optimal levels, (2) the relaxation on charging visits allows us to solve all instances feasibly and further reduces the average solution cost.

The Impact of Cost of Living on the Quality of Life of Cystic Fibrosis Patients: A Study in Greece.

Introduction Cystic fibrosis (CF) leads to the impairment of multiple essential organs and systems in the human body. The objective of this study was to analyze the financial consequences of having cystic fibrosis (CF) on patients, evaluate their general state of health, and specifically investigate the impact of living expenses on their quality of life. Methods The data were collected using three tools and a form for personal information entry. The first questionnaire wasemployed to quantify fluctuations in patients' cost of living. The Greek variant of the Short Form Questionnaire-36 (SF-36)and the Greek version of the Cystic Fibrosis Quality of Life (CFQoL)were implemented to assess quality of life.Statistical significance was set at p < 0.05, and analyses were conducted using SPSS statistical software. Results The study obtained a response rate of 93.2%, with 105 participants consenting to and effectively finishing the questionnaire. The mean age of the patients was 32.1 years, with 46.7% being female and 53.3% being male. Medication was being administered to 46.7% of the patients. The condition incurred an average cost of 767€ in the preceding semester. The maximum cost was 1007€. Patients with a higher monthly family income and those who were taking medication exhibited superior physical performance and functional capacity. Conclusion The research emphasizes that implementing causative treatment and minimizing hospitalizations can potentially enhance life satisfaction. The findings suggest possible approaches to enhance the quality of life in people with cystic fibrosis, in conjunction with the implementation of novel or enhanced treatment modalities.

Economies of Scale, Efficiency and Optimal Size of the Hospital

Hospitals are being expanded all over the world. Hospitals are becoming larger (i.e., increasing patient admissions each year) and more complex (i.e., offering a wider range of services to patients with more diverse medical care needs). In the hospital sector and other branches of the economy, economies of scale are important, according to which the volume of medical services can be increased by reducing average costs and increasing quality. However, measuring this relationship between the volume of medical services and costs is difficult because hospitals differ substantially in terms of specialization, patient composition, and other parameters that affect the volume of costs. The paper discusses the features of economies of scale in the healthcare sector and the dependence of the volume of medical services on costs and quality. Studies confirm that the influence of various factors on the costs and quality of medical services depends on the environment and the system of incentives in which hospitals operate. Relationships between patients and healthcare providers based solely on price negotiations do not ensure adequate healthcare quality. Due to informational asymmetry with respect to the real cost of hospital services and quality of treatment, medical service buyers cannot influence cost reductions and increase the quality of treatment, which increases hospital power. Thus, when evaluating the impact of hospital competition on costs and quality of care, we must remember that market mechanisms in health care do not always increase public welfare.

Cost of agricultural injuries in the United States: Estimates based on surveillance, insurance, and government statistics.

Agriculture is a hazardous industry but the frequency and severity of agricultural injuries are not well documented as nonfatal injuries to self-employed farmers are excluded from national surveillance. The aim of this study was to provide new injury rate and cost estimates in US agriculture. Injury data were obtained from 2018 to 2020 Farm and Ranch Health and Safety Surveys. Responses from 7,195 farm/ranch operators included injury frequency, medical expense, and lost work time data. These injury rate and cost data were used to estimate national injury costs for self-employed farmers using Census of Agriculture operator count, injury costs for hired agricultural workers using Bureau of Labor Statistics (BLS) nonfatal injury count, and fatal injury costs using BLS count of fatal injuries. The injury rate for self-employed farmers and ranchers was 15.25 injuries per 100 operators or 11.9 "recordable" injuries per 100 full time equivalent operators (FTE). Average costs for nonfatal injuries were: $10,878 for medical care, $4735 for lost work time, and $15,613 in total per injury case. The total national agricultural injury cost estimate was $11.31 billion per year; 11.3% higher than the earlier benchmark using 1992 data; both in March 2024 dollars. The cost burden was 2.1% of the US national gross farm income and 13.4% of the net farm income in 2019. Injuries result in significant economic losses to farm and ranch operators, their family members, workers, and society. Preventive efforts should be scaled up to reduce the frequency and costs of agricultural injuries.

The Costs and Impacts of Descubriendo la Lectura: Evidence From a Multisite Experimental Study

We estimate costs and impacts of Descubriendo la Lectura (DLL), an intervention designed to improve the literacy skills of Spanish-speaking first graders struggling with reading. Collecting cost data from 24 schools in seven districts across four states participating in a multisite randomized controlled trial of DLL, we used the ingredients method to identify all personnel and nonpersonnel resources and then assign costs to each ingredient. The average cost per student of DLL is approximately $7,120 (in 2022 dollars), with teacher and teacher leader personnel expenditures accounting for more than 90% of the total costs. Impact analyses from the student-level random assignment study suggest DLL has substantial effects on Spanish-language literacy achievement, with effect sizes from d = 0.23 to d = 0.91. Linking estimated costs and achievement impacts, the impact per $1,000 investment in DLL is between d = 0.03 and d = 0.13, and a cost between $7,824 and $30,957 per student is associated with a one standard deviation increase in student achievement. These estimates compare favorably with those found for other interventions with recent cost and impact data.

Cost Analysis of a Hand Hygiene Improvement Strategy in Long-Term Care Facilities

ObjectivesTo evaluate whether the costs of a successful tailored multifaceted strategy to improve hand hygiene compliance outweighed the savings by reducing infection costs in Dutch long-term care facilities (LTCFs). DesignA retrospective cost analysis alongside a stepped-wedge cluster-randomized controlled trial. Setting and ParticipantsThe study included 14 LTCFs (23 wards) in the Netherlands. MethodsThe cost analysis was based on the costs of the intervention vs the savings from avoided infections and associated treatment costs. Infection-related costs of the “usual-care” period were compared with the combined infection-related costs and intervention costs from the “intervention” period and the costs in the “post-intervention period.” Multilevel analyses, with a linear model with periods as fixed effects, random effects for cluster LTCFs, and fixed effects for each step, were completed. ResultsThere are no significant differences in total costs considering the 3 periods. When adjusting for time and clustering, the mean infection-related costs per week per LTCF for all the infections combined were highest during “usual-care” before the hand hygiene intervention was performed, namely 680 euros per week. Assuming the effect of the improvement strategy would be present for 12 months, the costs per week in the “intervention” and “post-intervention” periods were 627 euros (95% CI, 383–871) and 731 euros (95% CI, 508–954), respectively. Assuming the effect of the improvement strategy will last longer than 1 year (ie, 18 and 24 months), the average cost for the “intervention period” and the “post-intervention” period decreased to 615 euros and 719 euros during the intervention and 609 euros and 715 euros after the intervention, respectively. Conclusions and ImplicationsOur multifaceted hand hygiene improvement strategy achieves cost savings. The results of our study are the first of an economic analysis of a hand hygiene improvement strategy in LTCFs. The results need to be confirmed by further economic evaluations.

A techno-economic analysis of future hydrogen reconversion technologies

The transformation of fossil fuel-based power generation systems towards greenhouse gas-neutral ones based on renewable energy sources is one of the key challenges facing contemporary society. The temporal volatility that accompanies the integration of renewable energy (e.g. solar radiation and wind) must be compensated to ensure that at any given time, a sufficient supply of electrical energy for the demands of different sectors is available. Green hydrogen, which is produced using renewable energy sources via electrolysis, can be used to chemically store electrical energy on a seasonal basis. Reconversion technologies are needed to generate electricity from stored hydrogen during periods of low renewable electricity generation. This study presents a detailed techno-economic assessment of hydrogen gas turbines. These technologies are also superior to fuel cells due to their comparatively low investment costs, especially when it comes to covering the residual loads. As of today, hydrogen gas turbines are only available in laboratory or small-scale settings and have no market penetration or high technology readiness level. The primary focus of this study is to analyze the effects on gas turbine component costs when hydrogen is used instead of natural gas. Based on these findings, an economic analysis addressing the current state of these turbine components is conducted. A literature review on the subsystems is performed, considering statements from leading manufactures and researchers to derive the cost deviations and total cost per installed capacity (€/kWel). The results reveal that a hydrogen gas turbine power plant has an expected cost increase of 8.5% compared to a conventional gas turbine one. This leads to an average cost of 542.5 €/kWel for hydrogen gas turbines. For hydrogen combined cycle power plants, the expected cost increase corresponds to the cost of the gas turbine system, as the steam turbine subsystem remains unaffected by fuel switching. Additionally, power plant retrofit potentials were calculated and the respective costs in the case of an upgrade were estimated. For Germany as a case study for an industrialized country, the potential of a possible retrofit is between 2.7 and 11.4 GW resulting to a total investment between 0.3 and 1.1 billion €.

Cost Analysis of Oral Phenazopyridine vs Intravesical Lidocaine for Preprocedural Analgesia for Intradetrusor OnabotulinumtoxinA Injections.

Office administration of intradetrusor onabotulinumtoxinA is commonly used to treat overactive bladder. For preprocedure analgesia, either 50 mL 2% intravesical lidocaine instillation for 20 to 30 minutes or 200 mg oral phenazopyridine can be used. Phenazopyridine is associated with shorter appointment times and is noninferior to lidocaine for pain control in this setting. We performed a cost analysis of phenazopyridine vs lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. A health care sector-perspective cost analysis was performed. The following assumptions were made: (1) similar efficacy of each medication in providing adequate analgesia, (2) similar physician ease of performing the procedure with either analgesic, and (3) similar patient satisfaction with either analgesic. Average cost of medications, adverse reactions, nursing tasks, and office visit time were found in publicly available data. Sensitivity analyses were performed using TreeAge Pro 2021, R1 software. Phenazopyridine is less costly compared to lidocaine per visit for office intradetrusor onabotulinumtoxinA injection ($827 vs $925). A difference of $98 per procedure provides a total annual cost savings of over $24 million if all procedures are performed with phenazopyridine instead of lidocaine. Sensitivity analysis showed that phenazopyridine remained less costly under most circumstances, and threshold analysis provided exact circumstances under which phenazopyridine is no longer cost saving. Phenazopyridine provides cost savings compared to lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. If adopted by providers nationwide, phenazopyridine may reduce health care spending and minimize office visit time while maintaining patient pain control and satisfaction.

Impact of COVID-19 on the management of hypertension: a perspective on disease severity, service use patterns and expenditures from Ghana's health insurance claims data.

Hypertension is a leading cause of morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in health service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests including t-tests, z-tests, and exact Poisson tests to estimate and compare hypertension episode intensity and related claim expenditures before and during the pandemic using medical claims data from Ghana's National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019-February 2020) relative to the target/pandemic period (March 2020-February 2021). We observed that although there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant. There was also an 18.64% or $22.88 (95% CI: $21-$25, p = 0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana.

CDT: Cross-interface Data Transfer scheme for bandwidth-efficient LoRa communications in energy harvesting multi-hop wireless networks

With the capability of generating sustainable energy by exploiting the ambient environment (e.g., light, heat, vibrations, etc.), the energy harvesting (EH) technology is increasingly used on low-power smart objects, forming self-powered green Internet of Things (IoTs). Despite targeting different application domains, many of these green IoT systems adopt the distributed network paradigm by forming energy harvesting multi-hop wireless networks (EH-MWNs). While distributed networks have good scalability during the deployment phase, they are often complex, inelastic to change, and costly to manage. To this end, LoRa, a promising long-range wireless technology, has been suggested for centralized single-hop network controls in EH-MWNs. However, the signal propagation of LoRa is severely affected by the surrounding environment (e.g., obstructions, terrains, etc.), which not only creates a significant difference in packet delivery rate (PDR) between nodes but also increases the bandwidth cost for network controls. To address this issue, we propose a Cross-interface Data Transfer (CDT) scheme, which leverages the ZigBee interfaces coexisting in EH-MWNs to transfer LoRa data traffic from the nodes with a lower PDR to the nodes with a higher PDR for bandwidth-efficient transmissions. By jointly determining the pairs of nodes performing data transfer and the data transfer rates between them, CDT can reduce the overall LoRa bandwidth consumption while ensuring continuous operation of the EH-MWN. A prototype system is implemented by integrating commercial off-the-shelf LoRa and ZigBee interfaces into an IoT platform. Extensive real-world experiments show that under a moderate data traffic input, the bandwidth consumption of CDT is 25.8% and 48.8% lower than the standard LoRaWAN and a state-of-the-art data transfer scheme, respectively. The average energy cost per node is kept as low as 2.29 mW at the same time. Moreover, CDT also shows its performance advantages in terms of PDR and sustainability.

Influence of Postoperative Diet Type and Regimen on Hospital Comfort and Rehabilitation of Lung Cancer Patients

A reasonable and standardized dietary plan and procedure can help patients recovering quickly from lung cancer surgery. The aim of this study is to optimize the diet plan and procedure mainly based on medium chain triglyceride (MCT) diet and explore its clinical advantages for postoperative lung cancer patients. From October 2023 to December 2023, a total of 156 patients were collected, who underwent lung cancer surgery in Lung Cancer Center, West China Hospital of Sichuan University. The patients were randomized into MCT group (76 cases) and routine diet (RD) group (80 cases). Clinical symptoms, biochemical index, postoperative hospitalization time and cost, dietary satisfaction and hospitalization comfort between the two groups were analyzed. The mean anus exhausting time in MCT group [24.00 (9.75, 36.97) h] was significantly shorter than that in RD group [28.50 (24.00, 48.00) h] (P<0.001). And the incidence of dizziness (18.42%), nausea and vomiting (6.58%) in MCT group were remarkably lower than those in RD group (51.25%, 31.25%) (P<0.001). Hospitalization comfort score in MCT group [(16.74±1.70)] was significantly higher than that in RD group [(14.83±2.34)] (P=0.016). Meanwhile, the average hospitalization cost in MCT group [(39,701.82±8105.47)¥] showed an obvious decrease compared with RD group [(44,511.79±9593.19)¥] (P=0.007). Optimizing the dietary plan and procedure mainly based on MCT diet for postoperative lung cancer patients can help the recovery of gastrointestinal function and improve hospitalization comfort, which promoted overall postoperative rehabilitation of patients with lung cancer surgery.

Economic and energy efficiency of resource-saving technology for switchgrass cultivation

Purpose. The study aimed to compare the efficiency of the resource-saving technology with the conventional technology for switchgrass cultivation using the developed methodology for assessing the economic and energy efficiency. Methodology / approach. The study used general and special methods, including the methodology of scientific research in agronomy, laboratory determination of dry matter content in biomass, quantitative-weight analysis to establish crop yield, and the authors’ improved methodology for assessing economic and energy efficiency. The research results were statistically processed using variance and comparative analysis. Results. The results of the research on the use of resource-saving cultivation technology in comparison with conventional technology show an increase in switchgrass biomass yield from 14.6 to 15.7 t/ha, an increase in economic efficiency with profitability growth from 73.8 to 79.0 %, and an increase in energy efficiency with a growth of the energy efficiency coefficient by 0.7 – from 4 to 4.7 (average level of energy efficiency) when applying a specific complex of agrotechnical measures. When using resource-saving technology, the average full cost of cultivating switchgrass for six years is 8305.6 UAH/ha, compared to 7952.8 UAH/ha with conventional technology. However, resource-saving technology generates an average sales revenue of 14867.5 UAH/t, which is 1045 UAH/t more than conventional technology (13822.5 UAH/t). Originality / scientific novelty. For the first time, a field experiment was conducted to compare switchgrass cultivation using resource-saving and conventional technologies. The authors have developed a methodology to assess the economic and energy efficiency of cultivating switchgrass. The results indicate that the efficiency of switchgrass biomass production is influenced by improved cultivation technology. The authors have developed a three-dimensional econometric model that demonstrates how the profitability level depends on the chosen switchgrass cultivation technology. Practical value / implications. The research results have practical significance as they have led to the development of a methodology and evaluate the economic and energy efficiency of switchgrass cultivation. These results will be useful for agrarian enterprises to save resources.

Impact of residential heat pumps and photovoltaics on low-voltage grid reinforcements under varying insulation levels

The European Union’s 2050 climate-neutrality goal necessitates extensive deployment of low-carbon technologies (LCTs) like heat pumps and rooftop photovoltaic systems in dwellings. However, integrating these into low-voltage (LV) grids can cause grid issues (e.g., voltage deviation, feeder overloading), often requiring grid reinforcements. This study uses a techno-economic approach to calculate the grid reinforcement costs under various residential LCT integration and insulation scenarios in representative rural and urban grids in Germany and Italy. Two cost calculation methods (maximum and average) are compared. Results indicate that, compared to the average cost calculation method, the maximum cost calculation method generally gives a higher cost under the same LCTs integration rate. Increasing LCT integration raises costs while improving residential dwelling insulation reduces them. The estimated reinforcement cost for rural and urban zones in Germany and Italy is significant and can be up to more than a billion euros. Improving residential insulation levels can reduce costs significantly for both German and Italian grids. The results and methodology presented can help grid operators and policymakers deploy LCTs in LV grids resiliently and cost-effectively.

Chronic kidney disease and transvenous cardiac implantable electronic device infection-is there an impact on healthcare utilization, costs, disease progression, and mortality?

Cardiac implantable electronic device (CIED) infections are a burden to hospitals and costly for healthcare systems. Chronic kidney disease (CKD) increases the risk of CIED infections, but its differential impact on healthcare utilization, costs, and outcomes is not known. This retrospective analysis used de-identified Medicare Fee-for-Service claims to identify patients implanted with a CIED from July 2016 to December 2020. Outcomes were defined as hospital days and costs within 12 months post-implant, post-infection CKD progression, and mortality. Generalized linear models were used to calculate results by CKD and infection status while controlling for other comorbidities, with differences between cohorts representing the incremental effect associated with CKD. A total of 584 543 patients had a CIED implant, of which 26% had CKD and 1.4% had a device infection. The average total days in hospital for infected patients was 23.5 days with CKD vs. 14.5 days (P < 0.001) without. The average cost of infection was $121 756 with CKD vs. $55 366 without (P < 0.001), leading to an incremental cost associated with CKD of $66 390. Infected patients with CKD were more likely to have septicaemia or severe sepsis than those without CKD (11.0 vs. 4.6%, P < 0.001). After infection, CKD patients were more likely to experience CKD progression (hazard ratio 1.26, P < 0.001) and mortality (hazard ratio 1.89, P < 0.001). Cardiac implantable electronic device infection in patients with CKD was associated with more healthcare utilization, higher cost, greater disease progression, and greater mortality compared to patients without CKD.

Predictive energy control for grid-connected industrial PV-battery systems using GEP-ANFIS

Rising energy costs in Uganda's industrial sector have significantly increased manufacturing expenses and led to the closure of potential enterprises, underscoring the urgent need for efficient energy management solutions. The study presents an optimization-based predictive energy control model that integrates Gene Expression Programming (GEP) and Adaptive Network-based Fuzzy Inference Systems (ANFIS) for grid-connected solar PV-battery systems. The hybrid GEP-ANFIS model leverages GEP's strength in complex pattern recognition and ANFIS's adaptive learning capability to manage nonlinear data, resulting in more accurate and reliable energy predictions. The model utilizes historical load patterns, grid data, and solar PV/battery inputs to forecast load demand and solar power generation, optimizing energy usage based on Time of Use (TOU) pricing. The approach addresses the limitations of existing energy management techniques by enhancing predictive accuracy and ensuring seamless integration with industrial applications. The present work demonstrates that the proposed GEP-ANFIS double diode model consistently outperforms its counterparts, achieving a mean absolute percentage error (MAPE) of 7.25 %, a mean absolute deviation (MAD) of 2.95 %, and a root mean square error (RMSE) of 8.42 %. Moreover, the model exhibits superior accuracy in predicting short-term load demand, with a MAPE of 2.24 %, a MAD of 0.13 %, and an RMSE of 0.18 %. Additionally, the model results in an average energy cost reduction of 6.7 % for hybrid grid-connected solar PV/battery configurations, highlighting its economic benefits. The study's key contributions include the creation of a novel hybrid predictive model, significant cost savings, improved load prediction accuracy, and the integration of renewable energy sources into industrial energy management. The model's inferences can effectively address the challenges of rising energy costs, providing a robust framework for sustainable and efficient energy management in industrial settings.